Carcinoid syndrome natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
The presence of liver metastasis is associated with a particularly poor prognosis among patients with carcinoid tumor. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor. Common complications of carcinoid tumor include [[gastrointestinal bleeding]], [[right heart failure]], [[bowel obstruction]], [[hypotension]], and [[tricuspid insufficiency]] and [[pulmonary stenosis]].
If left untreated, patients with [[Carcinoid Syndrome|carcinoid syndrome]] may progress to develop [[flushing]], [[diarrhea]], and [[Carcinoid|carcinoid heart disease]] ([[valvular heart disease]] and [[Cardiac arrythmia|cardiac dysrythmias]]). Common [[complications]] of [[carcinoid tumor]] include increased risk of [[falls]] and [[injury]] (from [[hypotension]]), [[obstruction|bowel obstruction]], [[gastrointestinal bleeding]], [[heart failure|right-sided heart failure]], and [[fibrosis]] of the [[Tricuspid valves|tricuspid valve]] and [[pulmonary valve]], and rarely the [[mitral valve]] in cases with left sided involvement. [[Prognosis]] is generally good and the 5-year [[Survival rates|survival rate]] of [[patients]] with [[Carcinoid Syndrome|carcinoid syndrome]] is approximately 69.7%.


==Natural History==
==Natural History==
*They have a very slow growth rate compared to most malignant tumors.
*If left untreated, [[patients]] with [[Carcinoid Syndrome|carcinoid syndrome]] may progress to develop [[flushing]], [[diarrhea]], and [[Carcinoid disease|carcinoid]] [[Heart diseases|heart disease]] [[Valvular heart disease|(valvular heart disease]] and [[Cardiac arrythmia|cardiac dysrythmias]]):<ref>General Information About Gastrointestinal (GI) Carcinoid Tumors
 
. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_49_toc Accessed on September 24, 2015</ref>
*Carcinoid heart disease develops in more than one-third of patients with carcinoid syndrome. Pathologically, the cardiac valves become thickened because of fibrosis, and the [[tricuspid]] and pulmonic valves are affected to a greater extent than the [[mitral]] and [[aortic valves]].
**[[Pathological|Pathologically]], the [[cardiac]] [[Valves of the heart|valves]] become thickened because of [[fibrosis]]
**[[Tricuspid]] and [[pulmonic valves]] are affected to a greater extent than the [[mitral]] and [[aortic valves]]
*They have a very slow [[Growth|growth rate]] compared to most [[malignant tumors]]


==Complications==
==Complications==
Common complications of carcinoid tumor include:
Common [[complications]] of [[carcinoid tumor]] include:<ref>Carcinoid syndrome. U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000347.htm</ref>
* Increased risk of falls and injury (from [[hypotension]])
*Increased risk of [[falls]] and [[injury]] (from [[hypotension]])
* Bowel [[obstruction]] (from tumor)
*[[Obstruction|Bowel obstruction]]
* [[Gastrointestinal bleeding]]
*[[Gastrointestinal bleeding]]
* Right [[heart failure]]
*[[Carcinoid Disease|Carcinoid heart disease]] develops in more than one-third of [[patients]] with [[Carcinoid Syndrome|carcinoid syndrome:]]<ref>General Information About Gastrointestinal (GI) Carcinoid Tumors
*Serotonin causes fibrosis of the tricuspid valve and pulmonary valve, more rarely the mitral valve in cases with left sided involvement
. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_49_toc Accessed on September 24, 2015</ref>
**"TIPS" - [[tricuspid insufficiency|Tricuspid Insufficiency]], [[pulmonary stenosis|Pulmonic Stenosis]] (fibrosis of tricuspid and pulmonary valves)
*[[Fibrosis]] of the [[Tricuspid valves|tricuspid valve]] and [[pulmonary valve]], rarely the [[mitral valve]] in cases with left sided involvement
::*[[Tricuspid]] and [[pulmonic regurgitation]] ("TIPS" - [[tricuspid insufficiency|Tricuspid Insufficiency]], [[pulmonary stenosis|Pulmonic Stenosis]])
::*[[Pulmonary stenosis]]
::*[[Mitral]] and [[aortic insufficiency]]
::*[[Cardiac arrhythmias|Cardiac dysrhythmias]]


