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Carcinoid tumors
By Mayo Clinic staffMayo Clinic Health Manager
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Definition
Carcinoid tumors are a slow-growing type of cancer that can arise in several places throughout your body. Carcinoid tumors usually appear in the gastrointestinal tract (appendix, stomach, small intestine, colon, rectum) and in the lungs. But, carcinoid tumors can also begin in other organs, including the ovaries and testes.
Carcinoid tumors rarely cause signs and symptoms until late in the disease. Carcinoid tumors can produce and release hormones into your body that cause signs and symptoms such as diarrhea or skin flushing.
Symptoms
In many cases, carcinoid tumors don't cause any signs or symptoms. When they do occur, signs and symptoms are usually vague and depend on the location of the tumor. Signs and symptoms of carcinoid tumors may include:
- Abdominal pain
- Bowel obstruction
- Changes in bowel movements
- Chest pain
- Diarrhea
- Difficulty breathing
- Rectal bleeding
- Rectal pain
- Recurrent pneumonia
- Redness or a feeling of warmth in your face and neck (skin flushing)
When to see a doctor
Carcinoid tumors often don't cause any signs and symptoms. If you experience any signs and symptoms that bother you and are persistent, make an appointment with your doctor.
Causes
Cancer occurs when a cell develops a mutation in its DNA. The mutation allows the cell to continue growing and dividing when healthy cells would normally die. In the case of carcinoid tumors, the accumulating cells form a mass. Cancer cells can invade nearby healthy tissue and spread to other parts of the body.
It's not clear what causes the mutations that can lead to carcinoid tumors.
Carcinoid tumors develop from cells in the neuroendocrine system, a part of your body that has many functions, including production of certain hormones. These cells also have characteristics similar to nerve cells.
Risk factors
Factors that increase the risk of carcinoid tumors include:
- Older age. Older adults are more likely to be diagnosed with a carcinoid tumor than are younger people or children.
- Family history. A family history of multiple endocrine neoplasia, type I (MEN I) syndrome increases the risk of carcinoid tumors. In people with MEN I syndrome, multiple tumors occur in glands of the endocrine system.
- Smoking. Smoking tobacco may increase the risk of gastrointestinal carcinoid tumors.
- Other medical conditions. Conditions that affect the stomach's ability to produce acid, such as gastritis, pernicious anemia and Zollinger-Ellison syndrome, can increase your risk of gastrointestinal carcinoids.
Complications
The cells of carcinoid tumors can secrete hormones and other chemicals into your body, causing a range of complications, including:
- Stomach ulcers. Carcinoid tumors, particularly those in the stomach, can secrete a hormone that increases acid in the stomach, which can lead to ulcers.
- Carcinoid syndrome. Carcinoid syndrome causes redness or a feeling of warmth in your face and neck (skin flushing), chronic diarrhea, and difficulty breathing, among other signs and symptoms.
- Carcinoid heart disease. Carcinoid tumors may secrete hormones that can cause thickening of the lining of heart chambers, valves and blood vessels. This can lead to leaky heart valves, an enlarged heart and heart failure. Carcinoid heart disease can usually be controlled with medications and surgery.
- Cushing's syndrome. A lung carcinoid tumor can produce an excess of a hormone that can cause your body to produce too much of the hormone cortisol.
- Acromegaly. Another hormone secreted by some lung carcinoid tumors can cause this rare hormone disorder. Acromegaly causes bones to increase in size, including the hands, feet and face.
Preparing for your appointment
You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a doctor who specializes in problems involving the gastrointestinal tract (gastroenterologist) or a doctor who specializes in lung problems (pulmonologist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For carcinoid tumors, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- What are other possible causes for my symptoms or condition?
- What kinds of tests do I need?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What are the alternatives to the primary approach that you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?
- What will determine whether I should plan for a follow-up visit?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover points you want to address. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous, or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
What you can do in the meantime
Avoid any activities that seem to worsen your signs and symptoms. If you're experiencing frequent skin flushing, avoid common triggers, such as stress, alcohol and spicy foods.
Tests and diagnosis
Tests and procedures used to diagnose carcinoid tumors include:
- Blood test. If you have a carcinoid tumor, your blood may contain high levels of a protein caused by hormones secreted by a carcinoid tumor.
- Urine test. People with carcinoid tumors have excess levels of a chemical in their urine that's produced when the body breaks down hormones secreted by carcinoid tumors.
