Carcinoid syndrome surgery: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(30 intermediate revisions by one other user not shown)
Line 4: Line 4:


==Overview==
==Overview==
Surgery is the mainstay of treatment for carcinoid tumor. The feasibility of surgery depends on the stage of carcinoid tumor at diagnosis.
[[Surgery]] is the mainstay of treatment for [[Carcinoid tumor|carcinoid tumor.]] The feasibility of [[surgery]] depends on the [[Cancer staging|stage]] of [[carcinoid tumor]] at [[Diagnosis|diagnosis.]]


==Surgery==
==Surgery==
[[Surgery]], if feasible, is the only curative therapy. If the tumor has metastasized (most commonly, to the [[liver]]), the tumor may be ineligible for surgery (unresectable), though there are many promising treatment modalities, such as radiolabeled [[octreotide]], that are very effective in arresting the growth of the tumors and prolonging survival in patients with liver metastases.  
[[Surgery]], if feasible, is the only curative therapy. If the [[tumor]] has [[metastasized]] (most commonly, to the [[liver]]), the [[tumor]] may be ineligible for [[surgery]] (unresectable), though there are many promising treatment modalities, such as radiolabeled [[octreotide]], that are very effective in arresting the [[growth]] of the [[tumors]] and prolonging [[Survival rate|survival]] in patients with [[Liver (2)|liver]] [[metastases]].  


===Gastric Carcinoids===
===Gastric Carcinoids===
* Type I [[gastric]] [[Carcinoid tumours|carcinoids]]: smaller than 1 cm can be removed with [[endoscopic]] [[Mucosal|mucosal resection]]. Local [[Surgery operation|surgical excision]] may be performed for larger [[Tumors|tumors.]]<ref name="surgery">Treatment Option Overview for gastrointestinal Carcinoid Tumors.<nowiki><ref name="pmid12972355"></nowiki>{{cite journal |vauthors=Kulke MH |title=Neuroendocrine tumours: clinical presentation and management of localized disease |journal=Cancer Treat. Rev. |volume=29 |issue=5 |pages=363–70 |date=October 2003 |pmid=12972355 |doi= |url=}}
*Type II carcinoids,the surgery is focused on removing the source of hypergastrinemia, typically by excision of duodenal gastrinomas via duodenotomy with resection of lymph node metastases.<nowiki><ref name="pmid9298884"></nowiki>{{cite journal |vauthors=Bordi C, Falchetti A, Azzoni C, D'Adda T, Canavese G, Guariglia A, Santini D, Tomassetti P, Brandi ML |title=Aggressive forms of gastric neuroendocrine tumors in multiple endocrine neoplasia type I |journal=Am. J. Surg. Pathol. |volume=21 |issue=9 |pages=1075–82 |date=September 1997 |pmid=9298884 |doi= |url=}}</ref><ref name="pmid28763328">{{cite journal |vauthors=Callahan AF, White M, Ituarte P, Gagandeep S, Woo Y, Fong Y, Melstrom L |title=Surgical Intervention in Gastric Carcinoid is Associated With Improved Survival in Local and Regional Disease |journal=Am. J. Clin. Oncol. |volume=41 |issue=9 |pages=882–887 |date=September 2018 |pmid=28763328 |doi=10.1097/COC.0000000000000392 |url=}}</ref>


