[34] Carcinoid Tumours Flashcards
What are carcinoid tumours?
A diverse group of neuroendocrine tumours of enterochromaffin cell origin
What are carcinoid tumours capable of producing?
5HT
Where can carcinoid tumours be derived from?
Respiratory tract Stomach Ileum Appendix Colorectum
What might carcinoid tumours secrete?
5-HT VIP Gastrin Glucagon Insulin ACTH
What kind of carcinoid tumours rarely secrete 5-HT?
Hindgut tumours
What does carcinoid syndrome suggest?
The bypass of first-pass metabolism
What is carcinoid syndrome strongly associated with?
Metastatic disease
What % of carcinoid tumours are associated with MEN?
10%
What % of carcinoid tumours occur in the appendix?
45%
What % of carcinoid tumours occur in the ileum?
30%
What % of carcinoid tumours occur in the colorectum?
20%q
What % of carcinoid tumours are in the stomach?
10%
What % of carcinoid tumours are in the bronchus?
10%
What presentations might carcinoid tumours cause locally?
Appendicitis
Intussusception or obstruction
Abdominal pain
What are the symptoms of carcinoid syndrome?
Flushing Diarrhoea Valve fibrosis Wheeze Hepatic involvement Tryptophan deficiency
Describe the flushing in carcinoid syndrome
Paroxysmal
Occurs in upper body
May be wheals
What does valve fibrosis cause in carcinoid syndrome?
Tricuspid regurgitation
Pulmonary stenosis
What produces the wheeze in carcinoid syndrome?
Bronchoconstriction
What does tryptophan deficiency lead to in carcinoid syndrome?
Pellagra
What may be found on examination in carcinoid syndrome?
Increased urine 5-hydroxyindoleacetic acid
Increased plasma chromogranin A
What is the purpose of CT/MRI in carcinoid syndrome?
Find primary
What can be used to manage the symptoms in carcinoid syndrome?
Octreotide or loperamide
What is the curative treatment for carcinoid syndrome?
Resection
What is given post-carcinoid tumour resection?
Octreotide
Why is octreotide given post-carcinoid tumour resection?
To avoid carcinoid crisis
When does a carcinoid crisis occur?
If the tumour outgrows its blood supply, or is handled too much
What happens in carcinoid crisis?
There is massive mediator release, leading to vasodilation, hypotension, bronchoconstriction, and hyperglycaemia
How is carcinoid crisis managed?
High-dose octreotide
What is the median survival of carcinoid tumours?
5-8 years
