Carcinoid tumors arise from neuroendocrine cells in the gastrointestinal tract. They most commonly occur in the appendix, ileum, and rectum. While often asymptomatic, they may secrete serotonin and cause carcinoid syndrome in rare cases. Diagnosis involves urinary tests for serotonin metabolites and imaging exams. Treatment of localized tumors is surgical resection, while metastatic tumors may also require chemotherapy. Prognosis is generally good if the tumor is localized but worsens with increased size and spread.

1. Carcinoid Tumours
Daifallah Almansouri

2. Objectives
• Definition and Histopathology.
• Common sites; primary and secondary.
• Epidemiology.
• Classification.
• Presentation.
• Complications.
• Investigations.
• Management.
• Prognosis.
• summary.
Carcinoid Tumors

3. Definition and Histopathology
• It is malignant tumors of GIT arise from
neuroendocrine cells (enterochromaffin cells)
at the base of intestinal crypts.
• Macroscopically: small in size.
Carcinoid Tumors

4. Common Sites
• Most common primary sites; appendix, ileum
and rectum respectively.
• Mestastasis:
– Liver (larger and more yellow than the primary
lesion).
– Mesentery, peritoneum, lymph nodes.
Carcinoid Tumors

5. Epidemiology
• 1.5 per 100, 000
• most common neuroendocrine tumors
• 45-55 years
Carcinoid Tumors

6. Classification
• Three types according the origin:
– Foregut
– Midgut
– Hindgut

7. Symptomatology:
• Most patients are asymptomatic unless
metastasized (coincidental carcinoids)
• Secrete a number of vasoactive peptides;
mostly 5-hydroxytryptamine (serotonin) result
in carcinoid syndrome.
• haemorrhage or presenting symptoms
Carcinoid Tumors

8. Carcinoid syndrome:
less than 10%
– reddish-blue cyanosis,
– flushing attacks (induced
by alcohol)
– diarrhoea,
– Borborygmi (Abdominal
cramping)
– asthmatic attacks
– Peripheral edema
– sometimes pulmonary
and tricuspid stenosis.
Carcinoid Tumors

9. Investigations
• Lab:
– Urinary 5-HIAA (5-Hydroxyindoleacetic acid)
• Imaging:
– Primary tumor: GI series, CT, and MRI .
– Secondary (liver): CT
Carcinoid Tumors

12. Complication:
• carcinoid crises, metastasis, pressing
symptoms, hemorrhage.
Carcinoid Tumors

13. Management
• Primary: resection is suffecient.
• Secondary (liver metastasis): Chemotherapy,
enucleations, of or even partial hepatectomy.
• Octreotide to antagonize serotonin effect
– Post-appendectomy !
Carcinoid Tumors

15. Prognosis
• Prognosis is good if localised (grow more
slowly).
• tumor size (>2cm), histologic features, and
distant metastasis are significant factors in
predicting survival
• Follow up with tumer marker (5-HIAA) / 6-12
months.
Carcinoid Tumors

16. Summery
• Neuroendocrine cells tumor of intestine
especially the appendix. Mostly,
asymptomatic. When secrete serotonin result
in carcinoid syndrome. Serotonin metabolites
(urinary 5-HIAA) used in screening and help
in diagnosis along with CT. Primary managed
surgically and chemotherapy used in
secondary.
Carcinoid Tumors

17. References
• http://emedicine.medscape.com/article/9860
50-workup#a0720
• Bailey & Love's Short practice of surgery, 18,
illustrated.
• Clinical Surgery, Alfred Cuschieri, 2, illustrated.
• Schwartz' Principles of Surgery, 9th edition.
• http://radiographics.rsna.org/content/26/3/6
41/F35.expansion.html