*Type I gastric carcinoids: smaller than 1 cm can be removed with endoscopic mucosal resection. Local surgical excision may be performed for larger tumous, but exceptional cases with large multifocal lesions may require gastric resection.<ref name=surgery> Treatment Option Overview for gastrointestinal Carcinoid Tumors.<ref name="pmid12972355">{{cite journal |vauthors=Kulke MH |title=Neuroendocrine tumours: clinical presentation and management of localized disease |journal=Cancer Treat. Rev. |volume=29 |issue=5 |pages=363–70 |date=October 2003 |pmid=12972355 |doi= |url=}}
*Type II [[tumors]] can usually be managed with [[Endoscopic|endoscopic resection]] ([[tumors]] <1 cm) followed by close [[endoscopic]] surveillance.<ref name="pmid29257854">{{cite journal |vauthors=Dias AR, Azevedo BC, Alban LBV, Yagi OK, Ramos MFKP, Jacob CE, Barchi LC, Cecconello I, Ribeiro U, Zilberstein B |title=GASTRIC NEUROENDOCRINE TUMOR: REVIEW AND UPDATE |journal=Arq Bras Cir Dig |volume=30 |issue=2 |pages=150–154 |date=2017 |pmid=29257854 |pmc=5543797 |doi=10.1590/0102-6720201700020016 |url=}}</ref>
*Type III gastric carcinoids: They are treated with gastric resection and regional [[lymphadenectomy]].
*For larger or multifocal [[Tumour|tumours]] liberal surgical excision or gastric resection with regional [[lymphadenectomy]] is performed.<ref name="pmid16360380">{{cite journal |vauthors=Mullen JT, Wang H, Yao JC, Lee JH, Perrier ND, Pisters PW, Lee JE, Evans DB |title=Carcinoid tumors of the duodenum |journal=Surgery |volume=138 |issue=6 |pages=971–7; discussion 977–8 |date=December 2005 |pmid=16360380 |doi=10.1016/j.surg.2005.09.016 |url=}}</ref>
* Tumors larger than 2 cm or those with atypical histology or gastric wall invasion are most appropriately dealt with by [[gastrectomy]] or radical gastrectomy.<ref name="pmid8661813">{{cite journal |vauthors=Rindi G, Bordi C, Rappel S, La Rosa S, Stolte M, Solcia E |title=Gastric carcinoids and neuroendocrine carcinomas: pathogenesis, pathology, and behavior |journal=World J Surg |volume=20 |issue=2 |pages=168–72 |date=February 1996 |pmid=8661813 |doi= |url=}}</ref>
* Type II [[Carcinoid tumor|carcinoids tumor]] can usually be managed with [[endoscopic]] resection (tumors <1 cm) followed by close endoscopic surveillance.
*Type II gastric carcinoids:Tumors can usually be managed with endoscopic resection (particularly for tumors <1 cm) followed by close endoscopic surveillance. Liberal surgical excision or gastric resection with regional [[lymphadenectomy]] is performed for larger and multifocal tumors or for those with deep wall invasion or angioinvasion.
* For larger or multifocal tumors liberal surgical excision or [[Gastric|gastric resection]] with regional [[lymphadenectomy]] is performed.
*In patients with multiple tumors, [[somatostatin]] analog treatment may be used to reduce tumor growth, particularly if hypergastrinemia has not been reversed by surgery.<ref name="pmid17382267">{{cite journal |vauthors=Akerström G, Hellman P |title=Surgery on neuroendocrine tumours |journal=Best Pract. Res. Clin. Endocrinol. Metab. |volume=21 |issue=1 |pages=87–109 |date=March 2007 |pmid=17382267 |doi=10.1016/j.beem.2006.12.004 |url=}}</ref><ref name="pmid9298884">{{cite journal |vauthors=Bordi C, Falchetti A, Azzoni C, D'Adda T, Canavese G, Guariglia A, Santini D, Tomassetti P, Brandi ML |title=Aggressive forms of gastric neuroendocrine tumors in multiple endocrine neoplasia type I |journal=Am. J. Surg. Pathol. |volume=21 |issue=9 |pages=1075–82 |date=September 1997 |pmid=9298884 |doi= |url=}}</ref>
* For type III [[Carcinoid tumor|gastric carcinoids]] larger than 2 cm or those with atypical histology or [[Gastric|gastric wall]] invasion are most appropriately dealt with by [[gastrectomy]] or radical [[gastrectomy]].


