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

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==Overview==
==Overview==
The presence of liver metastasis is associated with a particularly poor prognosis among patients with carcinoid tumor. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor. Common complications of carcinoid tumor include [[gastrointestinal bleeding]], [[right heart failure]], [[bowel obstruction]], [[hypotension]], and [[tricuspid insufficiency]] and [[pulmonary stenosis]].
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==
*They have a very slow growth rate compared to most malignant tumors.
*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>
*Carcinoid heart disease develops in more than one-third of patients with carcinoid syndrome. Pathologically, the cardiac valves become thickened because of fibrosis, and the [[tricuspid]] and pulmonic valves are affected to a greater extent than the [[mitral]] and [[aortic valves]].
**[[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==
Common complications of carcinoid tumor include:
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>
* Increased risk of falls and injury (from [[hypotension]])
*Increased risk of [[falls]] and [[injury]] (from [[hypotension]])
* Bowel [[obstruction]] (from tumor)
*[[Obstruction|Bowel obstruction]]
* [[Gastrointestinal bleeding]]
*[[Gastrointestinal bleeding]]
* Right [[heart failure]]
*[[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
*Serotonin causes fibrosis of the tricuspid valve and pulmonary valve, more rarely the mitral valve in cases with left sided involvement
. 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>
**"TIPS" - [[tricuspid insufficiency|Tricuspid Insufficiency]], [[pulmonary stenosis|Pulmonic Stenosis]] (fibrosis of tricuspid and pulmonary valves)
*[[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==  
Prognosis is generally good, and the 5-year survival rate of patients with carcinoid syndrome is approximately 69.7%.<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>
*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>
*Factors that determine the prognosis of patients with gastrointestinal carcinoid tumors include:<ref>{{Cite web | title =Prognostic Factors| url =http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq }}</ref>
:*[[Stomach]]-75.1%
:*Site of origin
:*[[Intestine|Small Intestine]]-76.1%
:*Size of the primary tumor
:*[[Appendix]]-76.3%
:*Anatomical extent of disease
:*[[Rectum]]-87.5%
*Elevated  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>
*Negative prognostic factors include:
:*Site of [[origin]]
**Carcinoid heart disease
:*Size of th[[Primary tumor|e primary tumor]]
**High concentrations of the tumor markers - urinary [[5-HIAA]] and plasma [[chromogranin A]].
:*[[Anatomical]] extent of [[disease]]
**Metastasis to the liver
*Negative [[Prognostic|prognostic factors]] include:
**Carcinoid tumor of the thymus
**[[Carcinoid]] [[heart]] [[disease]]
**Overexpression of the proliferation antigen Ki-67
**High [[concentrations]] of the [[tumor markers]] - [[urinary]] [[5-HIAA]] and [[Plasma (blood)|plasma]] [[chromogranin A]]
**Mutation in ''[[p53]]'' gene
**[[Metastases|Metastasis]] to the [[liver]]
 
**[[Carcinoid tumor]] in the [[thymus]]
*Prognosis is better with new treatment methods such as [[sandostatin]].
**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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