CARCINOID SYNDROME

General Information

DEFINITION--A group of symptoms caused by malignant tumors (carcinoids) in the wall of the small intestine. Carcinoids secrete serotonin, histamine, prostaglandins and hormones--powerful chemicals that cause carcinoid symptoms.

BODY PARTS INVOLVED--Primary tumors appear in the appendix, ileum, rectum, ovaries or stomach. The malignancy may spread and cause symptoms that affect the skin, blood vessels, kidney, gastrointestinal tract, liver, heart and lungs.

SEX OR AGE MOST AFFECTED--Adults of both sexes.

SIGNS & SYMPTOMS--

Carcinoids are slow-growing and many persons with these tumors have no symptoms. The primary tumor may cause intestinal obstruction, characterized by painful cramps in the middle of the abdomen, vomiting, abdominal swelling and weight loss. In a few cases, carcinoid cells spread to other body parts and produce secondary, hormone-producing (serotonin) tumors. Heavy exercise, alcohol consumption, or eating bananas, tomatoes, plums, avocados, pineapple or walnuts may trigger symptoms of these secondary tumors. These symptoms include:

• Flushed skin on the head and neck that can last several hours.
• Watery eyes.
• Diarrhea with abdominal cramps.
• Respiratory symptoms similar to asthma (wheezing).
• Congestive heart failure.
• Irregular heartbeat.
• Nausea and vomiting.
• Low blood pressure.
• Unexplained weight loss.

CAUSES--Unknown.

RISK INCREASES WITH

• Adults over 60.
• Obesity.
• Smoking.
• Excess alcohol consumption.

HOW TO PREVENT--Cannot be prevented at present.

What To Expect

DIAGNOSTIC MEASURES--

• Carcinoids may be discovered during a diagnostic test or surgery for some other disorder.
• Medical history and physical exam by a doctor.
• Laboratory urine studies for 5-hydroxyindoleacetic and serotonin level.
• Endoscopy and X-rays of the abdominal organs.
• Sigmoidoscopy and CT scan of the colon (See Glossary for both).
• Biopsy (See Glossary).

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment. Treatment will be dependent on the extent of the disease.
• Surgical removal of the tumor if possible.

POSSIBLE COMPLICATIONS--Malignancy may spread to other body parts.

PROBABLE OUTCOME--This condition is currently considered incurable. However, symptoms can be relieved or controlled, and survival is possible for 10 to 20 years. Scientific research into causes and treatment continues, so there is hope for increasingly effective treatment and cure.

How To Treat

GENERAL MEASURES--

• The more you can learn and understand about a disease, the more you will be able to make informed decisions about where to go for your care, the treatments available, the risks involved, side effects of therapy and expected outcome.
• See Resources for Additional Information.

MEDICATION--

• For minor diarrhea, you may use non-prescription drugs, such as Pepto-Bismol.
• Your doctor may prescribe: Anticancer drugs to kill malignant cells. Methyldopa to prevent formation of serotonins. Phenothiazines to prevent flushed skin. Cortisone drugs to reduce inflammation anywhere in the body. Bronchodilators, if asthma-like symptoms are a problem.

ACTIVITY--Resume your normal activities as soon as symptoms improve, but avoid strenuous exercise.

DIET--

• Include at least 2 protein servings a day.
• Take niacin and tryptophan supplements if recommended by your doctor.
• Avoid foods that trigger symptoms of secondary tumors.
• Don't drink alcohol.

Call Your Doctor If

• You have symptoms of carcinoid syndrome.
• Symptoms become disabling, despite treatment.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.