Carcinoid syndrome natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
Prognosis varies from individual to individual. It ranges from a 95% 5 year survival for localized disease to a 20% 5 year survival for those with liver metastases. The average survival time from the start of octreotide treatment has increased to about 12 years.
If left untreated, patients with [[Carcinoid Syndrome|carcinoid syndrome]] may progress to develop [[flushing]], [[diarrhea]], and [[Carcinoid|carcinoid heart disease]] ([[valvular heart disease]] and [[Cardiac arrythmia|cardiac dysrythmias]]). Common [[complications]] of [[carcinoid tumor]] include increased risk of [[falls]] and [[injury]] (from [[hypotension]]), [[obstruction|bowel obstruction]], [[gastrointestinal bleeding]], [[heart failure|right-sided heart failure]], and [[fibrosis]] of the [[Tricuspid valves|tricuspid valve]] and [[pulmonary valve]], and rarely the [[mitral valve]] in cases with left sided involvement. [[Prognosis]] is generally good and the 5-year [[Survival rates|survival rate]] of [[patients]] with [[Carcinoid Syndrome|carcinoid syndrome]] is approximately 69.7%.


==Natural History==
==Natural History==
*If left untreated, [[patients]] with [[Carcinoid Syndrome|carcinoid syndrome]] may progress to develop [[flushing]], [[diarrhea]], and [[Carcinoid disease|carcinoid]] [[Heart diseases|heart disease]] [[Valvular heart disease|(valvular heart disease]] and [[Cardiac arrythmia|cardiac dysrythmias]]):<ref>General Information About Gastrointestinal (GI) Carcinoid Tumors
. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_49_toc Accessed on September 24, 2015</ref>
**[[Pathological|Pathologically]], the [[cardiac]] [[Valves of the heart|valves]] become thickened because of [[fibrosis]]
**[[Tricuspid]] and [[pulmonic valves]] are affected to a greater extent than the [[mitral]] and [[aortic valves]]
*They have a very slow [[Growth|growth rate]] compared to most [[malignant tumors]]


==Complications==
==Complications==
* Increased risk of falls and injury (from [[hypotension]])
Common [[complications]] of [[carcinoid tumor]] include:<ref>Carcinoid syndrome. U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000347.htm</ref>
* Bowel [[obstruction]] (from tumor)
*Increased risk of [[falls]] and [[injury]] (from [[hypotension]])
* [[Gastrointestinal bleeding]]
*[[Obstruction|Bowel obstruction]]
* Right-sided [[heart failure]]
*[[Gastrointestinal bleeding]]
*Serotonin causes fibrosis of the tricuspid valve and pulmonary valve, more rarely the mitral valve in cases with left sided involvement
*[[Carcinoid Disease|Carcinoid heart disease]] develops in more than one-third of [[patients]] with [[Carcinoid Syndrome|carcinoid syndrome:]]<ref>General Information About Gastrointestinal (GI) Carcinoid Tumors
**"TIPS" - [[tricuspid insufficiency|Tricuspid Insufficiency]], [[pulmonary stenosis|Pulmonic Stenosis]] (fibrosis of tricuspid and pulmonary valves)
. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_49_toc Accessed on September 24, 2015</ref>
*[[Fibrosis]] of the [[Tricuspid valves|tricuspid valve]] and [[pulmonary valve]], rarely the [[mitral valve]] in cases with left sided involvement
::*[[Tricuspid]] and [[pulmonic regurgitation]] ("TIPS" - [[tricuspid insufficiency|Tricuspid Insufficiency]], [[pulmonary stenosis|Pulmonic Stenosis]])
::*[[Pulmonary stenosis]]
::*[[Mitral]] and [[aortic insufficiency]]
::*[[Cardiac arrhythmias|Cardiac dysrhythmias]]


==Prognosis==
==Prognosis==  
*Factors that determine the clinical course and outcome of patients with GI carcinoid tumors are complex and multifaceted and include the following:<ref>{{Cite web | title =Prognostic Factors
*Prognosis o[[Carcinoid tumors|f carcinoid tumor]] is generally good and the 5-yea[[Survival rates|r survival rate]] of [[patients]] is approximately:<ref name="pmid15213627">{{cite journal| author=Maggard MA, O'Connell JB, Ko CY| title=Updated population-based review of carcinoid tumors. | journal=Ann Surg | year= 2004 | volume= 240 | issue= 1 | pages= 117-22 | pmid=15213627 | doi= | pmc=PMC1356383 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15213627  }} </ref>
| url =http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq }}</ref>
:*[[Stomach]]-75.1%
:*The site of origin
:*[[Intestine|Small Intestine]]-76.1%
:*The size of the primary tumor
:*[[Appendix]]-76.3%
:*The anatomical extent of disease
:*[[Rectum]]-87.5%
*Elevated expression of the proliferation antigen Ki-67 and the tumor suppressor protein p53 have been associated with poorer prognosis
*Factors that determine the prognosis of patients with [[gastrointestinal]] [[carcinoid tumors]] include:<ref>Carcinoid tumor. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq</ref>
*Adverse clinical prognostic indicators include:
:*Site of [[origin]]
:*Carcinoid syndrome
:*Size of th[[Primary tumor|e primary tumor]]
:*Carcinoid heart disease
:*[[Anatomical]] extent of [[disease]]
:*High concentrations of the tumor markers urinary [[5-HIAA]] and plasma [[chromogranin A]]
*Negative [[Prognostic|prognostic factors]] include:
*In people with the carcinoid syndrome, the tumor has usually spread to the liver, which lowers the survival rate
**[[Carcinoid]] [[heart]] [[disease]]
*The outlook is more favorable with new treatment methods, such as [[sandostatin]]
**High [[concentrations]] of the [[tumor markers]] - [[urinary]] [[5-HIAA]] and [[Plasma (blood)|plasma]] [[chromogranin A]]
**[[Metastases|Metastasis]] to the [[liver]]
**[[Carcinoid tumor]] in the [[thymus]]
**Overexpression of the [[proliferation]] [[antigen]] Ki-67
**[[Mutations|Mutation]] in the ''[[p53]]'' [[gene]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Disease]]
[[Category:Gastroenterology]]
[[Category:Types of cancer]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Gastroenterology]]
[[Category:Pulmonology]]
[[Category:Hematology]]




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Latest revision as of 21:51, 21 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

Overview

If left untreated, patients with carcinoid syndrome may progress to develop flushing, diarrhea, and carcinoid heart disease (valvular heart disease and cardiac dysrythmias). Common complications of carcinoid tumor include increased risk of falls and injury (from hypotension), bowel obstruction, gastrointestinal bleeding, right-sided heart failure, and fibrosis of the tricuspid valve and pulmonary valve, and rarely the mitral valve in cases with left sided involvement. Prognosis is generally good and the 5-year survival rate of patients with carcinoid syndrome is approximately 69.7%.

Natural History

Complications

Common complications of carcinoid tumor include:[2]

Prognosis

References

  1. ↑ General Information About Gastrointestinal (GI) Carcinoid Tumors . National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_49_toc Accessed on September 24, 2015
  2. ↑ Carcinoid syndrome. U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000347.htm
  3. ↑ General Information About Gastrointestinal (GI) Carcinoid Tumors . National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_49_toc Accessed on September 24, 2015
  4. ↑ Maggard MA, O'Connell JB, Ko CY (2004). "Updated population-based review of carcinoid tumors". Ann Surg. 240 (1): 117–22. PMC 1356383. PMID 15213627.
  5. ↑ Carcinoid tumor. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq


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