Carcinoid Tumor

Carcinoid Tumor


Carcinoid-Tumor


Carcinoid cancer is one of the rarest form of cancer which is composed of neuroendocrine factors with multiple metastasis points in the body. This cancer is often found during the advanced stages as it tends to hide its symptoms. Usually it involves with metastasis and affecting one or more organs. The embryonic origin has 3 distinct faces for carcinoid tumors Foregut carcinoid tumors may originate from arises in the lungs, bronchi, or stomach. Midgut carcinoid tumors are in the small intestine, appendix, and large bowel, and finally the hindgut carcinoid tumors that will arise at the distal colon or rectum. When it comes to carcinoid syndrome, the combination of symptoms are caused by those hormones released by the tumors into the blood stream. The most common hormones released are serotonin, histamine, and bradykinin which leads to such symptoms as flushing, diarrhea, abdominal pain, wheezing due to bronchospasm (airway narrowing), and valvular heart disease.

 

Characteristics of Carcinoid Tumors based on its location

  1. Carcinoid tumors pose a therapeutic and diagnostic challenge to the practitioners because the main characteristic is that they are asymptomatic.
  2. Many carcinoid tumors are latent or indolent, so it is expected that their true prevalence could be higher.
  3. Prognosis varies widely depending on the location, severity and staging of the tumor.
  4. It is involved with multiple organs.

Clinical Presentation

Signs and symptoms of carcinoid tumors vary greatly and depend on the location and size of the tumor and the presence of metastases. Findings will range from no tumor to full symptoms of carcinoid syndrome as following:

  1. For a small intestinal carcinoid tumor, one may feel a periodic abdominal pain due to fibrosis of the mesentery,
  2. Rare Acromegaly,
  3. Carcinoid crisis: symptoms range from intense flushing, tachycardia, hypertension or hypotension, altered mental status, diarrhea, abdominal pain and coma. This is one of the most dangerous and life threatening,
  4. Midgut tumors that metastasized lead to cutaneous flushing that affect head and neck. Unpleasant warm feeling, itching, palpitation, or erythema in the upper body,
  5. Diarrhea and malabsorption syndrome as a result of mid gut type where stools are watery and associated with steatorrhea (fatty),
  6. A feeling of Wheezing or asthma like syndrome due to bronchial constriction Other,
  7. Cardiac manifestations are observed in like tachycardia,
  8. Joint pain arthritis confusion and changes in mental status and other behavioral issues.

Diagnosis and differential diagnosis

It is very risky and confusing to diagnose because of its vague, complexity and multiple symptoms, especially in children.

Treatment

Treatment is a multi disciplinary approach with a doctor, neurosurgeon, nurse, etc. Some of the options are:

  1. Surgery is the final and ultimate therapy for a complete cure,
  2. Radio labeled octreotide guanidine is used for those with metastasis of this tumor to liver and surrounding organs,
  3. Chemotherapy could be partially used as it may not completely cure the illness, however it can only be used as a adjuvant therapy,
  4. Chemoembolization of hepatic artery for treating the metastatic carcinoid tumor has been popular in adults,
  5. Symptomatic management of skin changes, fever and infectious signs, GI tract upset, etc are important,
  6. The prognosis is still poor due to understanding of the illness and its mechanism. Treatments are still under experiment.