Câncer Neuroendócrino

O que é?

Câncer neuroendócrino é o nome usado para designar um grupo de tumores malignos que se originam nas células do sistema endócrino difuso, formado por células encontradas nos tratos respiratório (brônquios e pulmões) e digestivo (da boca ao reto). Essas células também estão presentes nas glândulas endócrinas, como as suprarrenais, o pâncreas, a tireoide, a hipófise, os ovários e os testículos. Os tumores neuroendócrinos podem ocorrer em qualquer um desses órgãos, em especial o pulmão e o sistema gastrointestinal.

De forma geral, os cânceres neuroendócrinos são classificados de acordo com o local em que se originam e seu grau de proliferação. Um dos tipos mais comuns é o carcinoide gastrointestinal, que atinge o sistema digestivo. Com base nos tipos de células dos quais são formados, os tumores neuroendócrinos podem ser classificados como: bem diferenciados (menos agressivo, de crescimento e disseminação lenta), mal diferenciados (crescem e se espalham rapidamente) e moderadamente diferenciados (com características entre os dois anteriores). Outros tipos são os carcinomas de células das ilhotas ou tumores neuroendócrinos do pâncreas e os carcinoides de estômago, intestino, apêndice e reto.

No pulmão, ocorrem quatro tipos de tumores neuroendócrinos: o câncer de pequenas células (de crescimento rápido e rápida disseminação), o carcinoma de grandes células (mais raro), o carcinoide típico (responde por cerca de 90% dos carcinoides de pulmão, de crescimento lento e difícil disseminação) e o carcinoide atípico (cresce mais rápido e é mais propenso a se disseminar).

Sintomas

Os sintomas variam de acordo com o órgão em que se originam. No caso dos cânceres gastrintestinais, como os tumores crescem lentamente, os sintomas demoram a aparecer e podem ser confundidos com os de outras doenças. Tumores no apêndice podem provocar apendicite, dores abdominais, náuseas e vômitos. Os que atingem o intestino delgado causam sangramento intestinal, anemia, fadiga, falta de ar, cólicas, dores abdominais, perda de peso, inchaço, diarreia, náuseas, vômitos e, algumas vezes, icterícia e pancreatite. No reto, os tumores provocam dor, hemorragia e constipação. No estômago, muitas vezes não causam sintomas e são comumente diagnosticados durante endoscopias realizadas para diagnóstico de outras doenças.

Alguns carcinoides podem liberar hormônios na corrente sanguínea, provocando sintomas diferentes dependendo do tipo de hormônio. Entre os sintomas mais comuns estão vermelhidão e sensação de calor, diarreia, dificuldade respiratória, taquicardia, aumento ou perda de peso, fraqueza muscular, aumento dos níveis de açúcar no sangue, aumento da pressão arterial, aumento de pelos no corpo e na face, depósitos de gordura na parte posterior do pescoço, estrias na pele.

Quando o tumor se desenvolve no pulmão, o paciente pode apresentar tosse, às vezes com expectoração com sangue, chiado como na asma, falta de ar, dor no peito, pneumonia, rubor facial, diarreia e batimentos cardíacos acelerados.

Diagnóstico

Como os carcinoides gastrointestinais geralmente não provocam sintomas, na maior parte das vezes são detectados durante a realização de exames ou cirurgias para outras doenças — por exemplo, durante uma endoscopia para diagnosticar uma úlcera, uma colonoscopia para avaliar problemas no intestino ou na remoção do apêndice. No caso do pulmão, o câncer costuma ser identificado em radiografias de tórax ou tomografias computadorizadas realizadas por outras razões clínicas.

Se há uma suspeita de câncer em razão desses exames ou da avaliação do histórico clínico e do exame físico no paciente, são solicitados exames de laboratório e de imagem. A biópsia é o procedimento que confirma a presença do câncer.

Prevenção

Incomum e em geral de crescimento lento, o câncer neuroendócrino não tem uma causa definida. A maioria ocorre por mutações adquiridas ao longo da vida, mas há casos hereditários, em que o tumor se desenvolve devido a alterações nos genes MEN1 ou RET, e por síndromes como neurofibromatose tipo 1 ou Von Hippel-Lindau. Pessoas com algumas doenças que reduzem a quantidade de ácido no estômago apresentam maior risco de desenvolver tumores no órgão.

Atualmente não existem maneiras conhecidas para evitar esse tipo de câncer. Não há uma relação clara entre o tabagismo e seu desenvolvimento.

Tratamento

Os principais tipos de tratamento para os carcinoides gastrointestinais e de pulmão são cirurgia, radioterapia e tratamento sistêmico. Em alguns casos, é necessário utilizar mais de um ou uma combinação desses tratamentos.

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