Skip to main content

Advertisement

Log in

Gastrointestinal carcinoid tumors

Current management strategies

  • Current Status
  • Published:
Diseases of the Colon & Rectum

Abstract

BACKGROUND: Carcinoid or neuroendocrine tumors of the gastrointestinal tract, although characteristically indolent, are also quite heterogeneous both with respect to histologic and endocrine features and with respect to clinical presentation and behavior. PURPOSE: This study was undertaken to review and summarize the current literature on classification controversies, site-specific carcinoid presentation and behavior, and diagnostic and management strategies for primary and advanced carcinoid tumors and the carcinoid syndrome. RESULTS: For carcinoid tumors, oncologic results depend on the location of the primary tumor, extent of locoregional and metastatic disease, functioning status of the tumor, and the feasibility of complete surgical extirpation. Whereas favorable survival rates are typically observed for appendiceal and rectal primaries, less favorable rates are often observed for colonic and ileal tumors. A search for additional tumors is generally advised because multiple carcinoids and second neoplasms are not uncommon. Because of the indolent nature of the tumor and because these therapies have been shown to improve quality and quantity of life, otherwise fit patients with advanced carcinoid disease should be treated with aggressive medical and surgical therapies. Development of a malignant carcinoid syndrome indicates the presence of a functionally active carcinoid tumor and portends a poor prognosis. CONCLUSION: Gastrointestinal carcinoids, although malignant, behave differently from other carcinomas. Results are highly variable and must be individualized according to the site of the primary tumor, extent of spread, and general condition of the patient. A prolongation of quality life can often be accomplished through aggressive medical and surgical therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Lubarsch O. Über den primären Kerbs des Ileum nebst Bemerkungen über gleichzeitige Vorkommen von Krebs und Tuberculose. Arch f path Anat 1988;2:280–317.

    Google Scholar 

  2. Feyrter F. Über diffuse endokrine epitheliale organe. Zentralbl F Inn Med 1938;59:545.

    Google Scholar 

  3. Pearse AG. The cytochemistry and ultrastructure of polypeptide hormone-producing cells of the APUD series and the embryologic, physiologic and pathologic implications of the concept. J Histochem Cytochem 1969;17:303–13.

    PubMed  Google Scholar 

  4. Capella C, Heitz PU, Hofler H, Solcia E, Kloppel G. Revised classification of neuroendocrine tumors of the lung, pancreas and gut. Digestion 1994;55(Suppl 3):11–23.

    PubMed  Google Scholar 

  5. Vinik AI, McLeod MK, Fig LM, Shapiro B, Lloyd RV, Cho K. Clinical features, diagnosis, and localization of carcinoid tumors and their management. Gastroenterol Clin North Am 1989;18:865–96.

    PubMed  Google Scholar 

  6. Dawson IM. The endocrine cells of the gastrointestinal tract and the neoplasms which arise from them. In: Morson BC, ed. Pathology of the gastrointestinal tract: current topics in patholgy. Berlin: Springer-Verlag, 1976:222–58.

    Google Scholar 

  7. Soga J, Tazawa K. Pathologic analysis of carcinoids: histologic reevaluation of 62 cases. Cancer 1971;28:990–8.

    PubMed  Google Scholar 

  8. Martin ED, Potet F. Pathology of endocrine tumors of the GI tract. Clin Gastroenterol 1974;3:511–32.

    Google Scholar 

  9. Johnson LA, Lavin P, Moertel CG,et al. Carcinoids: the association of histologic growth pattern and survival. Cancer 1983;51:882–9.

    PubMed  Google Scholar 

  10. Ariel IM. Argentaffin (carcinoid) tumors of the small intestine—report of eleven cases and review of the literature. Arch Pathol 1939;27:25–52.

    Google Scholar 

  11. Pearson CM, Fitzgerald PJ. Carcinoid tumors—a reemphasis of their malignant nature: review of 140 cases. Cancer 1949;2:1005–26.

