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Flashcards in Carcinoid Tumors Deck (39):
1

What is a carcinoid tumor?

Tumor arising from neuroendocrine cells (Kulchitsky cells).
Secretes serotonin.

2

Why is a carcinoid tumor called "carcinoid"?

A carcinoid resembles a carcinoma but is clinically and histologically less aggressive than most GI carcinomas

3

How can you remember that Kulchitsky cells are found in carcinoid tumors?

KUL CAR

4

What are the common sites for carcinoid tumors?

AIR:
Appendix, Ileum, Rectum
Also bronchus, jejunum, stomach, duodenum, colon, ovary, testicle, pancreas, thymus

5

What are the signs and symptoms of a carcinoid tumor?

Depends on the location (most cases are asymptomatic).
SBO, abdominal pain, bleeding, weight loss, diaphoresis, pellagra skin changes, intussusception, carcinoid syndrome, wheezing

6

Why SBO with carcinoid?

Severe mesenteric fibrosis

7

What are the pellagra-like symptoms of a carcinoid tumor?

1. Dermatitis
2. Diarrhea
3. Dementia

8

What causes pellagra in carcinoid patients?

Decreased niacin production

9

What is carcinoid syndrome?

Syndrome of symptoms caused by release of substances from a carcinoid tumor

10

What are the symptoms of carcinoid syndrome?

B FDR:
Bronchospasm, Flushing (skin), Diarrhea, Right-sided heart failure (from valve failure)

11

Why does right-sided heart failure develop but not left-sided heart failure in carcinoid syndrome?

Lungs act as a filter, thus the left heart doesn't see all the vasoactive compounds

12

What is the incidence of carcinoid syndrome in patients with a carcinoid tumor?

10%

13

What released substances cause carcinoid syndrome?

Serotonin and vasoactive peptides

14

What is the medical treatment for carcinoid syndrome?

Octreotide IV

15

What is the medical treatment of diarrhea alone in carcinoid syndrome?

Odansetron (Zofran)

16

How does the liver prevent carcinoid syndrome?

By degradation of serotonin and the other vasoactive peptides when the tumor drains into the portal vein

17

Why does carcinoid syndrome occur in some tumors and not in others?

Occurs when venous drainage from the tumor gains access to the systemic circulation by avoiding hepatic degradation of the vasoactive substances

18

What tumors can produce carcinoid syndrome?

Liver metastases; retroperitoneal disease draining into paravertebral veins; primary tumor outside of GI tract, portal venous drainage, or both

19

What does the liver break down serotonin into?

5-HIAA

20

What percentage of patients with a carcinoid have an elevated urine 5-HIAA level?

50%

21

What are the associated diagnostic lab findings with carcinoid tumor?

Elevated urine 5-HIAA as well as elevated urine and blood serotonin levels

22

How do you remember 5-HIAA for carcinoid?

5-HIGH CAR pile up

23

What stimulation test can often elevate serotonin levels and cause symptoms of carcinoid syndrome?

Pentagastrin stimulation

24

How do you localize a GI carcinoid?

Barium enema; upper GI series with small bowel follow-through; colonoscopy; enteroscopy; enteroclysis; EGD; radiology tests

25

What are the special radiologic (scintigraphy) localization tests for carcinoid tumors?

I-MIBG; In-octreotide; PET scan utilizing C-labeled HTP

26

What is the surgical treatment for carcinoid tumor?

Excision of the primary tumor and single or feasible metastasis in the liver; chemotherapy for advanced disease

27

What is the medical treatment for carcinoid tumor?

Palliation of the carcinoid syndrome (e.g. serotonin antagonists, somatostatin analog)

28

How effective is octreotide in treating carcinoid syndrome?

It relieves diarrhea and flushing in more than 85% of cases and may shrink tumor in 10-20%

29

What is a common anti-serotonin drug?

Cyproheptadine

30

What is the overall prognosis for carcinoid tumor?

66% alive at 5 years

31

What is the prognosis of patients with liver metastasis or carcinoid syndrome secondary to carcinoid tumor?

50% at 3 years

32

What does a carcinoid tumor look like?

Usually intramural bowel mass.
Appears as yellowish tumor upon incision.

33

For appendiceal carcinoid, when is a right hemicolectomy indicated vs. an appendectomy?

If the tumor is > 1.5 cm, right hemicolectomy is indicated.
If there are no signs of serosal or cecal involvement and tumor is

34

Which primary site of carcinoid tumor has the highest rate of metastasis?

Ileal primary tumor

35

Can a carcinoid tumor be confirmed malignant by looking at the histology?

No, metastasis must be present to diagnose malignancy

36

What is the correlation between carcinoid tumor size and malignancy potential?

Vast majority of tumors 2 cm, malignancy potential is significant.

37

What treatments might you use for the patient with unresectable liver metastasis that is refractory to medical treatment?

Chemoembolization or radiofrequency ablation

38

What are the overall survival rates for carcinoid tumors at 5 years? 10 years?

70%; 50%

39

What are the side effects of colorectal carcinoid?

Most common side effect is rectal bleeding +/- vague abdominal pain or discomfort