Carcinoid syndrome natural history, complications and prognosis

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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

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.

Natural History

• If left untreated, patients with carcinoid syndrome may progress to develop flushing, diarrhea, and carcinoid heart disease (valvular heart disease and cardiac dysrythmias).
  • Pathologically, the cardiac 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 rate compared to most malignant tumors.

Complications

Common complications of carcinoid tumor include:

• Increased risk of falls and injury (from hypotension)
• Bowel obstruction
• Gastrointestinal bleeding
• Right-sided heart failure
• Serotonin causes fibrosis of the tricuspid valve and pulmonary valve, more rarely the mitral valve in cases with left sided involvement
  • "TIPS" - Tricuspid Insufficiency, Pulmonic Stenosis (fibrosis of tricuspid and pulmonary valves)

Prognosis

Prognosis is generally good, and the 5-year survival rate of patients with carcinoid syndrome is approximately 69.7%.

• Factors that determine the prognosis of patients with gastrointestinal carcinoid tumors include:

• Site of origin
• Size of the primary tumor
• Anatomical extent of disease

• Negative prognostic factors include:
  • Carcinoid heart disease
  • High concentrations of the tumor markers - urinary 5-HIAA and plasma chromogranin A
  • Metastasis to the liver
  • Carcinoid tumor of the thymus
  • Overexpression of the proliferation antigen Ki-67
  • Mutation in p53 gene