===Duodenal Carcinoids===
=== Duodenal carcinoids ===
*In general, endoscopic excision of primary duodenal carcinoids appears to be most appropriate for tumors smaller than 1 cm.<ref name=surgery> Treatment Option Overview for gastrointestinal Carcinoid Tumors
* Primary [[Carcinoid tumor|duodenal carcinoids]] smaller than 1 cm are treated by [[endoscopic]] excision.
. NATIONAL CANCER INSTITUTE . http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_97_toc Accessed on September 22, 2015</ref>
 
*Duodenal carcinoids smaller than 2 cm may be excised locally. Tumors between 1 cm and 2 cm, complete resection is ensured by operative full-thickness excision. Follow-up endoscopy is indicated.  
* Duodenal [[Carcinoid tumor|carcinoids]] smaller than 2 cm may be excised locally. [[Tumors]] between 1 cm and 2 cm, complete resection is ensured by operative full-thickness [[excision]]. Follow-up [[endoscopy]] is indicated.
*Tumors larger than 1 cm may be difficult to remove completely endoscopically and should be evaluated with endoscopic [[ultrasonography]] before endoscopic resection is attempted because of their potential to invade beyond the submucosa.
 
*Tumors larger than 2 cm can be treated with operative full-thickness excision and regional [[lymphadenectomy]]. Lymphadenectomy is performed even in the face of negative preoperative imaging because of the high rate of [[lymph node]] metastasis for these tumors.
*[[Tumors]] larger than 1 cm may be difficult to remove completely [[Endoscopic|endoscopically]] and should be evaluated with [[endoscopic]] [[ultrasonography]] before [[endoscopic]] resection is attempted because of their potential to [[Invasion|invade]] beyond the [[submucosa]].<ref name="pmid12086896">{{cite journal |vauthors=Zyromski NJ, Kendrick ML, Nagorney DM, Grant CS, Donohue JH, Farnell MB, Thompson GB, Farley DR, Sarr MG |title=Duodenal carcinoid tumors: how aggressive should we be? |journal=J. Gastrointest. Surg. |volume=5 |issue=6 |pages=588–93 |date=2001 |pmid=12086896 |doi= |url=}}</ref>
*[[Tumors]] larger than 2 cm can be treated with operative full-thickness [[excision]] and [[lymphadenectomy|regional lymphadenectomy]].<ref name="pmid12086896">{{cite journal |vauthors=Zyromski NJ, Kendrick ML, Nagorney DM, Grant CS, Donohue JH, Farnell MB, Thompson GB, Farley DR, Sarr MG |title=Duodenal carcinoid tumors: how aggressive should we be? |journal=J. Gastrointest. Surg. |volume=5 |issue=6 |pages=588–93 |date=2001 |pmid=12086896 |doi= |url=}}</ref>
*A regional [[lymphadenectomy]] includes the [[lymph nodes]] in the following locations:
*A regional [[lymphadenectomy]] includes the [[lymph nodes]] in the following locations:


:*Posterior to the [[duodenum]] and pancreatic head and anterior to the [[inferior vena cava]]
:*[[Posterior]] to the [[duodenum]] and [[Pancreas|pancreatic head]] and anterior to the [[inferior vena cava]]
:*Posterolateral to the [[bile duct]] and [[portal vein]]
:*Posterolateral to the [[bile duct]] and [[portal vein]]
:*Anterior to the [[common hepatic artery]]
:*[[Anterior]] to the [[common hepatic artery]]


