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• Type 3 gastric carcinoids are called sporadic tumors and are the most malignant of the gastric tumors. Between 15% to 25% of gastric carcinoids are sporadic and are not associated with elevated levels of gastrin. They usually exhibit aggressive growth and tend to be already metastatic at the time of diagnosis. Because of the aggressive nature of this tumor, treatment usually consists of radical gastrectomy (surgical removal of the stomach).

Presenting symptoms of gastric carcinoid tumors may include:

• Peptic ulcer disease (PUD),
• Bleeding
• Obstruction of gastric outlet
• Pain

Most gastric carcinoid tumors produce gastrin and histamines but not serotonin.

Midgut Carcinoid Tumors

Small Intestines

The most common site for carcinoid tumors in men is the small intestines. These tumors are often asymptomatic (without symptoms), slow growing, and frequently are not discovered until they are locally advanced or metastatic. Most people remain asymptomatic if the tumors are very small (less than 2 cm.). Carcinoid syndrome associated with the midgut carcinoid tumors of the small intestines will generally only develop in those patients with hepatic (liver) metastasis.

The most common symptoms associated with small intestinal carcinoid tumors include:

• Periodic abdominal pain
• Weight loss
• Small bowel obstruction

Appendiceal Carcinoids

The appendix is the most common site for carcinoid tumors in women. Up to 80% of appendiceal carcinoids (carcinoid tumors of the appendix) are discovered incidentally during an appendectomy. Therefore, the majority of patients will be asymptomatic unless there is a coincident appendicitis. In general the prognosis is excellent for tumors less than 2 cm. in size as they are unlikely to metastasize. The risk of metastasis is greater in appendiceal tumors larger than 2 cm.

Hindgut Carcinoid Tumors

Colon

The typical presentation includes:

• Pain associated with obstruction
• GI bleeding (not common)

Most carcinoid tumors of the colon are found on the right side and are detected either at routine colonoscopy or evaluation for abdominal pain or weight loss.

Rectum

In most cases these tumors are discovered during colonoscopy and are asymptomatic. Larger tumors (i.e., greater than 2 cm) are more likely to develop metastases. The most common symptom, if present, is rectal bleeding.