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National Cancer Institute

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Gastrointestinal carcinoid tumor


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is gastrointestinal carcinoid tumor?
STAGE EXPLANATION
Stages of gastrointestinal carcinoid tumors
Localized
Regional
Metastatic
Recurrent
TREATMENT OPTION OVERVIEW
How gastrointestinal carcinoid tumors are treated
Treatment by type
LOCALIZED GASTROINTESTINAL CARCINOID TUMOR
REGIONAL GASTROINTESTINAL CARCINOID TUMOR
METASTATIC GASTROINTESTINAL CARCINOID TUMOR
Carcinoid syndrome
RECURRENT GASTROINTESTINAL CARCINOID TUMOR
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


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 6 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. 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 (small, bean-shaped structures that are found throughout the body that 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:

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) and lymph nodes.

If the cancer started in the rectum, treatment will probably be simple surgery to remove the cancer, surgery using electric current to burn the cancer away, surgery to remove part of the rectum, or surgery to remove the anus and part of the rectum. An opening will be made for waste to pass out of the body (colostomy) into a disposable bag attached near the colostomy (colostomy bag).

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 the organ affected by the cancer and possibly other nearby organs.


REGIONAL GASTROINTESTINAL CARCINOID TUMOR

The treatment will probably be surgery to remove the organ affected by the cancer and possibly other nearby organs.


METASTATIC GASTROINTESTINAL CARCINOID TUMOR

Treatment may be one of the following:

1. Surgery to relieve symptoms caused by the cancer. Surgery to freeze and kill the cancer may also be performed.

2. Chemotherapy to relieve symptoms caused by the cancer.

3. Chemotherapy injected directly into the hepatic artery to block the artery and kill cancer cells growing in the liver.

4. Radiation therapy to relieve symptoms caused by the cancer.

5. Radioactive substances injected into the cancer to relieve the symptoms caused by the cancer.

6. Biological or immunological therapy.


Carcinoid syndrome

Treatment options for metastatic carcinoid tumor 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) or injecting chemotherapy into the liver through the hepatic artery to block the artery and kill cancer cells growing in the liver.

3. Drugs designed to relieve symptoms caused by the cancer.

4. Biological therapy to relieve symptoms caused by the cancer.

5. A clinical trial of new combinations of chemotherapy drugs.


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.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about gastrointestinal carcinoid tumors, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, trained information specialists can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following general booklets on questions related to cancer may be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 09/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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