    PubMed  Google Scholar 

  12. Norment WB. Tumors of the appendix. Surg Gynecol Obstet 1932;55:590–6.

    Google Scholar 

  13. Moertel CG, Dockerty MB, Judd ES. Carcinoid tumors of the vermiform appendix. Cancer 1968;21:270–8.

    PubMed  Google Scholar 

  14. Collins DC. Seventy-one thousand human appendix specimens—a final report, summarizing forty years' study. Am J Proctol 1963;14:365–81.

    Google Scholar 

  15. Moertel CG, Weiland LH, Nagorney DM, Dockerty MB. Carcinoid tumor of the appendix: treatment and prognosis. N Engl J Med 1987;317:1699–701.

    PubMed  Google Scholar 

  16. Soga J, Yakuwa Y. Goblet cell carcinoids of the appendix: a statistical evaluation of the biological behaviors in 170 cases collected from the literature as compared to 456 ordinary type appendiceal carcinoids. J Exp Clin Cancer Res 1995;14:145–53.

    Google Scholar 

  17. Bowman GA, Rosenthal D. Carcinoid tumors of the appendix. Am J Surg 1983;146:700–3.

    PubMed  Google Scholar 

  18. Gouzi JL, Laigneau P, Delalande JP,et al. Indications for right hemicolectomy in carcinoid tumors of the appendix: The French Associations for Surgical Research. Surg Gynecol Obstet 1993;176:543–7.

    PubMed  Google Scholar 

  19. Godwin JD, 2d. Carcinoid tumors: an analysis of 2,837 cases. Cancer 1975;36:560–9.

    PubMed  Google Scholar 

  20. Anderson JR, Wilson BG. Carcinoid tumours of the appendix. Br J Surg 1985;72:545–6.

    PubMed  Google Scholar 

  21. Syracuse DC, Perzin KH, Price JB, Wiedel PD, Mesa-Tejada R. Carcinoid tumors of the appendix: mesoappendiceal extension and nodal metastases. Ann Surg 1979;190:58–63.

    PubMed  Google Scholar 

  22. Thirlby RC, Kasper CS, Jones RC. Metastatic carcinoid tumor of the appendix: report of a case and review of the literature. Dis Colon Rectum 1984;27:42–6.

    PubMed  Google Scholar 

  23. Glasser CM, Bhagavan BS. Carcinoid tumors of the appendix. Arch Pathol Lab Med 1980;104:272–5.

    PubMed  Google Scholar 

  24. Dent TL, Batsakis JG, Lindenauer SM. Carcinoid tumors of the appendix. Surgery 1973;73:828–32.

    PubMed  Google Scholar 

  25. Pearlman DM, Srinivasan K. Malignant carcinoid of appendix: metastasis from small primary tumor which appeared as appendiceal intussusception. N Y State J Med 1971;71:1529–31.

    PubMed  Google Scholar 

  26. MacGillivray DC, Heaton RB, Rushin JM, Cruess DF. Distant metastasis from a carcinoid tumor of the appendix less than one centimeter in size [see comments]. Surgery 1992;111:466–71.

    PubMed  Google Scholar 

  27. Rothmund M, Kisker O. Surgical treatment of carcinoid tumors of the small bowel, appendix, colon and rectum. Digestion 1994;55(Suppl 3):86–91.

    Google Scholar 

  28. Thompson GB, van Heerden JA, Martin JK Jr, Schutt AJ, Ilstrup DM, Carney JA. Carcinoid tumors of the gastrointestinal tract: presentation, management, and prognosis. Surgery 1985;98:1054–63.

    PubMed  Google Scholar 

  29. Morgan JG, Marks C, Hearn D. Carcinoid tumors of the gastrointestinal tract. Ann Surg 1974;180:720–7.

    PubMed  Google Scholar 

  30. Moertel CG, Sauer WG, Dockerty MB, Baggenstoss AH. Life history of the carcinoid tumor of the small intestine. Cancer 1961;14:901–12.