===Jejunal and Ileal Carcinoids===
===Jejunal and Ileal Carcinoids===
*At the time of diagnosis, 58% to 64% of patients with carcinoids of the small intestine have metastatic disease in the regional [[lymph nodes]] or the [[liver]].<ref name=surgery> Treatment Option Overview for gastrointestinal Carcinoid Tumors
*[[Carcinoid tumors|Carcinoids]] of the [[small intestine]] have metastatized in the regional [[lymph nodes]] or the [[liver]] in 50%-60% of cases<ref name="surgery">Treatment Option Overview for gastrointestinal Carcinoid Tumors
. NATIONAL CANCER INSTITUTE . http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_97_toc Accessed on September 22, 2015</ref>
. NATIONAL CANCER INSTITUTE . http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_97_toc Accessed on September 22, 2015</ref>
*Early surgical treatment should include removal of the [[mesentery]] by wedge resection and resection of lymph node metastases surrounding the [[mesenteric artery]] and vein to preserve intestinal vascular supply and to limit the intestinal resection.
*Early [[Surgery|surgical treatment]] should include removal of the [[mesentery]] by wedge [[resection]] and resection of [[Lymph nodes|lymph node]] [[metastases]] surrounding the [[mesenteric artery]] and [[Veins|vein]] to preserve [[Intestine|intestinal]] [[Blood|vascular supply]] and to limit the [[intestinal]] resection.<ref name="pmid20664473">{{cite journal |vauthors=Boudreaux JP, Klimstra DS, Hassan MM, Woltering EA, Jensen RT, Goldsmith SJ, Nutting C, Bushnell DL, Caplin ME, Yao JC |title=The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum |journal=Pancreas |volume=39 |issue=6 |pages=753–66 |date=August 2010 |pmid=20664473 |doi=10.1097/MPA.0b013e3181ebb2a5 |url=}}</ref>
*With grossly radical tumor resections, patients may remain symptom free for extended periods of time. However, because of the tenacity of carcinoid tumors, patients should undergo lifelong surveillance.
*Surgical treatment for advanced carcinoids involves prophylactic removal of [[mesenteric]] [[metastases]] early on because later the [[disease]] may become impossible to manage surgically.
*Surgical treatment for advanced carcinoids involves prophylactic removal of [[mesenteric]] metastases early on because later the disease may become impossible to manage surgically.
*Due to [[fibrosis]] between regions of the [[intestine]],surgery may result in [[fistulae]], [[intestinal]] devascularization, or creation of a short [[bowel]].
*Repeat surgery may be necessary if mesenteric metastases are left during primary surgery or have progressed after primary surgery.
*These operations are difficult because of fibrosis between regions of the intestine, and surgery may result in fistulation, intestinal devascularization, or creation of a short bowel.
*In patients with inoperable metastatic disease, 5-year survival is approximately 50% for those with inoperable liver metastases and approximately 40% for those with inoperable liver and mesenteric metastases.


===Appendiceal Carcinoids===
===Appendiceal Carcinoids===
*Approximately 90% of appendiceal carcinoids measure smaller than 1 cm and are not located in the appendiceal base, these tumors can be consistently cured by [[appendectomy]].
*[[Appendix|Appendiceal]] [[Carcinoid tumor|carcinoids]] smaller than 1 are cured by [[appendectomy]].<ref name="pmid20664473">{{cite journal |vauthors=Boudreaux JP, Klimstra DS, Hassan MM, Woltering EA, Jensen RT, Goldsmith SJ, Nutting C, Bushnell DL, Caplin ME, Yao JC |title=The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum |journal=Pancreas |volume=39 |issue=6 |pages=753–66 |date=August 2010 |pmid=20664473 |doi=10.1097/MPA.0b013e3181ebb2a5 |url=}}</ref>
*Appendiceal carcinoids larger than 2 cm require right-sided hemicolectomy and ileocecal lymphadenectomy because of the significant risk of metastasis.<ref name=surgery> Treatment Option Overview for gastrointestinal Carcinoid Tumors
*[[Appendix|Appendiceal]] [[Carcinoid tumor|carcinoids]] larger than 2 cm require right-sided [[hemicolectomy]] and [[ileocecal]] [[lymphadenectomy]] because of the significant risk of [[Metastasis|metastasis.]]<ref name="surgery">Treatment Option Overview for gastrointestinal Carcinoid Tumors
. NATIONAL CANCER INSTITUTE . http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_97_toc Accessed on September 22, 2015</ref>
. NATIONAL CANCER INSTITUTE . http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_97_toc Accessed on September 22, 2015</ref>
*For tumors measuring 1 to 2 cm, treatment is controversial, but hemicolectomy may be appropriate if there is invasion in the [[mesoappendix]], if there is residual tumor in the resection margins, or in the presence of [[lymph node]] metastases. For same-size lesions confined to the appendiceal wall, [[appendectomy]] alone may carry a low risk for metastases.
*For [[tumors]] between 1 to 2 cm, treatment is controversial, but [[hemicolectomy]] may be appropriate if there is [[invasion]] in the [[mesoappendix]], if there is residual [[tumor]] in the resection margins, or in the presence of [[lymph node]] [[metastases]].
*Indications for hemicolectomy may include operative specimens that show high proliferative activity (high Ki67 index), high mitotic index, or signs of angioinvasion, but evidence is limited and histologic parameters for risk evaluation in appendiceal carcinoids measuring 1 cm to 2 cm requires definition.


