Carcinoid Tumour



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Carcinoid tumour is a tumour arising from neuro-endocrine cells. These (neuro-endocrine cells) are cells originally derived from the same group of cells from which the brain and spinal cord developed.

During development in early life, these cells became scattered in multiple locations all over the body, and are found in places like the appendix, bronchus or wind pipe, colon, liver, lungs, ovaries, testis, thymus and thyroid.

They normally produce various kinds of chemicals called hormones into the blood stream that help in normal body functions including sending signals between cells. When any of these groups of cells grow out of normal control, a carcinoid tumour results.

Carcinoids are very rare, though they remain the most common tumour of neuroendocrine origin. Annually, about 1000 – 1200 cases of carcinoid tumour is diagnosed in the UK and 5000 in the US.

Men and women are equally affected, though with a slight increase in prevalence amounts women. Blacks are also more affected than whites. This tumour in even rarer in children, seen usually after the age of 30.

Over 70% of carcinoid tumours occur in appendix or small bowel, with 28 % of the reminder involving the lungs, trachea or bronchus.

Ordinary, these tumours could occur and go unnoticed. They only come to the fore if they cause bowel obstruction or produce excessive amounts of chemical substances as in carcinoid syndrome.

There could be a cause of nagging right upper abdominal pain, if the liver is involved. Carcinoids sometimes metastasize, and they could spread to the brain.


Causes of Carcinoid Tumour
The exact cause of carcinoid tumour is unknown. What is known is that genetic factors play a very important role. Contrary to popular believe, increased incidence of carcinoid tumour have been reported (Lung cancer: Principle and Practice – see below under reference) amongst cigarette smokers. So yes; smoking could increase the chances of developing carcinoid syndrome.


Sites of Carcinoid Tumour

As mentioned earlier, carcinoids could be found anywhere ranging from the appendix to the lungs, testis, ovaries or thyroid. It also affects the heart. Atypical carcinoid of the lungs is also a known entity. We shall now touch on this kind of tumour in some of these sites :

Tumour of the Appendix and Gut

Tumour of the Liver

Carcinoid Tumour of the Lungs



Symptoms and Signs of Carcinoid Tumour

Carcinoids are often very small and slow growing tumours. Even though they are sometimes been referred to as carcinoid cancer, they are not always cancerous.

Signs and symptoms of carcinoid tumours are therefore rare, and are often not suspected except where they cause the release of chemical substances, leading to carcinoid syndrome.

The symptoms of carcinoid cancer or tumour would also depend on the site.

For lung carcinoids, wheezing, cough, weight loss and features of heart disease would be expected. Liver carcinoids can cause chronic upper right abdominal pain. We shall discuss abdominal pain in carcinoids in more details here.

Abdominal pain in carcinoids is caused by at least three mechanisms.

A. Even though carcinoid tumours are usually very small discrete tumours, they sometimes cause obstruction of the lumen of the gut, if they get to reasonable size or by causing the bowel to twist. This is common in the appendix, where carcinoid tumour occur the most. If this happens, they in-evitable lead to abdominal pain. Where the appendix in involved, it could lead to features of acute appendicitis.

B. When the original (primary) tumour metastasize to the liver, tumour cells lying under the liver capsule could cause stretch of the capsule causing continuous abdominal pain

C. Chemicals continuously released in carcinoid syndrome causes fibrosis and adhesions (spider-web-like materials that cause the bowel to clump together), leading to continuous abdominal pain and potentially, intestinal obstruction.



Diagnosis, Treatment and Prognosis of Carcinoid Tumour

The diagnosis, treatment and prognosis of carcinoid is discussed below, and are about the same for carcinoid tumour in most parts of the body. Where difference exists, it shall be mentioned at the appropriate section. See the links below for further discussion of these.


Diagnosis


Treament


Prognosis




References:

Bailey & Love’s Short Practice of Surgery. 23 rd Edition.

C. D. Knox, C. D. Anderson, L. W. Lamps, R. B. Adkins, and C. W. PinsonLong-Term Survival after Resection for Primary Hepatic Carcinoid TumorAnn. Surg. Oncol., December 1, 2003; 10(10): 1171 - 1175.

Lung Cancer: Principles and Practiceedited by Harvey I Pass, David P Carbone, John D Minna, Andrew T Turrisi, David H Johnson

General Thoracic Surgery By Thomas W Shields, Joseph Locicero, Ronald B Ponn, Valerie W Rusch










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