Tumor Carcinoide Gastrointestinal

A maioria dos tumores carcinoides gastrintestinais se desenvolve lentamente e produzem sintomas inespecíficos. Geralmente, para o diagnóstico inicialmente são investigadas outras patologias que apresentam sintomas comuns. Isto pode atrasar o diagnóstico, às vezes por alguns anos.

Sintomas por Localização do Tumor

Os sintomas que uma pessoa pode ter devido a um tumor carcinoide gastrointestinal (GI) na maioria das vezes depende da localização do mesmo:

  • Apêndice. Pessoas com tumores no apêndice muitas vezes não apresentam sintomas. Geralmente um câncer no apêndice é diagnosticado após sua remoção cirúrgica por outra patologia. Às vezes, o tumor bloqueia a abertura entre o apêndice e o resto do intestino provocando apendicite. Quando isso acontece, os pacientes apresentam sintomas como dores abdominais, náuseas e vômitos.
  • Intestino Delgado. Às vezes, o tumor carcinoide pode provocar sangramento intestinal, consequentemente anemia com fadiga e falta de ar. Isso pode causar sintomas como cólicas, dores abdominais, perda de peso, fadiga, inchaço, diarreia, náuseas e vômitos. Esses sintomas podem durar anos antes do tumor carcinoide ser diagnosticado. Às vezes, um tumor carcinóide pode bloquear a abertura da ampola de Vater, que é onde o ducto biliar e do ducto pancreático se juntam antes de formar um ducto só para chegar ao intestino delgado. Quando este ducto se encontra obstruído, a bile pode refluir provocando icterícia. Os sucos pancreáticos também podem refluir, levando à pancreatite, que pode provocar sintomas como dores abdominais, náuseas e vômitos.
  • Reto. Os tumores carcinóides retais são frequentemente diagnosticados durante os exames de rotina, embora possam provocar dor, hemorragia e constipação.
  • Estômago. Os tumores carcinoides que se desenvolvem no estômago geralmente crescem lentamente e muitas vezes não causam sintomas. Eles são diagnosticados causalmente durante exames do estômago por endoscopia, realizado para diagnóstico de outras patologias. Alguns podem provocar sintomas como a síndrome carcinoide.

Sinais e Sintomas de Hormônios produzidos por Tumores Carcinoides

Alguns tumores carcinoides podem liberar hormônios na corrente sanguínea. Isso pode criar diferentes problemas dependendo de quais hormônios são liberados.

Síndrome Carcinoide

Cerca de 10% dos casos, os tumores carcinoides liberam substâncias semelhantes aos hormônios na corrente sanguínea causando sintomas, que resultam na síndrome carcinoide. Esses sintomas incluem:

  • Vermelhidão e sensação de calor.
  • Diarreia
  • Dificuldade respiratória.
  • Taquicardia (batimento cardíaco acelerado).

Muitos pacientes acreditam que estes sintomas são desencadeados por fatores como estresse, exercício pesado e consumo de álcool. Ao longo de um grande período de tempo, essas substâncias semelhantes aos hormônios podem danificar as válvulas cardíacas, causando falta de ar, fraqueza e sopro cardíaco (som anormal no coração).

Nem todos os tumores neuroendócrinos gastrointestinais provocam a síndrome carcinoide, por exemplo, os carcinoides retais geralmente não produzem as substâncias similares aos hormônios, que causam estes sintomas.

A maioria dos casos de síndrome carcinoide ocorre apenas após a disseminação da doença para outros órgãos. Normalmente, o sangue proveniente do trato gastrointestinal flui para o fígado, onde as substâncias produzidas pelos tumores carcinoides GI são quebradas antes de alcançarem o resto do corpo, evitando os sintomas da síndrome carcinoide.

Síndrome de Cushing

Alguns tumores neuroendócrinos produzem ACTH (hormônio adrenocorticotrófico), uma substância que faz com que as glândulas suprarrenais produzam cortisol em excesso. Isto pode provocar a síndrome de Cushing, com os seguintes sintomas: 

  • Aumento de peso.
  • Fraqueza muscular.
  • Aumento dos níveis de açúcar no sangue.
  • Aumento da pressão arterial.
  • Aumento de pelos no corpo e face.
  • Depósitos de gordura na parte posterior do pescoço.
  • Estrias na pele.

Síndrome de Zollinger-Ellison

Os tumores carcinoides podem produzir o hormônio gastrina. Uma quantidade excessiva de gastrina pode provocar a síndrome de Zollinger-Ellison, que é quando o estômago produz ácido em excesso. Níveis elevados de ácido podem levar a irritação do revestimento do estômago e até mesmo úlceras de estômago, que podem provocar sintomas como dor, náuseas e perda de apetite. Úlceras graves podem começar a sangrar e provocar sintomas como fadiga, falta de ar e diarreia.

Se o ácido estomacal atingir o intestino delgado, pode danificar o revestimento intestinal e quebrar as enzimas digestivas antes que elas tenham a chance de digerir os alimentos. Isso pode causar diarreia e perda de peso.

Fonte: American Cancer Society (08/02/2016)

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