Recognizing the symptoms of carcinoid syndrome

November 12, 2012

Recognizing the symptoms of carcinoid syndrome

Tumors that grow from cells associated with the endocrine system are referred to as carcinoid tumors, these tumors often produce too much of the hormone serotonin which, in turn, causes the development of carcinoid syndrome and its associated symptoms.

Unfortunately once the symptoms of carcinoid syndrome are recognized the original, slow growing, tumor has usually metastasized. Since carcinoid tumors can be treated, and often cured it is, therefore essential that they are discovered as early as possible in order to avoid further metastasizing.

Early recognition

It is not uncommon for patients to wait as long as seven years after the first appearance of carcinoid syndrome symptoms before receiving a diagnosis – this is largely because the symptoms are not generally recognized as being indicative of a serious health issue. The most common symptoms of this syndrome seen in patients may include some or all of the following -

  • Diarrhea

  • Flushing of the skin- this is a dry flush, unlike sweat, and may be unnoticed by the patient themselves.

  • Heart palpitations

  • Stomach cramps

  • Shortness of breath and wheeziness

Frequency of carcinoid syndrome

Studies estimate that only around 10% of patients with carcinoid tumors will develop the syndrome. Many of the hormones produced by carcinoid tumors are dispersed by the action of the liver before entering the general bloodstream. Clearly, however, once the tumors have metastasized to the liver, or indeed other parts of the body, the excess hormones produced will be dispersed throughout the systemic bloodstream and cause the symptoms of carcinoid syndrome to develop.

Diagnosis

The similarity of many of the symptoms of carcinoid syndrome to other medical conditions often means an initial misdiagnosis. Patients may receive initial treatment for conditions such as irritable bowel syndrome or colitis before being referred to an endocrinologist. This delay may be crucial for the patient prognosis – as with all cancers, treatment is much more likely to be successful if the disease has been discovered and diagnosed in its early stages.

Testing

Once your doctor suspects you are showing symptoms of carcinoid tumors he, or she, will carry out a number of tests to confirm the diagnosis before other tests are carried out in order to locate the tumors.

  • Blood and urine tests -tests will be carried out to measure serotonin levels over a period of twenty-four hours; levels of chromogranin A, a marker for endocrine tumors, will also be measured.

  • Imaging tests such as X-Rays, MRI, and CT scan will all be carried out in order to locate the tumors. In addition an octreoscan may be used to diagnose any tumors which have been located.

  • Endoscopy – using an endoscopy makes it possible for the doctor to examine most of the digestive tract.

  • During an endoscopy the medical practitioner will take a biopsy of any irregular areas or tumors which are seen.

Treatment

Treatment of any tumors will depend on their size, location and extent of any metastasizing. The aim of any treatment plan is to remove or shrink the tumor and manage the symptoms of the disease. Treatment options include the following -

  • Surgery – for carcinoid tumors a surgical procedure is usually the first stage of treatment assuming the tumors have been found in their early stages and located in a small area. Most small tumors can be removed completely even if they have spread to surrounding lymph nodes. Larger or more numerous tumors may require more extensive surgery – including removal of a section of the affected organ. Tumors that are very large and which have metastasized to several areas may be impossible to remove via a surgical procedure.

Non-surgical treatments include the following which may be used to treat both the disease and the symptoms.

  • Medication

  • Ablation

  • Chemotherapy

  • Radiation

Prognosis

If the symptoms of carcinoid syndrome are already present in a patient then it is likely that the related tumors have already metastasized to some extent. The slow growing nature of the tumors however means that successful treatment is still a possibility. Many patients survive for up to fifteen years with this condition.

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