Carcinoid tumors (Gastrointestinal)

What is carcinoid tumors (gastrointestinal)?

Carcinoid tumours of the gastrointestinal (GI) tract are a type of cancer that develops in the lining of the GI tract. When cells proliferate out of control, cancer develops.

Carcinoid tumours are a slow-growing malignancy that can develop in a variety of locations throughout the body. Carcinoid tumours, a type of neuroendocrine tumour, usually start in the digestive tract (stomach, appendix, small intestine, colon, or rectum) or in the lungs.

Carcinoid tumours frequently do not manifest symptoms until late in the course of the disease. Carcinoid tumours can manufacture and release hormones that induce signs and symptoms like diarrhoea and skin flushing.

Surgery is commonly used to treat carcinoid tumours, but medicines may also be used.

Carcinoid tumours of the gastrointestinal tract are made up of a specific type of neuroendocrine cell (a type of cell that is like a nerve cell and a hormone-making cell). These cells can be found all throughout the chest and abdomen, but the majority are in the gastrointestinal tract. Hormones produced by neuroendocrine cells aid in the control of digestive fluids and the muscles that move food through the stomach and intestines. Hormones may be produced by a GI carcinoid tumour and released into the body.

Carcinoid tumours in the gastrointestinal tract are uncommon, and most grow slowly. The small intestine, rectum, and appendix are the most common sites. Multiple tumours can arise at the same time.

When the DNA of healthy cells is disrupted, the cells alter and expand out of control, resulting in the formation of a tumour. Tumors can be malignant or noncancerous. If a malignant tumour is not detected and treated early, it can grow and spread to other parts of the body. This is referred to as a malignant tumour. The term “benign tumour” refers to a tumour that can develop but not spread. A benign tumour can usually be removed without causing significant damage. NET tumours are all malignant tumours.

A neuroendocrine tumour (NET) begins in the body’s neuroendocrine system’s specialised cells. These cells have both hormone-producing endocrine and nerve cell characteristics. They are found in all of the body’s organs and assist in the regulation of many of the body’s activities. Hormones are chemical molecules that travel through the bloodstream and influence the activity of various organs and cells in the body. The majority of NETs take years to develop and grow. Some NETs, on the other hand, can expand quickly.

Symptoms of carcinoid tumors

• Abdominal pain
• Diarrhea
• Nausea, vomiting and inability to pass stool due to intestinal blockage (bowel obstruction)
• Rectal bleeding
• Rectal pain
• Redness or a feeling of warmth in your face and neck (skin flushing)

Diagnosis of carcinoid tumors

The following tests and procedures may be used:

Physical Examination: An examination of the body to check for general signs of health, as well as signs of disease, such as tumours or anything else that seems out of the ordinary. A medical history of the patient’s health habits, as well as previous diseases and treatments, will be obtained.

Blood chemistry: A blood sample is tested to determine the levels of specific compounds produced into the blood by organs and tissues in the body, such as hormones. An abnormal amount of a material (greater or lower than normal) might be a symptom of sickness. The blood sample is examined for the presence of a hormone produced by carcinoid tumours. This test is performed to determine whether or not you have carcinoid syndrome.

Tumor marker tests: A process in which a sample of blood, urine, or tissue is examined to determine the levels of particular chemicals produced by organs, tissues, or tumour cells in the body, such as chromogranin A. A tumour marker is chromogranin A. When discovered in high concentrations in the body, it has been related to neuroendocrine tumours. 

Urine test: A test in which urine is taken for 24 hours to determine the quantities of particular chemicals, such as 5-HIAA or serotonin (hormone). An abnormally high or low level of a chemical can indicate sickness in the organ or tissue that produces it. This test is performed to determine whether or not you have carcinoid syndrome.

MIBG scan: A technique for detecting neuroendocrine cancers like carcinoid tumours. MIBG (metaiodobenzylguanidine) is a radioactive substance that is injected into a vein and passes through the circulation. Carcinoid tumours absorb the radioactive material, which is detected by a radiation detector.

CT Scan: A CT scan (also known as a CAT scan) is a process that involves taking a sequence of detailed photographs of different parts of the body from various angles. A computer connected to an x-ray equipment creates the images. To make the organs or tissues show up more clearly, a dye may be injected into a vein or ingested. Computed tomography, computerised tomography, and computerised axial tomography are all terms used to describe this operation.

