Carcinoid Carcinoid TumoursTumours

Dr. Ahmed AlmumtinDr. Ahmed Almumtin

IntroductionIntroduction

The term The term ““carcinoidcarcinoid””

““Carcinoid syndromeCarcinoid syndrome”” vs vs ““carcinoid tumourcarcinoid tumour””

EpidemiologyEpidemiology

Carcinoids are relatively rare tumors.Carcinoids are relatively rare tumors.

incidence 4.7:100,000incidence 4.7:100,000

median age 63median age 63

male : femalemale : female

is it really increasing?is it really increasing?

DistributionDistribution

Pathology and gradingPathology and grading

Origin.Origin.

Different behaviour.Different behaviour.

Grading vs differentiation.Grading vs differentiation.

Two sub-Groups:Two sub-Groups:

Well differentiatedWell differentiated

Poorly differentiated Poorly differentiated

Embryonic classificationEmbryonic classification

Based on Embryonic originBased on Embryonic origin

Foregut - stomachForegut - stomach

Midgut - Small intestine, AppendixMidgut - Small intestine, Appendix

Hindgut - Colon, Rectum, Genitourinary, Hindgut - Colon, Rectum, Genitourinary, Ovarian ..Ovarian ..

MetastaticMetastatic

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- Well differentiated:- Well differentiated:• Low gradeLow grade• Intermediate GradeIntermediate Grade

- Poorly differentiated- Poorly differentiated• High gradeHigh grade

WHO ClassificationWHO Classification

Continue classificationContinue classification

European Neuroendocrine Tumour Society European Neuroendocrine Tumour Society (ENTS) vs American Joint Committee on Cancer (ENTS) vs American Joint Committee on Cancer (AJNCC) vs WHO.(AJNCC) vs WHO.

Carcinoid syndromeCarcinoid syndrome

Carcinoid SyndromeCarcinoid Syndrome

DefinitionDefinition

Pathophysiology - mediatorsPathophysiology - mediators

Tryptophan MetabolismTryptophan Metabolism

HistamineHistamine

KillekrienKillekrien

ProstaglandinsProstaglandins

TachykininsTachykinins

Clinical featuresClinical features

Clinical Features of Clinical Features of carcinoid syndromecarcinoid syndrome

Cutaneous flushingCutaneous flushing

Venous Venous telangiectasiatelangiectasia

diarrhoeadiarrhoea

bronchospasmbronchospasm

cardiac valvular cardiac valvular lesionslesions

So, patient presentsSo, patient presents

as a result of the carcinoid as a result of the carcinoid syndromesyndrome

or as a result of tumour growthor as a result of tumour growth

or as incidental findingor as incidental finding

DiagnosisDiagnosisBiochemical testing:Biochemical testing:

Urinary 5-HIAAUrinary 5-HIAA

Urinary SerotoninUrinary Serotonin

serum chromograninserum chromogranin

Serum serotonin Serum serotonin

Tumour localisationTumour localisation

CTCT

MRIMRI

Scintigraphy OctreoScanScintigraphy OctreoScan

PET scanPET scan

EndoscopyEndoscopy

Basic principles of evaluation and Basic principles of evaluation and management of patients with management of patients with carcinoid tumourscarcinoid tumours

Radiographic Staging and LocalisationRadiographic Staging and Localisation

Pathologic assessment of tumour Pathologic assessment of tumour differentiation and/or gradedifferentiation and/or grade

Removal of TumourRemoval of Tumour

Control of carcinoid symptomsControl of carcinoid symptoms

Treatment of Localised Treatment of Localised CarcinoidsCarcinoids

- Appendix- Appendix- Small intestine- Small intestine- Rectum- Rectum- Colon- Colon- Stomach- Stomach

AppendixAppendix

SizeSize

>2 cm>2 cm

< 2cm< 2cm

Appendectomy vs Rt Appendectomy vs Rt hemicolectomyhemicolectomy

Small intestineSmall intestine

Usual location.Usual location.

MatastasisMatastasis

prognosisprognosis

RectumRectum

TreatmentTreatment

< 1 cm mucosa or < 1 cm mucosa or submucosasubmucosa

> 2 cm or beyond > 2 cm or beyond muscolaris propriamuscolaris propria

PrognosisPrognosis

ColonColon

AggressiveAggressive

5 years survival5 years survival

prognosisprognosis

StomachStomach

TypesTypes

optionsoptions

Medical therapy?Medical therapy?

PrognosisPrognosis

Stage and Site of originStage and Site of origin

Tumour differentiationTumour differentiation

Post-treatment F/UPost-treatment F/U

Gastric, Small intestine, Colonic, appendiceal Gastric, Small intestine, Colonic, appendiceal and Rectaland Rectal

3 to 12 months..3 to 12 months..

more than one yearmore than one year

Gastric <= 2 cmGastric <= 2 cm

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Thank youThank you