==Prognosis==  
==Prognosis==  
Prognosis is generally good, and the 5-year survival rate of patients with carcinoid syndrome is approximately 69.7%.
*Prognosis o[[Carcinoid tumors|f carcinoid tumor]] is generally good and the 5-yea[[Survival rates|r survival rate]] of [[patients]] is approximately:<ref name="pmid15213627">{{cite journal| author=Maggard MA, O'Connell JB, Ko CY| title=Updated population-based review of carcinoid tumors. | journal=Ann Surg | year= 2004 | volume= 240 | issue= 1 | pages= 117-22 | pmid=15213627 | doi= | pmc=PMC1356383 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15213627  }} </ref>
*Factors that determine the clinical course and outcome of patients with gastrointestinal carcinoid tumors are complex and multifaceted and include the following:<ref>{{Cite web | title =Prognostic Factors
:*[[Stomach]]-75.1%
| url =http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq }}</ref>
:*[[Intestine|Small Intestine]]-76.1%
:*The site of origin
:*[[Appendix]]-76.3%
:*The size of the primary tumor
:*[[Rectum]]-87.5%
:*The anatomical extent of disease
*Factors that determine the prognosis of patients with [[gastrointestinal]] [[carcinoid tumors]] include:<ref>Carcinoid tumor. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq</ref>
*Elevated expression of the proliferation antigen Ki-67 and the tumor suppressor protein p53 have been associated with poorer prognosis.
:*Site of [[origin]]
*Adverse clinical prognostic indicators include:
:*Size of th[[Primary tumor|e primary tumor]]
:*Carcinoid syndrome
:*[[Anatomical]] extent of [[disease]]
:*Carcinoid heart disease
*Negative [[Prognostic|prognostic factors]] include:
:*High concentrations of the tumor markers urinary [[5-HIAA]] and plasma [[chromogranin A]].
**[[Carcinoid]] [[heart]] [[disease]]
*In people with the carcinoid syndrome, the tumor has usually spread to the liver, which lowers the survival rate.
**High [[concentrations]] of the [[tumor markers]] - [[urinary]] [[5-HIAA]] and [[Plasma (blood)|plasma]] [[chromogranin A]]
*The outlook is more favorable with new treatment methods, such as [[sandostatin]].
**[[Metastases|Metastasis]] to the [[liver]]
*Thymic carcinoid tumor are generally thought to carry a poor prognosis due to high rates of recurrence and metastases.<ref> Thymic carcinoid tumour
**[[Carcinoid tumor]] in the [[thymus]]
. Radiopaedia. http://radiopaedia.org/articles/thymic-carcinoid-tumour Accessed on September 24, 2015</ref>
**Overexpression of the [[proliferation]] [[antigen]] Ki-67
**[[Mutations|Mutation]] in the ''[[p53]]'' [[gene]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Disease]]
[[Category:Gastroenterology]]
[[Category:Types of cancer]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Gastroenterology]]
[[Category:Pulmonology]]
[[Category:Hematology]]




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Latest revision as of 21:51, 21 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

Overview

If left untreated, patients with carcinoid syndrome may progress to develop flushing, diarrhea, and carcinoid heart disease (valvular heart disease and cardiac dysrythmias). Common complications of carcinoid tumor include increased risk of falls and injury (from hypotension), bowel obstruction, gastrointestinal bleeding, right-sided heart failure, and fibrosis of the tricuspid valve and pulmonary valve, and rarely the mitral valve in cases with left sided involvement. Prognosis is generally good and the 5-year survival rate of patients with carcinoid syndrome is approximately 69.7%.

Natural History

Complications

Common complications of carcinoid tumor include:[2]

Prognosis

References

  1. ↑ General Information About Gastrointestinal (GI) Carcinoid Tumors . National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_49_toc Accessed on September 24, 2015
  2. ↑ Carcinoid syndrome. U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000347.htm
  3. ↑ General Information About Gastrointestinal (GI) Carcinoid Tumors . National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq#link/_49_toc Accessed on September 24, 2015
  4. ↑ Maggard MA, O'Connell JB, Ko CY (2004). "Updated population-based review of carcinoid tumors". Ann Surg. 240 (1): 117–22. PMC 1356383. PMID 15213627.
  5. ↑ Carcinoid tumor. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq


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