- Imaging tests. Imaging tests, including a computerized tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET), ultrasound, octreotide scan and X-ray, may help your doctor pinpoint the carcinoid tumor's location.
- Using a scope or camera to see inside your body. Your doctor may use a long, thin tube equipped with a lens or camera to examine areas inside your body. An endoscopy, which involves passing a scope down your throat, may help your doctor see inside your gastrointestinal tract. Bronchoscopy, using a scope passed down your throat and into your lungs, can help find lung carcinoid tumors. Passing a scope through your rectum (colonoscopy) can help diagnose rectal carcinoid tumors. To see inside your small intestine, your doctor may recommend a test using a pill-sized camera that you swallow (capsule endoscopy).
- Biopsy. A sample of tissue from the tumor (biopsy) may be collected to confirm your diagnosis. What type of biopsy you'll undergo depends on where your tumor is located. In some cases a surgeon may use a needle to draw cells out of the tumor. In other cases, a biopsy may be collected during surgery. The tissue is sent to a laboratory for testing to determine the types of cells in the tumor and how aggressive those cells appear under the microscope.
Treatments and drugs
Treatment for a carcinoid tumor depends on the tumor's location, whether cancer has spread to other areas of the body, the types of hormones the tumor secretes, your overall health and your own preferences.
Treatments can include:
Surgery
When detected early, a carcinoid tumor may be removed completely using surgery. Most carcinoid tumors are advanced when discovered, so complete removal may not be possible. In some cases, surgeons may try to remove as much of the tumor as possible, to help control signs and symptoms. What types of operations are available to you will depend on the size and location of your carcinoid tumor.
Treatments for carcinoid tumors that have spread to the liver
Carcinoid tumors commonly spread (metastasize) to the liver. Options may include:
- Liver surgery. Surgery to remove part or all of the liver (hepatic resection) may control signs and symptoms caused by liver tumors.
- Stopping blood supply to liver tumors. Using hepatic artery embolization, a doctor can clog the liver's main artery (hepatic artery), cutting off the blood supply to cancer cells that have spread to the liver. Healthy liver cells survive by relying on blood from other blood vessels.
- Killing cancer cells with heat or cold. Radiofrequency ablation delivers heat treatments that cause carcinoid tumor cells in the liver to die. Cryoablation uses cycles of freezing and thawing to kill cancer cells.
Medications for carcinoid syndrome
Injections of medications may block tumor cells from secreting the hormones that can cause the signs and symptoms of carcinoid syndrome. Octreotide (Sandostatin) and lanreotide (Somatuline Depot) may help control flushing and diarrhea in most people with carcinoid syndrome. Both drugs are injected once a month and may cause side effects such as abdominal pain and bloating, diarrhea, and nausea. Side effects typically diminish over time.
Alternative medicine
No alternative medicine treatments have been found to cure carcinoid tumors. But alternative medicine may help you cope with the signs and symptoms of cancer and cancer treatment. Talk to your doctor about safe options.
Alternative treatments for stress
Being diagnosed with cancer can be a stressful experience. And if you have carcinoid syndrome caused by a carcinoid tumor, stress can also trigger skin flushing. Complementary and alternative medicine therapies may help you gain control over the stress in your life and help you better cope with your diagnosis. Consult with your doctor about trying:
- Massage
- Meditation
- Relaxation techniques
- Tai chi
- Yoga
Coping and support
Everyone has his or her own way of coping with cancer. But, you don't have to do it alone. If you have questions or would like guidance, talk with a member of your health care team. Also consider the following steps to help you deal with your diagnosis:
- Find out all you can about carcinoid tumors. Ask your doctor questions about your condition. Ask members of your health care team to recommend resources where you can get more information. The more you know about your condition, the better you're able to participate in decisions about your care.
- Talk to others with cancer. Support groups for people with cancer put you in touch with others who have faced the same challenges you're facing. Ask your doctor about groups in your area. Or contact your local chapter of the American Cancer Society. Carcinoid tumors are rare, so you may need to turn to online support groups to find people with your same diagnosis. Try the online chat rooms and message boards at the American Cancer Society's Cancer Survivors Network.
- Control what you can about your health. A cancer diagnosis can make you feel like you have no control over your health. But you can take steps to maintain a healthy lifestyle so that you'll better cope with your cancer treatment. Choose healthy meals with plenty of fruits and vegetables. When you feel up to it, work light exercise into your daily routine. Cut extra stress out of your life when possible. Get plenty of sleep so that you feel rested when you wake up.
