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Carcinoid syndrome

Definition


Disease: Carcinoid syndrome Carcinoid syndrome
Category: Tumors

Disease Definition:

When a rare cancerous tumor called a carcinoid tumor secretes certain chemicals into the bloodstream causing a variety of symptoms, carcinoid syndrome occurs. In the lungs, gastrointestinal tract or, rarely, in the ovaries, are the places where carcinoid tumors occur most commonly.

 

A person usually won’t experience symptoms until carcinoid tumors are quite advanced because they generally grow slowly. Through a test for an unrelated disease or condition is how a person may discover that he/she has carcinoid cancer.

 

Treating the cancer is usually involved in the treatment of carcinoid syndrome. But a cure may not be possible because most carcinoid tumors don’t cause carcinoid syndrome until they advance. In such cases, medications may make the patient more comfortable and relieve the symptoms of carcioid syndrome.
 

Work Group:


Symptoms, Causes

Symptoms:

Which chemicals the carcinoid tumor secretes into one's bloodstream is the thing on which the signs and symptoms depend. The following are the most common symptoms of carcinoid syndrome:

Skin flushing:

A person may experience flushing from 30 seconds to 30 minutes. The flushing may be experienced on the face and upper chest, which feel hot and change color, ranging from pink to red to purple. Though sometimes flushing can be provoked by eating food or drinking alcohol, but it may also happen for no obvious reason.

Facial skin lesions:

In people who've has carcinoid syndrome for many years, purplish areas of spider-like veins may appear on the nose and upper lips.

Diarrhea:

Carcinoid syndrome may be signed by frequent, watery stools accompanied by painful abdominal cramps.

Difficulty breathing:

At the same time a person experiences skin flushing, he/she may also experience asthma-like signs and symptoms, such as wheezing and shortness of breath.
 

Causes:

The cause of carcinoid tumors is not recognized.
A carcinoid tumor that secretes serotonin or other chemicals into the bloodstream is the cause of carcinoid syndrome. The gastrointestinal tract, including the appendix, colon and rectum, small intestine, stomach, or in the lungs, are some of the places where carcinoid tumors occur most commonly. Carcinoid tumors may develop in the ovaries in some rare cases.

 

The chemicals that cause carcinoid syndrome are secreted only by a small percent of carcinoid tumors, however, these tumors don’t have to be advanced to cause carcinoid syndrome. Usually, before these chemicals have a chance to travel through the body and affect it causing symptoms, the liver degrades and neutralizes them in an effective way. But when an advanced tumor spreads (metastasizes) to the liver itself, the chemicals that are secreted by these metastases won't be degraded as efficiently before they reach the bloodstream. Instead of secreting chemicals directly into the liver where the chemicals are processed and eliminated, the carcinoid lung tumors that secrete them do so much farther upstream. On the other hand, the chemicals of carcinoid tumors in the intestine are secreted into blood that must first pass through the liver before reaching the rest of the body. In most cases of carcinoid syndrome, there is an advanced tumor that has spread to the liver. 

 

The risk of developing carcinoid syndrome is only in people who have carcinoid tumors. If people with carcinoid tumors have a gastrointestinal carcinoid tumor, and particularly if the tumor has spread (metastasized) to the liver, they are more likely to experience carcinoid syndrome.
 

Complications

Complications:

A person with carcinoid syndrome may be at risk of some of these complications:

Bowel obstruction:

Leading to a bowel obstruction, the narrowing and kinking of the intestine can be caused by cancer that spreads to the lymph nodes adjacent to the small intestine. Vomiting and severe, cramping abdominal pain are some of the signs and symptoms of a bowel obstruction. To relieve this obstruction, surgery may be necessary.

Carcinoid crisis:

A severe episode of flushing, breathing difficulty, confusion and low blood pressure is caused by carcinoid crisis. Although carcinoid crisis could occur for no apparent reason, but some of its triggers may include chemotherapy, anesthesia and other cancer treatments. Carcinoid crisis can be fatal. To reduce the risk of carcinoid crisis, the patient may be given medications before chemotherapy or surgery.

Carcinoid heart disease:

Carcinoid heart disease may develop in people with carcinoid syndrome. Making it difficult for heart valves to function properly, carcinoid syndrome causes a thickening of the heart valves. The heart valves may leak as a result of this. Shortness of breath and fatigue during physical activity are the signs and symptoms of carcinoid heart disease. Heart failure may eventually result from carcinoid heart disease. The patient may be recommended medications for his/her heart. The only treatment to correct carcinoid heart disease is the surgical repair of damaged heart valves.
 

Treatments:

Treating the cancer is involved in treating carcinoid syndrome. One of the options may be surgery to remove the cancer or most of the cancer. The patient may be recommended treatment to shrink the tumors if surgery is not an option because the cancer is too widespread. And in this way, the signs and symptoms of carcinoid syndrome may be reduced.

The following may be included in the treatment options:

Chemotherapy:

Carcinoid tumors may shrink by chemotherapy drugs. Which chemotherapy drugs the patient receives is the thing on which the side effects that he/she may experience will depend. The patient could discuss his/her particular chemotherapy regimen with the doctor.

Biological therapy:

Sometimes, to slow the growth of carcinoid tumors and to relieve symptoms, an injectable medication called interferon alfa is used, which stimulates the body's immune system to work better. This drug may be prescribed either alone or in combination with octreotide. Bone pain, vomiting, fatigue and headaches are included in the significant side effects of interferon.

Killing cancer cells with heat:

To kill cancer cells, radiofrequency ablation delivers heat through a needle to the cancer cells in the liver. If the patient has a small number of liver metastases that are small in size, this treatment could be an option. Though there is a small risk of blood loss and infection, radiofrequency ablation is safe in general.

Octreotide:

The signs and symptoms of carcinoid syndrome can be reduced and the rate of growth of the carcinoid tumor can be slowed by monthly injections of octreotide. In most cases of carcinoid syndrome, octreotide controls flushing and diarrhea. Diarrhea and nausea, abdominal pain and bloating are some of the side effects of octreotide, though these symptoms may subside with time. Some people must stop taking the drug as they can't tolerate the side effects of octreotide.

Stopping blood supply to the tumor: 

Through a needle near the groin is inserted a catheter and it is threaded up to the main artery that carries blood to the liver (hepatic artery), in a procedure called hepatic artery embolization. To cut off the blood supply to any cancer cells that have spread to the liver, particles are released to clog the hepatic artery. The healthy liver cells survive by relying on blood from other blood vessels. Hepatic artery embolization is typically performed only in specialized medical centers, as it can be risky, especially in people with liver disease. The risks and benefits can be discussed with the doctor.

 

Based on the specific characteristics of the patient's cancer, various combinations of medications to treat the signs and symptoms may be tried, because there are medications to control the specific signs and symptoms.

 

Depending on the extent of tumor spread and whether carcinoid syndrome has developed, the prognosis for people living with carcinoid cancer varies widely. New ways to treat advanced cancer are being found and this may improve survival as cancer research continues.
 

Prognosis:

Not available

Expert's opinion

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