Carcinoid Tumors
Carcinoid tumors can produce chemical substances and hormones that may cause a variety of symptoms. They can involve almost any organ; however, they most commonly involve the appendix and small bowel. Another common site for these tumors is the lung tissue. Carcinoids are very slow growing tumors and it may take years before they become sizable. Most symptoms are related to the release of chemicals from the tumor.
Cause
The actual cause of Carcinoid Tumor is unknown.
Signs and Symptoms
Carcinoids may grow for a long time without causing any problems. Most patients are diagnosed in advanced stages. The symptoms depend on the location and site of involvement by Carcinoid:
- Flushing and redness of the face This is the most common sign of Carcinoid tumors. This can be triggered by alcohol consumption or emotional distress. It is due to enlargement of the vessels of the skin by chemical stimulation from chemicals released by the tumor.
- Diarrhea is also a common symptom.
- Abdominal pain
- Shortness of breath
- Weight loss
The constellation of these symptoms in patients with metastatic or widespread Carcinoid tumor is referred to as Carcinoid Syndrome.
Diagnosis
When suspected, CT scan or Ultrasound examination of the abdomen may establish the site and extent of the disease. A Fine needle aspiration of the Carcinoid may confirm the existence of this cancer. Detection of hormones and chemicals in the blood and urine may also assist in making a diagnosis.
Staging
This refers to the process of determining the extent of the disease. A CT scan of the abdomen, as well as bone scans, may be necessary to complete the staging workup.
Treatment
Surgery: Management of this disease relies on surgery in an attempt to remove most or all of the Carcinoid from the original site.
Chemotherapy: Is appropriate for patients in whom the disease is not cured with surgery. Streptozotocin, 5-FU and Leucovorin are among the most commonly used drugs for Carcinoid Tumors. These drugs are used in combination and can have moderate to severe toxic effects.
Radiation: For the most part, it is used to control the symptoms of the advanced disease.
Treatment of symptoms
Octreotide (Somatostatin) is the most effective drug for management of symptoms.
Pattern of Spread
If untreated, or if it fails to respond to treatment, a Carcinoid Tumor can spread to the Liver , Lymph glands in the abdomen as well as to the lungs.
Prognosis
In most Americans, this cancer carries a very good prognosis due to diagnosing the disease in its early stages. In such cases, the chance of survival is very good.
Follow up
After completion of treatment, in any combination that might have taken place, patients should remain under surveillance for a possibility of recurrence of cancer. Patients with very early stages are cured with surgery and follow-up need not be as intense. For patients with advanced disease, follow-up should be scheduled on a regular basis, initially every one to three months for one to two years. The frequency of follow-up will depend on the condition of the patient and his/her disease. In each follow-up visit, patients are examined, blood tests performed, if necessary, and a CT scan of abdomen obtained at intervals.
Treatment of advanced or recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are treated with chemotherapy using the same agents as mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas where the cancer has spread. If patients experience pain, various pain medications may be used to alleviate pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from Hospice.
