What is Carcinoid Syndrome
Carcinoid syndrome is a collective term of the symptoms that is often seen in carcinoid tumors. The tcarcinoid tumor is a type of neuroendocrine tumor and is a slow-growing one. since tumor is associated with cancer, carcinoid tumors can either be malignant or benign and it usually happens or occurs in the mucuosa of the gastrointestinal tract.
According to studies, carcinoid tumors occur because there is an overproduction of the serotonin, a hormone which is used in digestion and in the cardiovascular area as well as elevation of mood of an individual. But experts would also like to point out that carcinoid syndrome only occurs in about 10% of patients with carcinoid tumors. Only a few people will experience the syndrome because the carcinoid tumors are slow growing tumors. In that case, then carcinoid syndrome occurs, it is safe to say that the tumor is slightly advanced.
The occurrence of carcinoids in the United States is only less than 10% every year and internationally, the occurrence is only at 0.79 to 1.88 per 100,000 populations studied. But the numbers do not necessarily speak for the actual number of affected people because it can be more than the projected. Some individuals affected with the problem do not develop or do not show symptoms of carcinoid syndrome because of the slow growing cells. the development of carcinoid is not gender based nor ethnic based because it can happen to anyone with any race.
Carcinoid tumors that is smaller than 1 cm rarely travels or metastasizes. It takes more than 2 cm for metastasis to happen and it usually logs into the cardiovascular area or the liver. With that, death is often caused by cardiac and hepatic failure.
Carcinoid Syndrome Symptoms
This is the most common and important symptom to watch out for patients with carcinoid syndrome. This occurs 90% of the time and when flushing occurs, it is often described as intense blush causing the face, head, neck and upper chest to redden. It may be brief for about 2-5 minutes or it can last for several hours. it can also be accompanied by increase in heartbeat but the blood pressure falls. Flushing can be triggered because of emotions or drinking alcoholic beverages or just by sipping hot liquids.
Usually a patient will experience abdominal cramps and normal bowel movement it altered.
This is the second most common symptoms felt. About 78% of the patients will experience diarrhea. Diarrhea can range from mild to severe with watery stools and episodes of frequent bowel movement can happen several times a day disrupting work or any activities done for the day. Nocturnal diarrhea is also an important symptom for carcinoid syndrome
Lesions in the heart valves
Excess serotonin secretion can lead to valvular damage where it can lead to cardiac problems like valve stenosis and even cardiac failure.
Carcinoid Syndrome Causes
Carcinoid syndrome occurs when there is an overproduction of hormone to a patient with carcinoid tumor. The hormone is serotonin which serves as a natural chemical messenger in the body. If there is an overproduction, the serotonin reaches the tissues usually found in the gastrointestinal tract. the tumor is slow growing that is why there are not much symptoms felt first. Symptoms will be noticed once it metastasizes to the liver. the liver is the usual metastatic site because the blood circulation in the gastrointestinal area always passes by the hepatic arteries and veins.
Carcinoid Syndrome Treatment
Tumors are easily detected these days because of technology. For instance, biopsies are done to know if the tumor is benign or if it metastasize. To diagnose carcinoid syndrome, urine tests will be taken because there are substances in the urine that can indicate there is an overproduction of serotonin. Blood tests will also be taken to see if there is an increase of the protein called chromogranin A which is released by carcinoid tumors. Imaging tests will also be done to locate the tumor and see its size and shape.
The physicians will also ask if the patient experiences dry flushing or flushing but not sweating and nocturnal diarrhea. These are the 2 main symptoms that doctors will watch out for to diagnose carcinoid syndrome.
Once diagnosed the goal of the health care team is to preserve the lifestyle and overall health the patient experience. Their goal is to remove the tumor or reduce its size. Thus, treatment options include:
Chemotherapeutic drugs can help shrink carcinoid tumors but the effects will greatly depend on the drugs used.
This is one of the options of many physicians especially when tumor is localized and it is not widespread. Surgery is also done if the tumor impedes a vital organs’ circulation.
Octreotide or Sandostatin
It is usually injected to slow the rate of the tumor growth in the body. It also controls the skin flushing and diarrhea in most carcinoid patients. side effects include abdominal pain, some bloating, nausea and some diarrhea but these side effects will subside over time.
Hepatic artery embolization
This is mostly done with the carcinoid lodges into the liver. the procedure will stop the blood supply of the tumor in the hepatic area. this is done by inserting a catheter in the groin or femoral area and it will reach to the hepatic artery to stop the blood supply of the tumor. Patients should be aware that this procedure is risky especially for those with underlying hepatic problems.
It is a process wherein the cancer cells will be killed through delivering heat. This causes the cancer cells to die.
Instead of heat, the tumor freezes and it will eventually die. The two options are helpful if there are not much tumors in the area and if it is relatively small.
Lifestyle and Coping
Having a carcinoid syndrome can be stressful so it’s important that the family and patient should work together for faster coping. For patients, they need to avoid situations wherein it could cause them flushing. They need to stay away from circumstances wherein they could get upset or stressed. Since diarrhea is also evident, they need to take vitamins, fluids and electrolytes to avoid dehydration. About 20% total body water loss can be fatal so it’s important to keep them hydrated.
For family, relatives and friends, they should help the patient especially avoiding situations where it is stressful. They can also look for support groups and talk to other people who have a family member with the same condition. lastly, they should also take care of themselves for them to take care of the sick family member.
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