MRI (magnetic resonance imaging): MRI is a method that involves the use of a magnet, radio waves, and a computer to create a sequence of detailed images of inside organs. Nuclear magnetic resonance imaging is another name for this treatment.

PET scan (positron emission tomography scan): A process used to detect malignant tumour cells throughout the body. A vein is injected with a little amount of radioactive glucose (sugar). The PET scanner spins around the body, creating an image of where glucose is being used. Because malignant tumour cells are more active and take up more glucose than normal cells, they appear brighter in the image.

Endoscopic ultrasonography (EUS) is a process that involves inserting an endoscope into the body through the mouth or rectum. A narrow, tube-like equipment containing a light and a lens for viewing is known as an endoscope. High-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the stomach, small intestine, colon, or rectum, and echoes are produced by a probe at the end of the endoscope. The echoes combine to generate a sonogram, which is a depiction of the body’s tissues. Endosonography is another name for this surgery.

Upper endoscopy is a treatment that involves seeing into the body’s organs and tissues to look for abnormalities. An endoscope is introduced into the stomach through the mouth and passes into the oesophagus. The endoscope is occasionally passed from the stomach to the small intestine. A narrow, tube-like equipment containing a light and a lens for viewing is known as an endoscope. It may also include an instrument for removing tissue or lymph node samples, which are then examined under a microscope for illness signals.

Colonoscopy: An examination of the rectum and colon for polyps, abnormal regions, or cancer. A colonoscope is placed into the colon through the rectum. A colonoscope is a narrow, tube-like tool with a viewing light and lens. It may also include a tool for removing polyps or tissue samples, which are then examined under a microscope for cancer signals.

Capsule endoscopy is a method that allows you to see the whole small intestine. A capsule containing a microscopic camera is swallowed by the patient. The camera collects photos while the capsule passes through the gastrointestinal tract and sends them to a receiver on the exterior of the body.
Biopsy is the process of removing cells or tissues so that they can be examined under a microscope for signs of cancer. During endoscopy and colonoscopy, tissue samples may be collected.

Treatment of carcinoid tumors

Treatment for a carcinoid tumour is determined by the location of the tumour, whether cancer has spread to other parts of the body, the hormones secreted by the tumour, your overall health, and your personal preferences.

Treatment options for carcinoid tumours may include:

Surgery: A carcinoid tumour can be surgically removed completely if caught early. When carcinoid tumours are identified in an advanced stage, total removal may be impossible. To assist manage indications and symptoms, surgeons may aim to remove as much of the tumour as feasible in some cases.
Excess hormones can be controlled with medications. Blocking hormones released by the tumour with drugs may lessen the signs and symptoms of carcinoid syndrome while also slowing tumour growth.

Under the skin, octreotide (Sandostatin, Bynfezia Pen) and lanreotide (Somatuline Depot) are injected. Abdominal pain, bloating, and diarrhoea are all possible side effects of both medications. Telotristat (Xermelo) is a tablet that is occasionally taken in conjunction with octreotide or lanreotide to help with carcinoid syndrome symptoms.

Chemotherapy: Chemotherapy is a treatment that uses powerful medications to eliminate tumour cells. It’s either injected into a vein in your arm or swallowed as a pill. Chemotherapy is sometimes used to treat advanced carcinoid tumours that aren’t surgically removed.
Targeted drug therapy: Drug therapy with a specific goal in mind. Targeted medication treatments are designed to target specific abnormalities found in tumour cells. Targeted medication treatments can kill tumour cells by inhibiting these anomalies. For advanced carcinoid tumours, targeted medication therapy is frequently paired with chemotherapy.

Radiation treatment: Drugs that give radiation to cancer cells directly. PRRT (peptide receptor radionuclide therapy) is a treatment that combines a medicine that targets cancer cells with a radioactive material that destroys them. The medicine is injected into your body, where it travels to the cancer cells, attaches to them, and delivers radiation directly to them in PRRT for carcinoid tumours. People with advanced carcinoid tumours may be able to benefit from this treatment.

Cancer that has spread to the liver is treated. Carcinoid tumours frequently metastasize to the liver. Surgery to remove a portion of the liver, limiting blood flow to the liver (hepatic artery embolization), and utilising heat and cold to destroy cancer cells are all possible treatments.

Radiofrequency ablation uses high-intensity heat to kill carcinoid tumour cells in the liver.

Cryoablation kills cancer cells by freezing and thawing them repeatedly.