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Gastrointestinal
Carcinoid Tumors
Description
What are gastrointestinal
carcinoid tumors?
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.
- 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:
- Surgery (taking out
the cancer).
- Radiation therapy
(using high-dose x-rays to kill cancer cells).
- Biological 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 tumors
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 tumors
The treatment will probably be
surgery to remove the organ affected by the cancer and possibly
other nearby organs.
Metastatic Gastrointestinal
Carcinoid tumors
Treatment may be one of the
following:
- Surgery to relieve
symptoms caused by the cancer. Surgery to freeze and kill the
cancer may also be performed.
- Chemotherapy to
relieve symptoms caused by the cancer.
- Chemotherapy injected
directly into the hepatic artery to block the artery and kill
cancer cells growing in the liver.
- Radiation therapy to
relieve symptoms caused by the cancer.
- Radioactive substances
injected into the cancer to relieve the symptoms caused by the
cancer.
- Biological or
immunological therapy.
Carcinoid syndrome
Treatment options for metastatic
carcinoid tumor may be one of the following:
- Surgery to remove the
cancer.
- 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.
- Drugs designed to
relieve symptoms caused by the cancer.
- Biological therapy to
relieve symptoms caused by the cancer.
- A clinical trial of
new combinations of chemotherapy drugs.
Recurrent Gastrointestinal
Carcinoid tumors
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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National Cancer Institute
Date Last Modified: 12/30/2002
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