===Colonic Carcinoids===
===Colonic Carcinoids===
*Colonic carcinoid tumors are aggressive with a high proliferation rate, and they often present with more liver metastases than regional [[lymph node]] metastases.<ref name=surgery> Treatment Option Overview for gastrointestinal Carcinoid Tumors
*[[Colon|Colonic]] [[carcinoid tumors]] of the [[colon]] are treated similarly to [[adenocarcinoma]] of the [[colon]].
. NATIONAL CANCER INSTITUTE . http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_97_toc Accessed on September 22, 2015</ref>
*Radical resection by [[hemicolectomy]] or subtotal [[colectomy]] with [[lymphadenectomy]] should be done for [[Colon|colonic]] [[Carcinoid tumors|carcinoids tumors]].
*Colonic carcinoid tumors of the colon are treated similarly to adenocarcinoma of the colon.
*Attempts to achieve radical resection by [[hemicolectomy]] or subtotal colectomy with [[lymphadenectomy]] should be made, but frequently only debulking is possible.
*The overall 5-year survival rate is approximately 40% and is slightly worse than the survival rate for colon adenocarcinoma.


===Rectal Carcinoids===
===Rectal Carcinoids===
*Rectal carcinoids should be evaluated by [[endoscopic ultrasound]] (EUS) or rectal [[magnetic resonance imaging]] (MRI).<ref name=surgery> Treatment Option Overview for gastrointestinal Carcinoid Tumors
*[[Tumors]] smaller than 1 cm can be removed by [[endoscopic]] excision but excised specimens should be examined [[histologically]] to exclude [[Muscularis mucosa|muscularis]] [[invasion]].<ref name="pmid8044398">{{cite journal |vauthors=Mani S, Modlin IM, Ballantyne G, Ahlman H, West B |title=Carcinoids of the rectum |journal=J. Am. Coll. Surg. |volume=179 |issue=2 |pages=231–48 |date=August 1994 |pmid=8044398 |doi= |url=}}</ref>
. NATIONAL CANCER INSTITUTE . http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_97_toc Accessed on September 22, 2015</ref>  
*Patients with [[tumors]] that are greater than 2 cm or that have [[invasion]] of the [[muscularis]] as seen by [[endoscopic ultrasound]] or [[MRI]], surgical resection with [[abdominoperineal resection]] (APR) or low anterior resection (LAR) is recommended because of the high rate of [[Lymph nodes|nodal]] [[metastases]] and risk of distant [[metastatic]] [[disease]].
*Tumors smaller than 1 cm can be safely removed by endoscopic excision. Excised specimens should be examined histologically to exclude muscularis invasion.
*There is considerable debate about whether local excision or [[rectal]] resection (i.e., APR or LAR) is needed for [[tumors]] that are 1 cm to 2 cm.  
*Patients with tumors that are greater than 2 cm or that have invasion of the muscularis as seen by [[endoscopic ultrasound]] or MRI, surgical resection with abdominoperineal resection (APR) or low anterior resection (LAR) is recommended because of the high rate of nodal metastases and risk of distant metastatic disease.
*Although it may be possible to recognize [[tumors]] with particular atypia and high [[mitotic index]] before embarking on the more radical [[surgery]], the presence of [[muscularis]] [[invasion]] or regional [[metastases]] generally supports [[rectal]] resection.
*There is considerable debate about whether local excision or rectal resection (i.e., APR or LAR) is needed for tumors that are 1 cm to 2 cm.  
*Although it may be possible to recognize tumors with particular atypia and high mitotic index before embarking on the more radical surgery, the presence of muscularis invasion or regional metastases generally supports rectal resection.


