Test #2 Carcinoid tumors PPt-Josh Flashcards
What is a rare, slow-growing cancer.
Carcinoid tumor
Carcinoid tumors are a type of neuroendocrine tumor oringinating in the cells of the ______ system
Neuroendocrine system
Carcinoid tumors usually start in what 2 places
Digestive tract
or
Lungs
with Carcinoid tumors the EARLY STAGES don’t produce symptoms, therefore the average age of diagnosis is what?
60 years old
in the LATER STAGES the Carcinoid tumors sometimes produce hormones that can cause what?
Carcinoid syndrome
Carcinoid syndrome is usually produced by a 1 cm tumors in the _____ and _____
ileum
Jejunum
What are the most common NEUROENDOCRINE tumor? with an est 1.5 clinical cases per 100,000 popultions?
Carcinoid tumors ( no shit right this is what the fucking topic is)
Most Carcinoid tumors are _____ growing without symptoms, however aggressive and metastatic disease does occur!
slow
Carcinoid tumors specifically in the _________ can also metasasize! (hint part of the GI tract)
appendix
Carcinoid tumors most common in what race
African americans (another good reason to be white)
Carcinoid tumors arise from what cells? and where are those cells located?
enterochromaffin cells (ECL) located in the digestive tract (thus the reason it is usually located in the intestines)
Carcinoid tumors are found in what intestinal Glands.
crypts of lieberkuhn
Carcinoid tumors are usually found in the intestinal glands crypts of lieberkuhn, but can also be found where else
lungs mediastinum thymus liver pancreas bronchus ovaries prostate kidneys
In children Carcinoid tumors mostly occur in the ______and are benig and asymptomatic
Appendix
Carcinoid tumors mainly secrete what?
Serotonin
Carcinoid tumors mainly secrete serotonin, but what other 4 peptides are also secreted
chromograins
pancreatic polypeptide
5-hydroxytrptophan (5-htp)
histamine
Carcinoid tumors can metastasize to bone and be associated with what disorders
atypical carcinoid syndrome
acromegaly
cushing’s disease
other endocrine diseases
what are the 7 main things Carcinoid tumors secret
Serotonin Histamine Dopamine Substance P Corticotrophin Prostaglandins kallikrein
how are Carcinoid tumors classified?
based on location in the primitive gut (foregut, midgut, hindgut) that gives rise to the tumor!!!
AKA “the site of origin”
Foregut tumors are divided into what 2 types
Sporadic primary tumors
tumors secondary to achlorhydria
Foregut Tumors:
what are examples of Sporadic primary tumors
Carcinoids of the lung bronchus stomach proximal duodenum pancreas
what Class of tumor are derived from the 2nd portion of the duodenum, the jejunum, the ilium, and the right colon (ascending)
Midgut
The midgut tumors produced high or low levels of peptides
high
what Carcinoid tumors classification arise from the transverse, descending colon, and rectum?
Hindgut
what class of Carcinoid tumors rarely cause carcinoid syndrome, are asymptomatic even when metastatic
Hindgut
With hindgut metastasis to where is common
bone
do hindgut tumors rarely or commonly secrete peptides
rarely
what is the most common location of a Carcinoid tumors
Appendix
Pulmonary Carcinoid tumors TYPICAL:
they typically cause high levels of ______ and _____ in the blood?
serotonin
CgA
Pulmonary Carcinoid tumors TYPICAL:
cause HIGH levels of ______ in the urine?
5-HIAA
Pulmonary Carcinoid tumors TYPICAL:
are malignant lung masses in central airways common or uncommon?
Uncommon (only 2%)
Pulmonary Carcinoid tumors TYPICAL:
what are s/s
cough
hemoptysis
recurrent pneumonia
occasional chest pain
Pulmonary Carcinoid tumors TYPICAL:
are diagnoses how?
microscopic exam post removal!
AKA biopsy
Pulmonary Carcinoid tumors TYPICAL:
what is treatment?
surgical removal
lobectomy
laser/argon plasma coagulation
on so that was TYPICAL now we are goig to ATYPICAL
just want to ensure no confusion
Pulmonary Carcinoid tumors ATYPICAL:
these are tumors whith what levels if serotonin and CgA in blood
normal
Pulmonary Carcinoid tumors ATYPICAL:
these have ________ levels of 5-HIAA in urine and _____levels of serotonin and 5-HTP in urine
normal
high
Carcinoid Syndrome:
These are an array of symptoms that occur ______ to a carcinoid tumor
secondary
Carcinoid Syndrome:
are they common? or uncommon?
uncommon (10%) of pts
Carcinoid Syndrome:
what are S/S?
