Carcinoid: Symptoms, Causes, Treatment, Cost, Diet and Side Effects

Carcinoid tumours are neuroendocrine tumours that have very slow growth rate and originate from the neuroendocrine system. The tumour usually begins from the cells of the digestive tract which is composed of stomach, small intestine, appendix, colon and rectum. It can start in the lungs too. Carcinoid tumour is the most malignant tumour affecting the appendix. It can also metastasise from any part of the body to the liver affecting its functions.

Carcinoids are mostly asymptomatic until they reach the last stages or may be discovered during some other surgery. Symptoms of carcinoid tumours in lungs may include wheezing, chest pain and diarrhoea, shortness of breath, pinkish purple thing and long marks on the skin, unexplainable weight gain on the upper back and midsection of the body and flushing of facial and neck skin.

Symptoms of carcinoid tumours in the digestive tract are characterised by nausea and vomiting, diarrhoea, abdominal pain, rectal pain and bleeding and skin flushing especially of the neck and face. If the tumour is small treatment may not be required because carcinoids are generally slow growing. Treatment options for carcinoid include radiation, drugs and surgery. Medication is used to alleviate the symptoms of carcinoid. But before that surgery is usually preferred so that most of the tumour cells are removed from the body.

Carcinoid is a type of cancer that progresses at a slower rate and can occur in different parts of the body. It is asymptomatic in the initial stages but later on shows symptoms depending upon the location of the tumor. Important carcinoid symptoms may include:

• Abdominal pain or cramps.
• Diarrhea with rectal bleeding.
• Difficulty in breathing.
• Flushing of skin.
• Abnormal weight gain.
• The appearance of marks on the skin which may be pink or purple colored.
• Nausea and vomiting.
• Obstruction in the bowel movement.

Summary: Carcinoid is a progressive and slow-growing type of cancer that is often asymptomatic initially. It shows symptoms in later stages depending upon the location of the tumor.

Carcinoid is caused due to mutations in the DNA of cells. This leads to an abnormal cell division. These cells are cancerous in nature and start invading surrounding tissues and organs. Thus, the healthy cells get destroyed and cancer cells continue to spread in different body parts.

The formation of carcinoid tumors usually takes place in the neuroendocrine cells of the body. However, the exact cause of DNA mutations is still unknown.

Summary: Carcinoid tumors are formed as a result of uncontrolled cell division and growth, induced by DNA mutations. These cells attack surrounding cells, tissues, or organs.

Based on the diagnosis, a proper treatment plan is decided in the case of carcinoid tumors. Hence, an early diagnosis is important so as to prevent risks of further complications. Important tests or procedures involved in the diagnosis include:

• Blood tests: Carcinoid tumor cells secrete hormones or chemicals. These are present in the blood, thus blood tests are performed to detect their presence.
• Urine tests: As a result of the breakdown of hormones secreted by carcinoid cells, certain chemicals are released. These are present in the urine of the affected individual.
• Imaging tests: These include radiological examinations such as computed tomography scan, MRI, positron emission tomography scan, X-ray, etc.
• Biopsy: This involves the collection of sample tissue from the tumor. The sample is sent to the laboratory for confirmation of the diagnosis.
• A camera or scope for an inside view of the body: This includes endoscopy and bronchoscopy. Equipment with a long and thin tube along with a lens or camera is used to examine areas inside the body.

Summary: The diagnosis of carcinoid tumors is important as a treatment plan is decided on its basis. An early diagnosis under the supervision of a specialist is necessary to prevent risks of further complications.

The prevention of carcinoid tumors is not possible since the exact cause of the condition is yet to be discovered. Certain risk factors such as smoking might trigger the increased chances of carcinoid cancer in the gastrointestinal system. Hence, it is advised either not to start smoking or to quit the habit for the prevention of cancer.

Summary: Although prevention of Carcinoid is not possible, certain risk factors associated with it can be prevented. Smoking is one of such factors which can increase the chances of occurrence of the tumor.

Surgery is the first treatment option that is undertaken for the removal of carcinoid tumours. Gastrointestinal carcinoid tumour removal can be done by local excision, radio frequency ablation or electro-fulguration, segmental colon resection or hemicolectomy, low anterior resection, abdominoperineal resection and liver transplantation. In local excision the complete tumour along with some healthy tissue around the tumour are removed. Surgical removal of localised tumours is possible by making a skin incision or its removal can also be done through the anus.

Some gastrointestinal carcinoids can also be removed with the help of endoscope. Some tumours, especially the rectal tumours are removed by heating them with electric current. Segmental colon resection removes half or one third of the colon along with surrounding lymph nodes and blood vessels to remove the carcinoids in colon. Low anterior resection removes the upper portion of the rectum which is affected by the tumour. In abdominoperineal resection the part of colon on which the tumour has grown, the rectum and the anus are completely removed followed by colostomy wherein an opening is made from the colon by pulling out the healthy large intestine to the outside of the body for removal of the feces.