    PubMed  Google Scholar 

  31. Mir Madjlessi SH, Winkelman EI, Davis GA. Carcinoid tumors of the terminal ileum simulating Crohn's disease. Cleve Clin J Med 1988;55:257–62.

    PubMed  Google Scholar 

  32. Martensson H, Nobin A, Sundler F. Carcinoid tumors in the gastrointestinal tract-an analysis of 156 cases. Acta Chir Scand 1983;149:607–16.

    PubMed  Google Scholar 

  33. Saha S, Hoda S, Godfrey R, Sutherland C, Raybon K. Carcinoid tumors of the gastrointestinal tract: a 44-year experience. South Med J 1989;82:1501–5.

    PubMed  Google Scholar 

  34. Sjoblom SM. Clinical presentation and prognosis of gastrointestinal carcinoid tumours. Scand J Gastroenterol 1988;23:779–87.

    PubMed  Google Scholar 

  35. Zakariai YM, Quan SH, Hajdu SI. Carcinoid tumors of the gastrointestinal tract. Cancer 1975;35:588–91.

    PubMed  Google Scholar 

  36. Dawes L, Schulte WJ, Condon RE. Carcinoid tumors. Arch Surg 1984;119:375–8.

    PubMed  Google Scholar 

  37. Kuiper DH, Gracie WA, Pollard HM. Twenty years of gastrointestinal carcinoids. Cancer 1970;25:1424–30.

    PubMed  Google Scholar 

  38. Eller R, Frazee R, Roberts J. Gastrointestinal carcinoid tumors. Am Surg 1991;57:434–7.

    PubMed  Google Scholar 

  39. Strodel WE, Talpos G, Eckhauser F, Thompson N. Surgical therapy for small-bowel carcinoid tumors. Arch Surg 1983;118:391–7.

    PubMed  Google Scholar 

  40. Chejfec G, Falkmer S, Askensten U, Grimelius L, Gould VE. Neuroendocrine tumors of the gastrointestinal tract. Pathol Res Pract 1988;183:143–54.

    PubMed  Google Scholar 

  41. Nwiloh JO, Pillarisetty S, Moscovic EA, Freeman HP. Carcinoid tumors. J Surg Oncol 1990;45:261–4.

    PubMed  Google Scholar 

  42. Onley JR, Urdaneta LF, Al Jurf AS, Jochimsen PR, Shirazi SS. Carcinoid tumors of the gastrointestinal tract. Am Surg 1985;51:37–41.

    PubMed  Google Scholar 

  43. Zeitels J, Naunheim K, Kaplan EL, Straus F 2d. Carcinoid tumors: a 37-year experience. Arch Surg 1982;117:732–7.

    PubMed  Google Scholar 

  44. McNeal JE. Mechanism of obstruction in carcinoid tumors of the small intestine. Am J Clin Pathol 1971;56:452–8.

    PubMed  Google Scholar 

  45. Anthony PP, Drury RA. Elastic vascular sclerosis of mesenteric blood vessels in argentaffin carcinoma. J Clin Pathol 1970;23:110–8.

    PubMed  Google Scholar 

  46. Strobbe L, D'Hondt E, Ramboer C, Ceuppens H, Hinnekens P, Verhamme M. Ileal carcinoid tumors and intestinal ischemia. Hepatogastroenterology 1994;41:499–502.

    PubMed  Google Scholar 

  47. Clements JL Jr, Hixson GL Jr, Berk RN, Dodds WJ, Goldstein H. Gastrointestinal carcinoid tumors: an analysis of 104 cases. Mt Sinai J Med 1984;51:351–9.

    PubMed  Google Scholar 

  48. Ashley SW, Wells SA Jr. Tumors of the small intestine. Semin Oncol 1988;15:116–28.

    PubMed  Google Scholar 

  49. Jeffree MA, Barter SJ, Hemingway AP, Nolan DJ. Primary carcinoid tumours of the ileum: the radiological appearances. Clin Radiol 1984;35:451–5.