===Metastatic Gastrointestinal Carcinoid Tumors===
===Metastatic Gastrointestinal Carcinoid Tumors===
Definitive role of surgery in metastatic disease has not been established, conservative resections of the [[intestine]], mesenteric tumors, and fibrotic areas may improve symptoms and quality of life substantially in patients with metastatic [[hepatic]], [[mesenteric]], and [[peritoneal]] carcinoids.<ref name=surgery> Treatment Option Overview for gastrointestinal Carcinoid Tumors
Definitive role of [[surgery]] in [[metastatic]] disease has not been established, conservative [[resections]] of the [[intestine]] [[mesenteric]] [[tumors]], and [[Fibrosis|fibrotic]] areas may improve [[symptoms]] and quality of life substantially in patients with [[metastatic]] [[hepatic]], [[mesenteric]], and [[peritoneal]] carcinoids.<ref name="surgery">Treatment Option Overview for gastrointestinal Carcinoid Tumors
. NATIONAL CANCER INSTITUTE . http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_97_toc Accessed on September 22, 2015</ref>
. NATIONAL CANCER INSTITUTE . http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_97_toc Accessed on September 22, 2015</ref><ref name="ModlinLye2003">{{cite journal|last1=Modlin|first1=Irvin M.|last2=Lye|first2=Kevin D.|last3=Kidd|first3=Mark|title=A 5-decade analysis of 13,715 carcinoid tumors|journal=Cancer|volume=97|issue=4|year=2003|pages=934–959|issn=0008-543X|doi=10.1002/cncr.11105}}</ref>


* If the condition of the patient is such that surgery is not a greater risk than the disease, the primary tumor should be resected to prevent an emergency presentation with [[obstruction]], [[perforation]], or [[bleeding]].
*The primary tumor should be resected to prevent an emergency presentation with [[obstruction]], [[perforation]], or [[bleeding]] if the condition of the patient is such that surgery is not a greater risk than the disease
*Management of hepatic metastases may include surgical resection; hepatic artery [[embolization]], [[cryoablation]] and [[radiofrequency ablation]], and orthotopic [[liver transplantation]].
*Management of [[hepatic]] [[metastases]] may include:
*In the case of liver metastases, localization and resection of the primary tumor may be considered, even among patients in whom the primary neoplasm is asymptomatic.
#[[Surgical]] resection
*Palliative [[radiation therapy]] has some efficacy for bone and brain metastases and in the management of [[spinal cord]] metastases.
#[[Hepatic artery]] [[embolization]]
#[[Cryoablation]]
#[[Radiofrequency ablation]]
#Orthotopic [[liver transplantation]].
*In the case of [[Liver (2)|liver]] [[metastases]], localization and resection of the [[primary tumor]] may be considered, even among patients in whom the [[Neoplasm|primary neoplasm]] is [[Asymptomatic condition|asymptomatic]].
*[[Palliative therapy|Palliative]] [[radiation therapy]] has some [[efficacy]] for [[bone]] and [[brain]] [[metastases]] and in the management of [[spinal cord]] [[Metastases|metastase]]<nowiki/>s.


===Recurrent gastrointestinal Carcinoid Tumors===
===Recurrent gastrointestinal Carcinoid Tumors===


Treatment of recurrent gastrointestinal carcinoid tumor depends on many factors:<ref name=surgery> Treatment Option Overview for gastrointestinal Carcinoid Tumors
Treatment of recurrent [[gastrointestinal]] [[carcinoid tumor]] depends on many factors:<ref name="surgery">Treatment Option Overview for gastrointestinal Carcinoid Tumors
. NATIONAL CANCER INSTITUTE . http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_97_toc Accessed on September 22, 2015</ref>
. NATIONAL CANCER INSTITUTE . http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_97_toc Accessed on September 22, 2015</ref>
*Previous treatment
*Previous treatment
*Site of recurrence  
*Site of recurrence  
*Individual patient considerations
*Individual [[patient]] considerations


