[Management of digestive system carcinoid tumors and carcinoid syndrome]. / Manejo del tumor carcinoide del aparato digestivo y del síndrome carcinoide.

INTRODUCTION: Carcinoid tumors are rare, most of the publications are case reports and the clinical series are uncommon. The quality of life and survival time of these patients depend on the adequate control of tumor growth and good palliation of their symptoms. AIMS: The purpose of this study is to inform epidemiological data and forms of management for these tumors and the Carcinoid Syndrome at the National Institute of Cancerology (INCan) at Mexico City in the last 15 years. METHODS: A retrospective review of the clinical records of patients diagnosed and treated at the INCan with carcinoid tumors from 1982 to 1997 was performed. RESULTS: The most common origin place was the gastrointestinal tract (GI), and the majority involved the right colon and the appendix. The longest survivors were patients with tumors originated in the appendix, tumors smaller than 2 cm or localized. At the time of diagnosis 47% of patients had metastatic disease that was also a poor prognostic factor. The experience in our hospital seem to support the use of interferon alone or in combination with octreotide or debulking surgery for the palliation of carcinoid syndrome. CONCLUSIONS: Carcinoid tumors are rare, and have a slow growth and less aggressive biological nature than noncarcinoid tumors. Treatment should be focused on trying to cure the small or localized lesions or to find the best palliative method for those symptomatic advanced lesions.

[Primary carcinoma of the gallbladder]. / Carcinoma primario de la vesícula biliar.

OBJECTIVE: Determine the general features of primary gallbladder carcinoma (GBC), the diagnostic procedure and the current management as well as to analyze the experience at the National Institute of Cancer in Mexico City (INCan). INTRODUCTION: GBC is a rare and frequently lethal disease. The majority of patients are diagnosed at late clinical stages when the prognosis is poor. However in recent years several investigators have shown that radical procedures increase survival. MATERIAL AND METHODS: A review of relevant articles regarding epidemiological features, laboratory and imaging studies together with the actual form of management according to the stage at diagnosis was made. A review of clinical records of patients with GBC at the INCan in the last 10 years was also made. RESULTS: The prognosis of GBC carcinoma depends of the stage at the time of diagnosis, tumors confined to the gallbladder (Nevin I-III) have better prognosis than those presented with lymphadenopathy or liver invasion. Actually the surgical procedure most accepted is wedge liver resection and lymphadenectomy, because it seems to improve survival. At the INCan one hundred patients were analyzed of which only six were diagnosed with lesion Nevin I all alive with a mean follow up of 33 months, with lesions Nevin II five out of 13 are alive and were treated with wedge liver resection or radiotherapy, lesion Nevin III only 4 alive and received radiotherapy. Patients with lesions Nevin IV and V have the poorest prognosis. CONCLUSION: GBC is a highly lethal disease. Early diagnosis make possible to perform radical resections and improve survival.