World Library  
Flag as Inappropriate
Email this Article
 

Carcinoid

Carcinoid
Picture of a carcinoid tumor (center of image) that encroaches into the lumen of the small bowel (pathology specimen). The prominent folds are plicae circulares, a characteristic of the small bowel.
Classification and external resources
Specialty Oncology
ICD-10 C75, E34.0
ICD-9-CM 209.60
ICD-O M8240/3
OMIM 114900
DiseasesDB 2040
MedlinePlus 000347
eMedicine med/271
MeSH D002276
Primary site of a carcinoid cancer of gut

Carcinoid (also carcinoid tumor) is a slow-growing[1] type of neuroendocrine tumor originating in the cells of the neuroendocrine system. In some cases, metastasis may occur. Carcinoid tumors of the midgut (jejunum, ileum, appendix, and cecum) are associated with carcinoid syndrome.

Contents

  • Signs and symptoms 1
    • Gastrointestinal 1.1
    • Lung 1.2
    • Other sites / metastases 1.3
  • Treatment 2
  • Goblet cell carcinoid 3
  • History 4
  • See also 5
  • References 6
  • External links 7

Signs and symptoms

While most carcinoids are asymptomatic through the natural lifetime and are discovered only upon surgery for unrelated reasons (so-called coincidental carcinoids), all carcinoids are considered to have malignant potential.

About 10% of carcinoids secrete excessive levels of a range of hormones, most notably serotonin (5-HT), causing:

The outflow of serotonin can cause a depletion of tryptophan leading to niacin deficiency. Niacin deficiency, aka pellagra, is associated with dermatitis, dementia, and diarrhea.

This constellation of symptoms is called carcinoid syndrome or (if acute) carcinoid crisis. Occasionally, haemorrhage or the effects of tumor bulk are the presenting symptoms. The most common originating sites of carcinoid is the small bowel, particularly the ileum; carcinoid tumors are the most common malignancy of the appendix. Carcinoid tumors may rarely arise from the ovary or thymus.[2]

They are most commonly found in the midgut at the level of the ileum or in the appendix. The next most common affected area is the respiratory tract, with 28% of all cases — per PAN-SEER data (1973 – 1999). The rectum is also a common site.

Gastrointestinal

Carcinoid tumors are apudomas that arise from the enterochromaffin cells throughout the gut. Over two-thirds of carcinoid tumors are found in the gastrointestinal tract.[3]

Lung

Carcinoid tumors are also found in the lungs.

Other sites / metastases

Carcinoid metastasis can lead to carcinoid syndrome. This is due to the over-production of many substances, including serotonin, which is released into the systemic circulation, and which can lead to symptoms of cutaneous flushing, diarrhea, bronchoconstriction, and right-sided cardiac valve disease. It is estimated that less than 6% of carcinoid patients will develop carcinoid syndrome, and of these 50% have cardiac involvement.[4]

Treatment

[5] for arresting the growth of the tumors and prolonging survival in patients with liver metastases, though these are currently experimental.

Chemotherapy is of little benefit and is generally not indicated. Octreotide or Lanreotide (somatostatin analogues) may decrease the secretory activity of the carcinoid, and may also have an anti-proliferative effect. Interferon treatment is also effective, and usually combined with somatostatin analogues.

While the metastatic potential of a coincidental carcinoid is probably low, the current recommendation is for follow up in 3 months with CT or MRI, labs for tumor markers, like serotonin, and a history and physical, annual physicals thereafter.

Carcinoid tumors are the most common malignant tumor of the appendix, but they are most commonly associated with the small intestine, and they can also be found in the rectum and stomach. They are known to grow in the liver, but this finding is usually a manifestation of metastatic disease from a primary carcinoid occurring elsewhere in the body. They have a very slow growth rate compared to most malignant tumors.

Goblet cell carcinoid

This is considered to be a hybrid between an exocrine and endocrine tumor derived from crypt cells of the appendix. Histologically, it forms clusters of goblet cells containing mucin with a minor admixture of Paneth cells and endocrine cells. The growth pattern is distinctive: typically producing a concentric band of tumor nests interspersed among the muscle and stroma of the appendiceal wall extending up the shaft of the appendix. This makes the lesion difficult to suspect grossly and difficult to measure. Small tumor nests may be camouflaged amongst the muscle or in periappendiceal fat; cytokeratin preparations best demonstrate the tumor cells; mucin stains are also helpful in identifying them. They behave in a more aggressive manner than do classical appendiceal carcinoids. Spread is usually to regional lymph nodes, peritoneum, and particularly the ovary. They do not produce sufficient hormonal substances to cause the carcinoid or other endocrine syndromes. In fact, they more closely resemble exocrine than endocrine tumors. The term 'crypt cell carcinoma' has been used for them, and though perhaps more accurate than considering them carcinoids, has not been a successful competitor.

History

They were first characterized in 1907 by Siegfried Oberndorfer, a German pathologist at the University of Munich, who coined the term karzinoide, or "carcinoma-like", to describe the unique feature of behaving like a benign tumor despite having a malignant appearance microscopically. The recognition of their endocrine-related properties were later described by Gosset and Masson in 1914, and these tumors are now known to arise from the enterochromaffin (EC) and enterochromaffin-like (ECL) cells of the gut. Some sources credit Otto Lubarsch with the discovery.[6]

In 2000, the [7]

The WHO now divides these growths into neuroendocrine tumors and neuroendocrine cancers. Neuroendocrine tumors are growths that look benign but that might possibly be able to spread to other parts of the body. Neuroendocrine cancers are abnormal growths of neuroendocrine cells which can spread to other parts of the body.

See also

  • Don Meyer, head coach emeritus of the Northern State University men's basketball team. Professor Meyer was found to have carcinoid cancer following an automobile accident in September 2009.
  • Derrick Bell, Professor and Legal Scholar, died of carcinoid cancer October 5, 2011.

References

  1. ^ Maroun J, Kocha W, Kvols L; et al. (April 2006). "Guidelines for the diagnosis and management of carcinoid tumors. Part 1: The gastrointestinal tract. A statement from a Canadian National Carcinoid Expert Group". Curr Oncol 13 (2): 67–76.  
  2. ^ Daffner KR, Sherman JC, Gilberto Gonzalez R, Hasserjian RP (2008). "Case 35-2008 — A 65-Year-Old Man with Confusion and Memory Loss". N Engl J Med 359 (20): 2155–2164.  
  3. ^ Modlin IM, Lye KD, Kidd M (February 2003). "A 5-decade analysis of 13,715 carcinoid tumors". Cancer 97 (4): 934–59.  
  4. ^ ncbi.nlm.nih.gov
  5. ^ a b http://www.carcinoid.org/content/medical-reviews
  6. ^ Kulke MH, Mayer RJ (March 1999). "Carcinoid tumors".  
  7. ^ a b "ACS :: What Is a Gastrointestinal Carcinoid Tumor?". 

Cunningham JL, Janson ET (2011). "The Hallmarks of Ileal Carcinoids". Eur J Clin Invest 41 (12): 1353–60.  

External links

  • Caring for Carcinoid Foundation
  • Carcinoid Cancer Foundation
  • European Neuroendocrine Tumor Society
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and USA.gov, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for USA.gov and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
 
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
 
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.
 



Copyright © World Library Foundation. All rights reserved. eBooks from World eBook Library are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.