==Carcinoid heart disease==
==Carcinoid heart disease==
*Valve replacement is the most effective treatment option for advanced carcinoid heart disease.{{cite web |url=https://doi.org/10.1007/s11936-013-0265-2 |title=Carcinoid Valve Disease &#124; SpringerLink |format= |work= |accessdate=}}<ref name="pmid26564596">{{cite journal |vauthors=Connolly HM, Schaff HV, Abel MD, Rubin J, Askew JW, Li Z, Inda JJ, Luis SA, Nishimura RA, Pellikka PA |title=Early and Late Outcomes of Surgical Treatment in Carcinoid Heart Disease |journal=J. Am. Coll. Cardiol. |volume=66 |issue=20 |pages=2189–2196 |date=November 2015 |pmid=26564596 |doi=10.1016/j.jacc.2015.09.014 |url=}}</ref>
*[[Valve replacement]] is the most effective treatment option for advanced [[Carcinoid disease|carcinoid heart disease]].{{cite web |url=https://doi.org/10.1007/s11936-013-0265-2 |title=Carcinoid Valve Disease &#124; SpringerLink |format= |work= |accessdate=}}<ref name="pmid26564596">{{cite journal |vauthors=Connolly HM, Schaff HV, Abel MD, Rubin J, Askew JW, Li Z, Inda JJ, Luis SA, Nishimura RA, Pellikka PA |title=Early and Late Outcomes of Surgical Treatment in Carcinoid Heart Disease |journal=J. Am. Coll. Cardiol. |volume=66 |issue=20 |pages=2189–2196 |date=November 2015 |pmid=26564596 |doi=10.1016/j.jacc.2015.09.014 |url=}}</ref>


==References==
==References==

Latest revision as of 23:03, 6 May 2019

Carcinoid syndrome Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Carcinoid Syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Staging

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Carcinoid syndrome surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Carcinoid syndrome surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Carcinoid syndrome surgery

CDC on Carcinoid syndrome surgery

Carcinoid syndrome surgery in the news

Blogs on Carcinoid syndrome surgery

Directions to Hospitals Treating Carcinoid syndrome

Risk calculators and risk factors for Carcinoid syndrome surgery

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

Overview

Surgery is the mainstay of treatment for carcinoid tumor. The feasibility of surgery depends on the stage of carcinoid tumor at diagnosis.

Surgery

Surgery, if feasible, is the only curative therapy. If the tumor has metastasized (most commonly, to the liver), the tumor may be ineligible for surgery (unresectable), though there are many promising treatment modalities, such as radiolabeled octreotide, that are very effective in arresting the growth of the tumors and prolonging survival in patients with liver metastases.

Gastric Carcinoids

Duodenal carcinoids

  • Duodenal carcinoids smaller than 2 cm may be excised locally. Tumors between 1 cm and 2 cm, complete resection is ensured by operative full-thickness excision. Follow-up endoscopy is indicated.

Jejunal and Ileal Carcinoids

Appendiceal Carcinoids

Colonic Carcinoids

Rectal Carcinoids

Metastatic Gastrointestinal Carcinoid Tumors

Definitive role of surgery in metastatic disease has not been established, conservative resections of the intestine mesenteric tumors, and fibrotic areas may improve symptoms and quality of life substantially in patients with metastatic hepatic, mesenteric, and peritoneal carcinoids.[1][8]

  • The primary tumor should be resected to prevent an emergency presentation with obstruction, perforation, or bleeding if the condition of the patient is such that surgery is not a greater risk than the disease
  • Management of hepatic metastases may include:
  1. Surgical resection
  2. Hepatic artery embolization
  3. Cryoablation
  4. Radiofrequency ablation
  5. Orthotopic liver transplantation.

