From: ' To: "jeevacation®gmail.com" <jeevacation®gmail.com> Subject: carcinoid FYI from medical text Date: Tue, 13 Jul 2010 17:29:13 +0000 Treatment of carcinoid tumors and the carcinoid syndrome Authors Shanthi V Sitaraman MD PhD. FRCP Stephen E Goldfinger MD Section Editors Kenneth K Tanabe MD David C Whitcomb MD PhD Deputy Editor Carla H Ginsburg MD MPH AGAF Last literature review version 18.1: January 2010 I This topic last updated: December 21, 2009 (More) INTRODUCTION — Carcinoid syndrome is the term applied to a constellation of symptoms mediated by various humoral factors elaborated by some carcinoid tumors (table 1) [1]. Two of the most common manifestations are flushing and diarrhea (table 2). (See "Clinical features of the carcinoid syndrome".) Management of patients with these tumors should include: • Localization of the tumor and possible metastases by CT scan and somatostatin receptor scintigraphy Rat (See "Diagnosis of the carcinoid syndrome and tumor localization".) • Removal of the tumor if metastases have not occurred. • Control of carcinoid symptoms if present. More than 90 percent of patients with the carcinoid syndrome have metastatic disease, typically to the liver. Exceptions are bronchial and ovarian tumors that can produce symptoms without metastasis (table 3). (See "Bronchial carcinoid tumors".) LOCALIZED CARCINOID TUMORS — The treatment of choice for a patient who has a localized carcinoid tumor is surgery. The extent of the surgical resection depends on the site of origin and size of the primary tumor. (See 'Clinical characteristics of primary carcinoid tumors" for a detailed discussion on carcinoid tumors arising in specific organs). Appendix — The prognosis of appendiceal carcinoids is best predicted by the size of the tumor. Tumors less than 2 cm in size (found in approximately 95 percent of patients) are unlikely to have metastasized when diagnosed (table 4). In contrast, up to 30 percent of larger tumors ha