[MOL] Educational Series: Carcinoid tumor, gastrointestinal/ pls. save [02870] Medicine On Line


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[MOL] Educational Series: Carcinoid tumor, gastrointestinal/ pls. save



EDUCATIONAL SERIES: Carcinoid tumor, gastrointestinal

What is gastrointestinal carcinoid tumor?

Gastrointestinal carcinoid tumors are cancers in which cancer
(malignant) cells are found in certain
hormone-making cells of the digestive, or gastrointestinal, system. The
digestive system absorbs
vitamins, minerals, carbohydrates, fats, proteins, and water from the
food that is eaten and stores
waste until the body eliminates it. The digestive system is made up of
the stomach and the small and
large intestines. The last six feet of intestine is called the colon.
The last 10 inches of the colon is the
rectum. The appendix is an organ attached to the large intestine.

There are often no signs of a gastrointestinal carcinoid tumor in its
early stages. Often the cancer will
make too much of some of the hormones, which can cause symptoms. A
doctor should be seen if
the following symptoms persist: pain in the abdomen, flushing and
swelling of the skin of the face and
neck, wheezing, diarrhea, and symptoms of heart failure, including
breathlessness.

If there are symptoms, a doctor may order blood and urine tests to look
for signs of cancer. Other
tests may also be done. If there is a carcinoid tumor, the patient has a
greater chance of getting other
cancers in the digestive system, either at the same time or at a later
time.

The chance of recovery (prognosis) and choice of treatment depend on
whether the cancer is just in
the gastrointestinal system or has spread to other places, and on the
patient's general state of health.



STAGE EXPLANATION


Stages of gastrointestinal carcinoid tumors

Once gastrointestinal carcinoid tumor is found, more tests will be done
to find out if cancer cells have
spread to other parts of the body. This is called staging. A doctor
needs to know the stage of the
disease to plan treatment. The following stages are used for
gastrointestinal carcinoid tumor:


Localized

The cancer is found in the appendix, the colon or rectum, the small
intestine, or stomach, but it has
not spread to other parts of the body.


Regional

Cancer has spread from the appendix, colon or rectum, stomach, or small
intestine to nearby tissues
or lymph nodes. (Lymph nodes are small, bean-shaped structures that are
found throughout the
body. They produce and store infection-fighting cells.)


Metastatic

Cancer has spread to other parts of the body.


Recurrent

Recurrent disease means that the cancer has come back (recurred) after
it has been treated. It may
come back in the first place it was found or in another part of the
body.



TREATMENT OPTION OVERVIEW


How gastrointestinal carcinoid tumors are treated

There are treatments for all patients with gastrointestinal carcinoid
tumors. Four kinds of treatment
are used:

     surgery (taking out the cancer)
     radiation therapy (using high-dose x-rays to kill cancer cells)
     biological response modifier therapy (using the body's natural
immune system to fight cancer)
     chemotherapy (using drugs to kill cancer cells)

Depending on where the cancer started, the doctor may take out the
cancer using one of the
following operations:

     A simple appendectomy removes the appendix. If part of the colon is
also
     taken out, the operation is called a hemicolectomy. The doctor may
also
     remove lymph nodes and look at them under a microscope to see if
they
     contain cancer.

     Local excision uses a special instrument inserted into the colon or
rectum
     through the anus to cut the tumor out. This operation can be used
for very
     small tumors.

     Fulguration uses a special tool inserted into the colon or rectum
through the
     anus. An electric current is then used to burn the tumor away.

     Bowel resection takes out the cancer and a small amount of healthy
tissue on
     either side. The healthy parts of the bowel are then sewn together.
The
     doctor will also remove lymph nodes and have them looked at under a

     microscope to see if they contain cancer.

     Cryosurgery kills the cancer by freezing it.

     Hepatic artery ligation cuts and ties off the main blood vessel
that brings
     blood into the liver (the hepatic artery).

     Hepatic artery embolization uses drugs or other agents to reduce or
block
     the flow of blood to the liver in order to kill cancer cells
growing in the
     liver.

Radiation therapy uses high-energy x-rays to kill cancer cells and
shrink tumors. Radiation may
come from a machine outside the body (external radiation therapy) or
from putting materials that
produce radiation (radioisotopes) through thin plastic tubes in the area
where the cancer cells are
found (internal radiation therapy).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken
by pill, or it may be put
into the body by a needle in the vein or muscle. Chemotherapy is called
a systemic treatment
because the drug enters the bloodstream, travels through the body, and
can kill cancer cells outside
the digestive system.

Biological therapy tries to get the patient's body to fight the cancer.
It uses materials made by the
body or made in a laboratory to boost, direct, or restore the body's
natural defenses against disease.
Biological therapy is sometimes called biological response modifier
(BRM) therapy or
immunotherapy.


Treatment by type

Treatment of gastrointestinal carcinoid tumor depends on the type of
tumor, the stage, and the
patient's overall health.

Standard treatment may be considered because of its effectiveness in
patients in past studies, or
participation in a clinical trial may be considered. Not all patients
are cured with standard therapy
and some standard treatments may have more side effects than are
desired. For these reasons,
clinical trials are designed to find better ways to treat cancer
patients and are based on the most
up-to-date information. Clinical trials are ongoing in most parts of the
country for most stages of
gastrointestinal carcinoid tumor. To learn more about clinical trials,
call the Cancer Information
Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.



LOCALIZED GASTROINTESTINAL CARCINOID TUMOR

If the cancer started in the appendix, the treatment will probably be
surgery to remove the appendix
(appendectomy) with or without removal of part of the colon
(hemicolectomy).

If the cancer started in the rectum, treatment may be one of the
following:

     1. Local excision.

     2. Simple fulguration.

     3. Surgery to remove part of the bowel (bowel resection).

If the cancer started in the small intestine, the treatment will
probably be surgery to remove part of
the bowel (bowel resection). Lymph nodes may also be taken out and
looked at under the
microscope to see if they contain cancer.

If the cancer started in the stomach, pancreas, or colon, the treatment
will probably be surgery to
remove part of the gastrointestinal tract.



REGIONAL GASTROINTESTINAL CARCINOID TUMOR

The treatment will probably be surgery to remove the cancer.



METASTATIC GASTROINTESTINAL CARCINOID TUMOR

Treatment may be one of the following:

     1. Surgery to remove the cancer. If the cancer has spread to the
liver, treatment may include
     cryosurgery.

     2. Chemotherapy.

     3. Hepatic arterial embolization to kill cancer cells growing in
the liver.

     4. Radiation therapy to relieve pain and discomfort.


Carcinoid syndrome

Treatment options: Metastatic carcinoid tumor

Treatment may be one of the following:

     1. Surgery to remove the cancer.

     2. Surgery to cut and tie the main artery that goes to the liver
(hepatic artery ligation).

     3. Hepatic arterial embolization to kill cancer cells growing in
the liver.

     4. Drugs to relieve symptoms such as diarrhea.

     5. Biological therapy to relieve symptoms.

     6. Chemotherapy.

     7. A clinical trial of chemotherapy to relieve symptoms.



RECURRENT GASTROINTESTINAL CARCINOID TUMOR

The treatment depends on many factors, including where the cancer came
back and what treatment
the patient received before. Clinical trials are studying new
treatments.


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