Recurrent gastrointestinal Carcinoid Tumors

Treatment of recurrent gastrointestinal carcinoid tumor depends on many factors:[1]

  • Previous treatment
  • Site of recurrence
  • Individual patient considerations

Carcinoid heart disease

  • Valve replacement is the most effective treatment option for advanced carcinoid heart disease."Carcinoid Valve Disease | SpringerLink".[9]

References

  1. 1.0 1.1 1.2 1.3 1.4 Treatment Option Overview for gastrointestinal Carcinoid Tumors.<ref name="pmid12972355">Kulke MH (October 2003). "Neuroendocrine tumours: clinical presentation and management of localized disease". Cancer Treat. Rev. 29 (5): 363–70. PMID 12972355.
    • Type II carcinoids,the surgery is focused on removing the source of hypergastrinemia, typically by excision of duodenal gastrinomas via duodenotomy with resection of lymph node metastases.<ref name="pmid9298884">Bordi C, Falchetti A, Azzoni C, D'Adda T, Canavese G, Guariglia A, Santini D, Tomassetti P, Brandi ML (September 1997). "Aggressive forms of gastric neuroendocrine tumors in multiple endocrine neoplasia type I". Am. J. Surg. Pathol. 21 (9): 1075–82. PMID 9298884.
  2. Callahan AF, White M, Ituarte P, Gagandeep S, Woo Y, Fong Y, Melstrom L (September 2018). "Surgical Intervention in Gastric Carcinoid is Associated With Improved Survival in Local and Regional Disease". Am. J. Clin. Oncol. 41 (9): 882–887. doi:10.1097/COC.0000000000000392. PMID 28763328.
  3. Dias AR, Azevedo BC, Alban L, Yagi OK, Ramos M, Jacob CE, Barchi LC, Cecconello I, Ribeiro U, Zilberstein B (2017). "GASTRIC NEUROENDOCRINE TUMOR: REVIEW AND UPDATE". Arq Bras Cir Dig. 30 (2): 150–154. doi:10.1590/0102-6720201700020016. PMC 5543797. PMID 29257854. Vancouver style error: initials (help)
  4. Mullen JT, Wang H, Yao JC, Lee JH, Perrier ND, Pisters PW, Lee JE, Evans DB (December 2005). "Carcinoid tumors of the duodenum". Surgery. 138 (6): 971–7, discussion 977–8. doi:10.1016/j.surg.2005.09.016. PMID 16360380.
  5. 5.0 5.1 Zyromski NJ, Kendrick ML, Nagorney DM, Grant CS, Donohue JH, Farnell MB, Thompson GB, Farley DR, Sarr MG (2001). "Duodenal carcinoid tumors: how aggressive should we be?". J. Gastrointest. Surg. 5 (6): 588–93. PMID 12086896.
  6. 6.0 6.1 Boudreaux JP, Klimstra DS, Hassan MM, Woltering EA, Jensen RT, Goldsmith SJ, Nutting C, Bushnell DL, Caplin ME, Yao JC (August 2010). "The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum". Pancreas. 39 (6): 753–66. doi:10.1097/MPA.0b013e3181ebb2a5. PMID 20664473.
  7. Mani S, Modlin IM, Ballantyne G, Ahlman H, West B (August 1994). "Carcinoids of the rectum". J. Am. Coll. Surg. 179 (2): 231–48. PMID 8044398.
  8. Modlin, Irvin M.; Lye, Kevin D.; Kidd, Mark (2003). "A 5-decade analysis of 13,715 carcinoid tumors". Cancer. 97 (4): 934–959. doi:10.1002/cncr.11105. ISSN 0008-543X.
  9. Connolly HM, Schaff HV, Abel MD, Rubin J, Askew JW, Li Z, Inda JJ, Luis SA, Nishimura RA, Pellikka PA (November 2015). "Early and Late Outcomes of Surgical Treatment in Carcinoid Heart Disease". J. Am. Coll. Cardiol. 66 (20): 2189–2196. doi:10.1016/j.jacc.2015.09.014. PMID 26564596.

Template:WikiDoc Sources