    PubMed  Google Scholar 

  50. Balthazar EJ. Carcinoid tumors of the alimentary tract. I. Radiographic diagnosis. Gastrointest Radiol 1978;3:47–56.

    PubMed  Google Scholar 

  51. Kinkhabwala M, Balthazar EJ. Carcinoid tumors of the alimentary tract. II. Angiographic diagnosis of small intestinal and colonic lesions. Gastrointest Radiol 1978;3:57–61.

    PubMed  Google Scholar 

  52. Goldstein HM, Miller M. Angiographic evaluation of carcinoid tumors of the small intestine: the value of epinephrine. Radiology 1975;115:23–8.

    PubMed  Google Scholar 

  53. Gore RM, Goldberg HI. Computed tomographic evaluation of the gastrointestinal tract in diseases other than primary adenocarcinoma. Radiol Clin North Am 1982;20:781–96.

    PubMed  Google Scholar 

  54. Stockmann F, Creutzfeldt W. Approach to hepatic involvement by endocrine tumors of the gastrointestinal tract. Semin Liver Dis 1988;8:254–62.

    PubMed  Google Scholar 

  55. Zeegen R, Rothwell-Jackson R, Sandler M. Massive hepatic resection for the carcinoid syndrome. Gut 1969;10:617–22.

    PubMed  Google Scholar 

  56. Gillett DJ, Smith RC. Treatment of the carcinoid syndrome by hemihepatectomy and radical excision of the primary lesion. Am J Surg 1974;128:95–9.

    PubMed  Google Scholar 

  57. McEntee GP, Nagorney DM, Kvols LK, Moertel CG, Grant CS. Cytoreductive hepatic surgery for neuroendocrine tumors. Surgery 1990;108:1091–6.

    PubMed  Google Scholar 

  58. Martin JK Jr, Moertel CG, Adson MA, Schutt AJ. Surgical treatment of functioning metastatic carcinoid tumors. Arch Surg 1983;118:537–42.

    PubMed  Google Scholar 

  59. Bengmark S, Ericsson M, Lunderquist A, Martensson H, Nobin A, Sako M. Temporary liver dearterialization in patients with metastatic carcinoid disease. World J Surg 1982;6:46–53.

    PubMed  Google Scholar 

  60. Mays ET, Conti S, Fallahzadeh H, Rosenblatt M. Hepatic artery ligation. Surgery 1979;86:536–43.

    PubMed  Google Scholar 

  61. Murray-Lyon IM, Parsons VA, Blendis LM,et al. Treatment of secondary hepatic tumours by ligation of hepatic artery and infusion of cytotoxic drugs. Lancet 1970;2:172–5.

    PubMed  Google Scholar 

  62. Taylor I, Dockray GJ, Lamb G. Hepatic artery ligation and embolization for the carcinoid syndrome-report of intra-operative liver blood flow studies in a case with high substance P concentration in liver metastases. Clin Oncol 1980;6:277–84.

    PubMed  Google Scholar 

  63. Allison DJ, Modlin IM, Jenkins WJ. Treatment of carcinoid liver metastases by hepatic-artery embolisation. Lancet 1977;2:1323–5.

    PubMed  Google Scholar 

  64. Lunderquist A, Ericsson M, Nobin A, Sanden G. Gelfoam powder embolization of the hepatic artery in liver metastases of carcinoid tumors. Radiologe 1982;22:65–70.

    PubMed  Google Scholar 

  65. Martensson H, Nobin A, Bengmark S, Lunderquist A, Owman T, Sanden G. Embolization of the liver in the management of metastatic carcinoid tumors. J Surg Oncol 1984;27:152–8.

    PubMed  Google Scholar 

  66. Stockmann F, Von Romatowski HJ, Reimold WV, Schuster R, Creutzfeldt W. Hepatic artery embolization for treatment of endocrine gastrointestinal tumors with liver metastases. Z Gastroenterol 1984;22:652–60.

    PubMed  Google Scholar 

  67. Wangberg B, Geterud K, Nilsson O,et al. Embolisation therapy in the midgut carcinoid syndrome: just tumour ischaemia? Acta Oncol 1993;32:251–6.

