Carcinoid Syndrome

Carcinoid Syndrome is a condition that is marked by discomforting symptoms and life-threatening complications. Read on to know all about this disease including its causes, symptoms, diagnosis, treatment and prognosis.

What is Carcinoid Syndrome?

It is a cluster of symptoms that arise in individuals who suffer from Carcinoid tumors that arise in the small intestine, appendix, bronchial tubes in the lungs and the colon.

Carcinoid Syndrome Incidence

Carcinoid tumors are quite rare and often grow slowly. Approximately 70% of these tumors are discovered in the gastrointestinal tract. The condition arises in approximately 1 in every 10 people suffering from Carcinoid tumors. This is usually seen after the tumor spreads to the lungs or the liver.

Carcinoid is commonly seen to originate in the small bowel, especially the region known as the Ileum.

Carcinoid Syndrome Symptoms

Carcinoid tumors are generally asymptomatic, meaning they do not give rise to any symptoms. Symptoms occur only rarely. Some of the main symptoms of Carcinoid Syndrome are

• Diarrhea
• Abdominal pain that arises and goes away from time to time
• Low blood pressure
• Heart palpitations
• Wheezing
• Flushing of bright redness of the upper chest, neck and face
• Peripheral edema

In Carcinoid Syndrome flushing is a very common symptom. Approximately 90% of people suffering from this condition experience this symptom at some point during their illness. Diarrhea arises in an estimated 75% of sufferers while heart disease develops in about 50% patients.

Metastatic Carcinoid Syndrome

It refers to a cancerous Carcinoid condition that spreads to other parts of the body. Also known as Carcinoid Metastasis, it is a dreaded condition that leads to Carcinoid Syndrome.

Malignant Carcinoid Syndrome

It refers to a cluster of symptoms that are typically seen in sufferers with metastases arising from carcinoid tumors. Carcinoid tumors generally release high amounts of the serotonin hormone. These tumors develop from neuroendocrine cells, which are widely circulated in the body of humans. The tumors are particularly found in the organs descending from the primitive intestine.

Carcinoid Syndrome Causes

The condition results from the growth of tumors that secrete some types of hormones that enter the bloodstream. Such hormones include Serotonin. In some cases, the liver disintegrates the hormones before any health problems can arise from them. But in some people, Carcinoid Syndrome can develop.

Physical exertion and intake of substances like chocolate, red wine or blue cheese can also act as triggers and causes of Carcinoid Syndrome.

Carcinoid Syndrome Diagnosis

The diagnosis of this condition is usually carried out with the aid of blood tests (involving Serotonin blood test), MRI and CT scan of the abdomen or chest and Octreotide radiolabelled scan. Tests are also conducted to determine 5-HIAA levels in urine. Blood tests are commonly done to detect the presence of elevated hormone level in the bloodstream. Medical imaging studies are helpful in identifying the Carcinoid tumors.

Most of the tumors are detected when tests are performed for other reasons, such as during a surgery of the abdomen.

A physical examination may be useful in detecting heart valve lesions and symptoms of Pellagra (Niacin-Deficiency Disease).

It was difficult to diagnose this condition earlier. With the rise of newer instruments and diagnostic techniques this syndrome is easier to detect than in the past.

Carcinoid Syndrome Risk Factors

People suffering from Carcinoid tumors are particularly susceptible to this condition. People who are habituated to smoking or have a poor diet are at greater risk of having this disease. Individuals suffering from health conditions affecting the lungs or the digestive tract may also get this syndrome. Race has also been found to be a causative factor with dark skinned people seen as more likely to suffer from Carcinoid Tumors.

Carcinoid Syndrome Treatment

In case tumor spreads to other organs such as the liver, cure may be done by cutting off the local supply of blood to the tumor. Treatment may also be carried out by direct use of chemotherapy on the liver.

If complete ablation (surgical removal) of a tumor becomes impossible, cutting out large parts of the tumor can provide relief from the symptoms. This process is known as “Debulking”. Treatment may also be done by administering patients with Octreotide injections in case of advanced tumors that are non-removable by surgery.

In some cases, doctors simply recommend intake of medicines that counteract the hormones. Such drugs restore normalcy to bodily functions and also repair the balance of the endocrine system. Medications may also be used to reduce the size of tumors or slow down their growth. Some common medicines used for curing this condition involve Selective Serotonin Reuptake Inhibitors (SSRIs) like Fluoxetine (Prozac) and Paroxetine (Paxil). These medications may, however, lead to worsening of the existing symptoms by raising Serotonin levels. But these medicines should not be stopped unless advised by the doctor.

Interferon along with Octreotide is used to stop growth of tumors. Antihistamine drugs should be useful for patients in cases where Carcinoid tumor is found to secrete the amino-alkane called Histamine.

The treatment of Carcinoid Syndrome also involves surgical removal of the tumor. The condition can be permanently resolved if the tumor is excised completely. Surgery may be used only in more advanced or extreme cases, thereby curing the Carcinoid Syndrome.

Carcinoid Syndrome Management

People with this condition should strict to certain dietary modifications. This involves avoiding alcohol and food items that contain Tyramine in high amounts such as avocado, processed foods and aged cheeses. Large meals should also be avoided. All these may trigger symptoms.

Carcinoid Syndrome Complications

A major complication of this disease is the development of Carcinoid Crisis. It is a dangerous complication that may arise during surgery. It is marked by highly complicated symptoms like

• High and rapid drop in blood pressure which may give rise to shocks
• Acute bronchospasm
• Acute rise in blood glucose level
• Unusually rapid heart rate

Carcinoid Crisis may result in life-threatening conditions. The best way to avoid development of this crisis is to administer patients with Somatostatin before surgical operation begins.

There may also be some other types of complications like

• Gastrointestinal bleeding
• Bowel obstruction, resulting from tumor
• Failure of heart valve
• Increased risks of suffering falls and subsequent injuries due to low blood pressure

Carcinoid Syndrome Prognosis

Chances of survival can be low if tumors spread to the liver in suffering individuals. People with this condition may also have a high chance of suffering from a separate kind of cancer known as Second Primary Tumor at the same time.

Carcinoid Syndrome Prevention

The condition may be prevented by treating Carcinoid tumors at the earliest. In most cases, this condition develops from presence of Carcinoid tumors. Removing the tumors can obviously help avoid development of this disease.

Carcinoid Syndrome can be effectively cured if diagnosed early and when the tumors have not spread to vital organs. If treated early, it can be completely cured and will not involve any recurring symptoms.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001387/

http://emedicine.medscape.com/article/282515-overview

http://www.mayoclinic.com/health/carcinoid-syndrome/DS00690

http://www.medicinenet.com/carcinoid_syndrome/article.htm