Small Bowel Carcinoid/Neuroendocrine Tumors Flashcards
What is carcinoid syndrome?
It develops when vasoactive substances produced by the tumor enter the systemic circulation without undergoing metabolic degradation by the liver
What causes the formation of dense fibrosis of carcinoid tumors?
Infiltrative growth and the local release of serotonin and other substances
What is carcinoid heart disease characterized by?
Fibrous plaques caused by circulating serotonin that preferentially involved the right side of the heart
What percentage of pts with carcinoid tumors are diagnosed at the time of surgery?
30-50%
What can cause a false-positive chromogranin A test?
Atrophic gastritis, renal impairment, inflammatory bowel disease or use of proton pump inhibitors
What are the specific issues in the preoperative assessment of pts with small bowel carcinoids?
1) determination of the extent of local and distant disease, 2) identification of synchronous carcinoid and noncarcinoid tumors, 3) fluid and electrolyte repletion, 4) pharmacologic treatment of carcinoid syndrome, and 5) detection of cardiac abnormalities
How is carcinoid crisis treated?
A bolus of IV octreotide (100 microgm), followed by octreotide infusion, antihistamines, hydrocortisone, and albuterol as needed
What is the treatment of duodenal carcinoid tumors?
Lesions 2cm and lesions with lymph node involvement should be treated with duodenal resection, most commonly pancreaticoduodenectomy
If a pt has carcinoid heart disease and metastases to the liver, which surgery goes first?
Heart surgery should be performed 3 months prior to liver surgery
Besides resection, what are the other management options for liver mets?
Ablation, embolization, transplantation, and molecular targeted radionuclide therapy, alone or in combination with medical treatment.
What is the most commonly used ablative technique?
Radiofrequency ablation (RFA) but other techniques include cryotherapy and laser-induced thermotherapy
When can RFA not be recommended?
In pts with tumors greater than 5cm or those near vital structures, large vessels, and central bile ducts
When is transarterial embolization contraindicated?
In pts with portal vein thrombosis and hepatic insufficiency
What are the side effects of somatostatin analogs?
Abdominal discomfort, flatulence, steatorrhea, malabsorption, and gallstone formation
How are carcinoid tumors grouped?
Localized (confined to the organ in which the tumor originated), Regional (involvement of surrounding structures including lymph nodes and contiguous), and Distant (spread beyond nearby structures to other organs)
