Carcinoid tumors
Carcinoid tumors comprise of a group of a slow-growing type of cancers that can arise in several places of body, but most commonly in the gastrointestinal tract and in the lungs, especially appendix, terminal ileum and small intestine.
Carcinoid tumors arise from cells of the neuroendocrine system that share many characteristics similar to nerve cells.
Factors that are associated with increased risk of having carcinoid tumors include old age, family history, smoking, gastritis and others. A rare hereditary cancer syndrome called MEN I is associated with increased risk of carcinoid tumors. Patients who unfortunately carry a gene mutation associated with MEN I syndrome, can develop multiple tumors in the glands of the endocrine system.
Carcinoid tumors rarely cause signs and symptoms until it is advanced, when the cancer has spread to liver or lungs. Some carcinoid tumors can produce and release hormones and cause symptoms such as diarrhea or facial or skin flushing. Some carcinoid tumors do not produce hormones. Carcinoid tumors of the gastrointestinal tract usually do not cause symptoms until the tumors have spread to the liver because the hormones made by the tumors can now bypass the metabolism of the liver and get released to the whole body through bloodstreams.
In many cases, carcinoid tumors don't cause any signs or symptoms and can be found by accident. When signs and symptoms do occur they can be usually vague and related to the location of the tumor. Signs and symptoms of carcinoid tumors may include: abdominal pain, bowel obstruction, facial or skin flushing, diarrhea, difficulty breathing, rectal bleeding or pain, chest pain, wheezing. Carcinoid tumors that produce and release hormones can sometimes cause heart valve problems (usually affecting tricuspid valve in the right heart), called carcinoid heart disease. Carcinoid tumors can cause a variety of other signs and symptoms related to hormones made by the tumors.
Treatment for carcinoid tumors usually starts with a drug called sandostatin (octreotide). It has been shown in clinical trials that sandostatin can slow down the progression of carcinoid tumors and alleviate symptoms especially diarrhea and flushing. Octreotide is usually a very well tolerated drug and is given by subcutaneous or muscular injection. When the tumors no longer respond to octreotide, chemotherapy might be considered. Other forms of treatment (such as chemoembolization, radiofrequency ablation) might be considered, depending on the location of the tumor as well as other factors. Tumors that show rich vascular supplies in the liver might respond to chemoembolization. If a patient happens to have just one or two small tumors (less than 3-4 centimeter) in the liver, radiofrequency ablation might be considered. These treatment methods need to be carefully considered because serious side effects could occur and not all patients can benefit from these treatment methods.
