Treatment Options for Carcinoid Tumors

Surgical Intervention for Carcinoid Tumor

Surgery is considered to be the first line treatment of carcinoid tumors and is the only curative procedure for early, localized carcinoid tumors. The size of most carcinoid tumors is predictive of their malignant potential so that the highest rate of curative success is correlated with tumors that are excised when still small (usually under 2 cm. in size). At later stages, when there is indication of metastasis or carcinoid syndrome, surgery is considered to be palliative and instrumental in controlling symptoms.

There are various types of surgery that may be utilized in the control of carcinoid tumors, including:

• Removal of an organ (e.g., appendix)
• Local excision - surgically removing the tumor
• Fulguration - application of an electric current through a special tool to destroy tumors (e.g., in colon or rectum)
• Resection - removing the tumor plus some surrounding tissue followed by reconnecting the borders of healthy tissue

Surgery at an early stage (small and localized) is highly effective and under certain circumstances may be performed on an outpatient basis depending on the location of the tumor. At any time, surgery may be performed to debulk (reduce the size) tumors if they are causing symptoms related to obstruction.

Surgical considerations vary with the location of carcinoid tumors and include:

Bronchial Tumors

Most symptoms of bronchial carcinoid tumors are due to mechanical obstruction and first line treatment is surgical resection to remove the tumor.

Gastric Tumors

Type I tumors which are generally benign or very slow growing usually require limited endoscopic resection and follow-up. Type II tumors may require wider excision margins or resection. Tumors of any type that are larger than 1 cm. in size and are not solitary are often treated with surgery to remove the source of gastrin. Type III tumors, which are the most aggressive of the gastric tumors, may require extensive surgery even if small in size.

Small Intestine Tumors

Size does not generally correlate with malignant potential in tumors of the small intestine and estimates are that up to 60% of midgut tumors metastasize to surrounding lymph nodes and 50% develop metastases to the liver. Depending on the stage of tumor development, surgery usually involves wide area excision and/or resection of small intestinal tissue and surrounding lymph nodes.

If there is intestinal obstruction either from the tumor or from fibrosis (development of fibrous connective tissue) in adjacent areas, surgery may be performed at any time in order to relieve the obstruction.

Appendiceal Tumors

The size of tumors of the appendix is highly predictive of prognosis. Tumors that are smaller than 2 cm. (estimated to be the case for approximately 95% of patients) have a low likelihood of metastasizing. If the tumor is larger, the appendix, portions of the colon, and surrounding lymph nodes are usually removed.

Colon Tumors

Small tumors of the colon are often found at routine colonoscopy and can be removed during the procedure by local excision. Frequently, tumors are discovered only when they have become symptomatic and may have already metastasized. This requires significantly more extensive surgery.

Rectal Tumors

Tumors are often found during a rectal examination or routine colonoscopy. If they are less than 1 cm, they can usually be treated by local excision. The degree of aggressive treatment for larger tumors is a subject of continuing debate.