Carcinoid Tumours

Question 1

What are carcinoid tumours

Answer 1

Enterochromaffin cell tumours, produce 5HT

Question 2

Carcinoid tumour sites

Answer 2

45% appendix, 30% ileum, 20% rectum

80% of >2cm tumours metastasize so always consider malignant

Question 3

Carcinoid tumour signs/symptoms

Answer 3

GI tumour signs, hepatic metastases cause RUQ pain

Hormonal imbalances as variety of hormones secreted e.g. glucagon, insulin, gastrin, ACTH, PTH

Question 4

Carcinoid syndrome definition

Answer 4

Occurs in 5% of carcinoid tumours and implies hepatic involvement

Question 5

Carcinoid syndrome signs/symptoms

Answer 5

Bronchoconstriction
Flushing in upper body
Diarrhoea
CCF

Question 6

Carcinoid tumour tests

Answer 6

24h urine 5HIAA (5HT metabolite) increased
CXR+chest/pelvis CT to find primary tumours
PET/octreoscan
Plasma chromogranin A is NET marker

Question 7

Carcinoid tumour treatment

Answer 7

Octreotide (or longer acting lanreotide), somatostatin analogue which blocks tumour mediator release in carcinoid syndrome
Resection of tumour at primary site

Question 8

Carcinoid crisis

Answer 8

Tumour outgrows vascular supply/handled too much in surgery, mediators flood out so vasodilation, hypotension, tachycardia, bronchoconstriction, hyperglycaemia
Treat with high dose octreotide and management of vitals