Carcinoids: Cancer in Slow Motion

As many as 1 in every 300 people have Carcinoid tumors. Carcinoid tumors are a very slow growing tumor that are found in home producing cells throughout the body. Carcinoid tumors most often develop in the small intestines, large intestines, pancreas, stomach, appendix, rectum and lungs. Most people with Carcinoid tumors do not have any symptoms so medical attention is not sought early. Studies show that 1 out of every 300,000 cases of Carcinoid Disease comes to clinical attention. Approximately 700 to 900 new cases of Carcinoid Disease are diagnosed each year in the United States.

Dr. Eugene Woltering, MD, who is a professor of Neuroscience, says that the average case of Carcinoid Disease is found by accident because the patient has no symptoms. It is usually found during a surgical procedure, such as an appendectomy, or other stomach exploratory surgery. No proven cause and a genetic link, although suspected, has not been found yet.

Carcinoid Disease is unlike other types of cancers. Mainly because Carcinoid tumors are almost always very slow growing. Tumors can grow significantly and masticize over decades rather than months or a few years as in other cancers. The tumors in Carcinoid Disease divide and spread slowly but they are still life threatening. Carcinoid tumors also release an excess number of hormones in the body. If the tumors are large enough and/or if they have spread to the liver, the hormones can lead to symptoms known as Carcinoid Syndrome.

There are three main elements of Carcinoid Syndrome:

Flushing

This flushing is unlike hot flashes a menopausal woman experiences. Patients will turn beet red and due to repeated flushing, patients will develop prominent veins along their noses.

Diarrhea

The diarrhea in Carcinoid Syndrome is watery and of high volume, associated with cramps. The patient can have multiple bouts of diarrhea a day. It can be very debilitating to patients due to fluid and electrolyte loss.

Wheezing

Asthma type wheezing that is unexplained.

Other symptoms of Carcinoid Syndrome include swelling of the legs and heart disease.

In a small number of cases, Carcinoid Disease will act like other types of cancer. Fast-growing, or A-typical Carcinoids, represents about 5 - 10% of Carcinoid disease patients. These patients are at a much higher risk of death due to the rapid growth of the cancer cells and are more like the classic cancers.

Carcinoid Disease is diagnosed through urine and blood tests, CT scan, MRI and exploratory surgery. Levels of serotonin or its byproducts in the patient's urine are measured over a 24-hour period. Upon initial diagnosis, the size and location of tumor is of importance, as well as if there appears to be any lymph node involvement. Patients with small tumors and no lymph node involvement are less likely to suffer widespread disease.

The severity of disease increases with the degree of lymph node involvement or for patients where disease has spread inside the abdomen, or to the bone, liver or brain. The 5-year survival rate after tumors are removed that have not metastasized is 70 - 90 percent. Patients with metastasized disease often live 10 - 15 years. Those patients where the disease has spread to the liver receive a poor diagnosis.

Surgery is the first step in removing Carcinoid tumors. If the tumors cannot be removed, doctors will kill the cancer cells using radio frequency ablation, or radio waves. For A-typical Carcinoid Disease, chemotherapy is used.

Prescription medications most widely used by doctors to treat Carcinoid patients after surgery are Somatostatin analogues, Sandostatin. Sandostatin is an artificial version of the hormone Somatostatin. The Somatostatin analogues are administered in the muscle or under the skin. The analogue is transported to the tumor cell through the blood where they bind to what Dr. Woltering refers to as the "Somatostatin receptor." These analogues are shown to be very effective in treating Carcinoid Disease. Eighty percent of patients symptoms will improve and this treatment has been shown to lengthen the lives of Carcinoid patients significantly.

Carcinoid Disease is rare in children. Carcinoid Disease has been found to be more common in patients over the age of 50 and is more prevalent in men.