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Tumores neuroendocrinos: Una enfermedad de difícil diagnóstico
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Tumores neuroendocrinos: Una enfermedad de difícil diagnóstico

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Tumores neuroendocrinos: Una enfermedad de difícil diagnóstico

Los síntomas suelen pasar desapercibidos o se toman como parte del cuadro clínico de otras enfermedades. Los llamados Tumores Neuroendocrinos (TNE) son masas anormales de tejido que se originan en las células neuroendocrinas.

Este tejido anormal se forma porque las células se multiplican a un ritmo superior al normal, son poco frecuentes y muy complejas. Generalmente son de difícil diagnóstico debido a que estos tumores tienen la capacidad de liberar hormonas, produciendo cuadros clínicos confusos.

Las células neuroendocrinas suelen estar en glándulas como: la tiroides, la hipófisis, las suprarrenales y el páncreas o dispersas en el sistema digestivo, razón por la cual la mayoría de los TNE se originan en estas áreas y son denominados gastro-entero-pancreáticos. Dentro de esta categoría, los más frecuentes son los llamados tumores carcinoides, ubicados en el intestino delgado, recto, apéndice y estómago.

Aunque su aparición es baja en comparación con otros tipos de tumores (piel, cuello uterino,  próstata, mamas, u  otros) se sabe que su prevalencia es de aproximadamente 35 casos por cada 100 000 habitantes en el mundo, lo cual representa una probabilidad de 9800 casos en Venezuela. La aparición de la enfermedad es de aproximadamente 2.5-5 casos por 100 000/año, es decir un total de 700 a 1400 nuevos casos por año. El  grupo más numeroso son los tumores carcinoides del intestino medio, con una tasa de incidencia de 2.4/100 000/año2, lo cual representa en nuestro país unos 672 nuevos casos por año.

El Dr. Gerber Gómez, asesor médico de Sanofi, explicó que "cuando la liberación de hormonas es excesiva, se producen manifestaciones clínicas dependiendo del efecto de la hormona secretada y los tumores son denominados Tumores Neuroendocrinos Funcionantes. Los TNE que no liberan grandes cantidades de hormonas, no generan síntomas y son denominados Tumores Neuroendocrinos  No Funcionantes".

"En términos de tratamiento, éste debe tener un enfoque multimodal; es decir, un enfoque en el que se considere integralmente al individuo y su calidad de vida. Todo con el propósito de extirpar o reducir la tumoración en los casos posibles, así como controlar los síntomas, prolongar y mejorar la calidad de vida del paciente. Es importante señalar que el tratamiento va a depender del sitio del tumor primario y si se trata de tumores funcionantes o no" señaló el Dr. Gómez.

La calidad de vida de los pacientes con tumores neuroendocrinos funcionantes puede verse severamente comprometida, por los síntomas que acompañan la enfermedad. La mayoría de los tumores gastro-entero-pancreáticos secretan serotonina, un neurotransmisor  necesario para que el cerebro y el cuerpo en general, puedan funcionar correctamente. Los trastornos asociados a fallas en este neurotransmisor producen síntomas como  diarrea, broncoespasmos y bochornos (sensación de calor, principalmente en el rostro acompañada de enrojecimiento) que experimentan los pacientes.

Para controlar estos síntomas se prescriben principios activos que buscan aliviar el cuadro clínico del  paciente. Recientemente ha sido aprobado en Venezuela el registro del Lanreotide, un principio activo muy parecido a la somatostatina, para el tratamiento de los síntomas asociados a los tumores carcinoides. El Lanreotide ha demostrado ser muy efectivo en el control de los síntomas clínicos asociados a la hipersecreción de hormonas hasta en un 60% de los pacientes e incluso más,  de acuerdo a diversos reportes 5.

La terapia con Lanreotide es similar a la terapia estándar con análogos de somatostatina (SSA); sin embargo, se diferencia de manera positiva de otros por una serie de razones que benefician significativamente al paciente.  El Lanreotide es capaz de controlar dentro de las primeras 24 horas síntomas como bochornos y diarrea (efecto que se optimiza y mantiene en el largo plazo) y en tratamientos de larga duración o que alcancen control puede utilizarse  en intervalo de dosis extendido de 6 a 8 semanas6, controlando la enfermedad en forma similar a otros SSA administrados cada 28 días, reduciendo de esta forma el número de dosis al año y mejorando significativamente la calidad de vida del paciente.

mayo 10/2013 (Diario Salud), infomed.cu

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