Flushing (head and upper thorax) Diarrhea (abd cramps d/t serotonin) left heart failure bronchoconstriction Right heart failure (more common than left)
Carcinoid Syndrome:
most of the symptoms are causes by what 2 hormons/peptides?
serotonin & kallihrein
Carcinoid Syndrome additional S/S:
what happens to Pulmonic and tricuspid valves?
thickening and stenosis
Carcinoid Syndrome additional S/S:
what can happen to the endocardial tissue?
endocardial fibrosis
Carcinoid Syndrome additional S/S:
what can occur to the liver?
hepatomegaly
Carcinoid Syndrome additional S/S:
Gi symptoms
diarrhea
Cramps
nausea
Vomiting
Carcinoid Syndrome additional S/S:
what can occur with the skin
Flushing
Apparent cyanosis
Carcinoid Syndrome additional S/S:
what can occur with the respiratory system
Cough
wheezing
Dyspnea
Carcinoid Syndrome additional S/S:
what can occur with the pelvis
retroperitoneal and pelvis fibrosis
Carcinoid Syndrome:
occurs in 10% of pts, with tumors, and becomes apparent when _________ substances from the tumor enter systemic circulation escaping hepatic degradation
vasoactive
Carcinoid Syndrome:
Fact #1- if primary tumor is from the GI tract (serotonin released into the hepatic portal circulation), carcinoid syndrome generally doesn’t occur until the tumor has metastasized to the ______
Liver
Carcinoid Syndrome:
Fact #2- if the primary tumor is in the _______, no mets is needed for a carcinoid syndrome to occur
Lungs
what is a term used to describe when all carcinoid syndrome symptoms occur at teh same time?
carcinoid crisis
S/S of Carcinoid CRISIS
flushing
tachycardia
bronchospasm
widely fluctuating BP
Is carcinoid crisis potentially fatal
you bet your ass
what are the most common causes of Carcinoid crisis?
Anesthetic intervention
Radiological and surgical intervention
what does CgA stand for?
Chromagranin A
pts with Carcinoid Syndrome secrete more than ____mg of 5-HIAA per/day
25mg
Carcinoid Syndrome:
ways to diagnosis
24 hr urine CgA labs Imaging (octreoscan) CT/MRI/PET Barrium swallow Laparotomy
Anesthesia Implications: Preop
minimize tumor activity before the day of sx with what drug?
Octreotide
Anesthesia Implications: Preop
what is the octreotide infusion rate? and for how long preop
50-100mcg/hr
12 hrs
Anesthesia Implications: Preop
the uncontrolled hormone release precipitated by the surgical stimulus can cause what?
HTN crisis and Hemodynamic collapse
Anesthesia Implications: Techniques Regional
when should you insert it
prior to GA
Anesthesia Implications: Techniques Regional
why is it benificial
reduction in carcinoid crisis
Anesthesia Implications: Techniques Regional
what is a draw back of Epidurals
hypotension -> tx with vasoconstrictors
lead to exaggerated response
Anesthesia Implications: Techniques GETA
Avoid what drugs
Morphine Atricurium Keatamine EPI Norepi isopuretol
Anesthesia Implications: Techniques GETA
drugs good to use
propofol remifentanil vec roc etomidate fentanyl
Anesthesia Implications: Techniques GETA
what is the best VAA to use b/c it has the lowest metabolic rate
Isoflurane
Anesthesia Implications: Intraop
what are some monitors you may want?
a-linw
PA cath
CVP
ABGS
Anesthesia Implications: Intraop
what is the best drug for HTN treatment?
Octreoide 20-25mcg boluses
Octreotide:
what is it
an analogue of somatastatin-blunts vasoactive and bronchoconstriction effects of carcinoid tumor secretion.
Octreotide:
MOA
mimics inhibitory effects of somatostatin, inhibits release of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide
Octreotide:
SE
N/v bradycardia Conduction defects QT prolongation Abd cramps
Thats it!!!
A special thanks goes out to david Holt for his exhilarating presentation
