From the Guidelines
Type 1 gastric carcinoids should be managed with endoscopic resection for lesions less than 1-2 cm, while type 3 gastric carcinoids require more aggressive treatment, usually involving surgical resection with lymph node dissection, due to their high metastatic potential and poor prognosis. The management of type 1 and type 3 gastric carcinoids differs significantly due to their distinct pathophysiology and prognosis. Type 1 gastric carcinoids are the most common type, accounting for 70-80% of cases, and are associated with chronic atrophic gastritis and hypergastrinemia 1. They typically present as small, multiple polyps in the gastric fundus or body, are usually well-differentiated, and have a low metastatic potential (less than 5%) 1. In contrast, type 3 gastric carcinoids are sporadic tumors not associated with hypergastrinemia or other conditions, are typically solitary, larger lesions, and are more aggressive with a high metastatic potential (50-100%) 1.
The prognosis for type 1 gastric carcinoids is generally excellent with a 5-year survival rate exceeding 95%, while type 3 has a much poorer prognosis with 5-year survival rates of 25-30% 1. The distinction between these types is crucial for determining appropriate treatment and follow-up strategies. According to the most recent guidelines, individuals with type 1 gastric carcinoids >2 cm should undergo cross-sectional imaging and be referred for surgical resection, given the risk of metastasis 1. On the other hand, type 3 gastric carcinoids require radical resection of the tumor with regional lymphadenectomy, regardless of size 1.
Key differences between type 1 and type 3 gastric carcinoids include:
- Pathophysiology: Type 1 is associated with chronic atrophic gastritis and hypergastrinemia, while type 3 is sporadic and not associated with any underlying condition 1.
- Prognosis: Type 1 has a low metastatic potential and excellent prognosis, while type 3 has a high metastatic potential and poor prognosis 1.
- Management: Type 1 can be managed with endoscopic resection for lesions less than 1-2 cm, while type 3 requires surgical resection with lymph node dissection 1.
- Treatment outcomes: Type 1 has a high 5-year survival rate, while type 3 has a lower 5-year survival rate 1.
In summary, the management of type 1 and type 3 gastric carcinoids should be tailored to their distinct pathophysiology, prognosis, and treatment outcomes, with a focus on minimizing morbidity, mortality, and improving quality of life 1.
From the Research
Type 1 Gastric Carcinoid
- Type 1 gastric carcinoids (TIGCs) are related to chronic atrophic gastritis and are characterized by hypergastrinemia and hyperplasia of enterochromaffin-like cells 2
- TIGCs are the most frequently diagnosed of all gastric carcinoids, accounting for about 70-80% 2, 3
- Endoscopically, TIGCs are present as small (<10 mm), polypoid lesions or, more frequently, as smooth, rounded submucosal lesions 2
- Most TIGCs are well-differentiated tumors, with metastasis being rare, and patients with TIGCs generally have an excellent prognosis 2, 4
- Treatment options for TIGCs include total gastrectomy, partial resection, antrectomy, endoscopic resection, and endoscopic surveillance 2, 4
Type 3 Gastric Carcinoid
- Type 3 gastric carcinoids represent 15-25% of gastric carcinoids and are characterized by a far more aggressive course 3
- Type 3 gastric carcinoids are not associated with chronic atrophic gastritis or hypergastrinemia, and have a higher metastatic potential compared to type 1 gastric carcinoids 3
- The optimal clinical approach to type 3 gastric carcinoids remains to be elucidated, but surgical treatment is often recommended due to their aggressive nature 3
Comparison of Type 1 and Type 3 Gastric Carcinoids
- Type 1 gastric carcinoids are generally benign and have a low metastatic potential, whereas type 3 gastric carcinoids are more aggressive and have a higher metastatic potential 3, 5
- Treatment options for type 1 gastric carcinoids include endoscopic surveillance, endoscopic resection, and surgical resection, whereas type 3 gastric carcinoids often require surgical treatment due to their aggressive nature 2, 3, 4
- The prognosis of type 1 gastric carcinoid patients is generally favorable, with a high recurrence-free survival and disease-specific survival rate, whereas the prognosis of type 3 gastric carcinoid patients is often poorer due to their aggressive nature 4