Liver transplantation is opted only in younger adults if the carcinoid began in the liver. In case of lung carcinoid surgical removal involves sleeve resection, wedge resection, lobectomy, pneumonectomy and lymph node dissection. In sleeve resection the tumour in the trachea is removed along with some portion of healthy tissue above and below the tumour. After this resection, the two parts of the trachea are connected. In case there is a very small carcinoid in the lungs, it is removed by wedge resection wherein a small wedge of the lung is removed which had the tumour in it. Lobectomy is one to remove a complete lobe of the lungs in case the tumour is very large or sleeve resection removal is not possible.

Pneumonectomy is done to remove the complete lung. Radiotherapy is also used to remove carcinoid tumour cells using high energy particles or X-rays. Medications are used to slow down tumour growth further and to boost the immune system. Drugs like Lanreotide (Somatuline Depot) and octreotide (Sandostatin) are given to block hormone secretion from tumour cells which in turn may help in easing the symptoms of carcinoid. Drugs like interferon alfa (Pegasys, Intron a) are administered in the patient’s body to boost the immune system so that the symptoms due to carcinoid are relieved.

Any person who has very large carcinoid and experiences severe symptoms due to the tumour is eligible for treatment.

If the carcinoid is very small and its growth is also very slow, then treatment may not be required because such a slow growing tumour may not show distinct signs and symptoms.

Yes there are side effects like abdominal pain, diarrhoea and bloating of stomach due to hormone blocking drugs like octreotide and lanreotide, flu-like symptoms and fatigue due to drugs that boost the immune system like interferon alfa, fatigue is experienced after radiation therapy also. Other side effects of radiation therapy are sore throat, dry cough and shortness of breath in some patients.

Post treatment guidelines for carcinoid treatment can be taking ample amount of rest, keeping the body hydrated, eating healthy foods rich in fibre to avoid constipation, eating lots of fruits and having plenty of fruit juices.

It may take several weeks or even months to recover after the treatment of carcinoid like surgery or radiation therapy. Surgical method that involves colostomy may not regenerate the removed portion of the gastrointestinal tract that includes anus, rectum and part of the colon. In such a case the open end of large intestine is always kept pulled out the body for removal of feces. This arrangement will be there for the entire life.

Diet in the case of carcinoid cancer mainly depends upon the symptoms experienced by the affected person. Carcinoid tumors may affect different organ systems in the body and hence, different symptoms are shown in different cases. Some of the food items to be preferred during such conditions may include:

• Foods rich in low saturated fats
• Easily digestible carbohydrates
• Vitamins and minerals supplements
• Foods rich in healthy fats

Summary: Dietary modifications in the case of carcinoid cancer mainly depend upon the type of symptoms experienced by the affected individual. A healthy diet consisting of essential vitamins, minerals, healthy fats, and carbohydrates should be preferred.

Carcinoids may need urgent medical care and treatment in certain cases. Following are some of the symptoms that indicate emergency consultation and treatment:

• Flushing of the skin when accompanied by severe episodes
• Abnormally low blood pressure
• Difficulty in breathing
• Abnormal cognitive functioning
• Severe chest pain
• Tachycardia and palpitations

Summary: Certain symptoms are experienced by the patients suffering from carcinoid cancer that indicate emergency medical care and treatment. Such symptoms should not be ignored as they may be life-threatening.

It may take around Rs. 500 and can go upto Rs. 20 lakh for treatment of carcinoid in India.

Yes, the results are permanent.

A healthy weight can be achieved by a healthy diet and staying active. Hence, physical activities and exercises are necessary for such conditions. Low impact exercises are preferred which may include:

• Mild aerobics - These include mild forms of aerobics such as walking, jogging, swimming, cycling, etc.
• Basic stretching exercises
• Yoga and meditation

Summary: Physical activities and exercises are important for people suffering from carcinoid tumors as this helps to maintain a healthy weight. But only low-impact exercises should be preferred under medical supervision.

Some important medicines to be preferred in the treatment of carcinoid tumors mainly include:

• Octreotide or Lanreotide - These are helpful to recover from conditions like flushing and diarrhea.
• Interferon - It mainly helps to retard the growth of carcinoid tumors.
• Medicines for skin rashes
• Medicines to ease breathing
• Medicines to control diarrhea-like conditions

Summary: Symptomatic treatment is done in cases of carcinoid cancer depending upon the types of symptoms shown. Medicines used mainly include medicines against diarrhea, flushing, skin rashes, etc.

There may be some herbal or ayurvedic treatment available for treating carcinoids. Intake of cinnamon powder daily may also be helpful in controlling symptoms of carcinoid in the body.