    PubMed  Google Scholar 

  68. Saltykow S. Über die Genese der “karzinoiden Tumoren,” sowie der “Adenomyone” des Darmes. Beitr Path Anat U Z Aug Path 1912;54:559–94.

    Google Scholar 

  69. Bluth I. Gastrointestinal carcinoid tumors: roentgen features. Radiology 1960;74:573–80.

    PubMed  Google Scholar 

  70. Spread C, Berkel H, Jewell L, Jenkins H, Yakimets W. Colon carcinoid tumors: a population-based study. Dis Colon Rectum 1994;37:482–91.

    PubMed  Google Scholar 

  71. Rosenberg JM, Welch JP. Carcinoid tumors of the colon: a study of 72 patients. Am J Surg 1985;149:775–9.

    PubMed  Google Scholar 

  72. Berardi RS. Carcinoid tumors of the colon (exclusive of the rectum): review of the literature. Dis Colon Rectum 1972;15:383–91.

    PubMed  Google Scholar 

  73. Ballantyne GH, Savoca PE, Flannery JT, Ahlman MH, Modlin IM. Incidence and mortality of carcinoids of the colon: data from the Connecticut Tumor Registry. Cancer 1992;69:2400–5.

    PubMed  Google Scholar 

  74. Aranha GV, Greenlee HB. Surgical management of carcinoid tumors of the gastrointestinal tract. Am Surg 1980;46:429–35.

    PubMed  Google Scholar 

  75. Caldarola VT, Jackman RJ, Moertel CG, Dockerty MB. Carcinoid tumors of the rectum. Am J Surg 1964;107:844–9.

    PubMed  Google Scholar 

  76. Jetmore AB, Ray JE, Gathright JB Jr, McMullen KM, Hicks TC, Timmcke AE. Rectal carcinoids: the most frequent carcinoid tumor. Dis Colon Rectum 1992;35:717–25.

    PubMed  Google Scholar 

  77. Naunheim KS, Zeitels J, Kaplan EL,et al. Rectal carcinoid tumors-treatment and prognosis. Surgery 1983;94:670–6.

    PubMed  Google Scholar 

  78. Orloff MJ. Carcinoid tumors of the rectum. Cancer 1971;28:175–80.

    PubMed  Google Scholar 

  79. Grablowsky OM, Ribaudo JM, Ray JE. Carcinoid tumors of the rectum: experience with 38 cases. Rev Surg 1975;32:67–9.

    PubMed  Google Scholar 

  80. Matsui K, Iwase T, Kitagawa M. Small, polypoid-appearing carcinoid tumors of the rectum: clinicopathologic study of 16 cases and effectiveness of endoscopic treatment. Am J Gastroenterol 1993;88:1949–53.

    PubMed  Google Scholar 

  81. Sauven P, Ridge JA, Quan SH, Sigurdson ER. Anorectal carcinoid tumors: is aggressive surgery warranted? [see comments]. Ann Surg 1990;211:67–71.

    PubMed  Google Scholar 

  82. Ransom WB. A case of primary carcinoma of the ileum. Lancet 1890;2:1020–3.

    Google Scholar 

  83. Davis Z, Moertel CG, McIlrath DC. The malignant carcinoid syndrome. Surg Gynecol Obstet 1973;137:637–44.

    PubMed  Google Scholar 

  84. Grahame Smith DG. The carcinoid syndrome. Am J Cardiol 1968;21:376–87.

    PubMed  Google Scholar 

  85. Feldman JM. Carcinoid tumors and the carcinoid syndrome. Curr Probl Surg 1989;26:835–85.

    PubMed  Google Scholar 

  86. Tilson MD. Carcinoid syndrome. Surg Clin North Am 1974;54:409–23.

    PubMed  Google Scholar 

  87. Lundin L. Carcinoid heart disease: a cardiologist's viewpoint. Acta Oncol 1991;30:499–502.

    PubMed  Google Scholar 

  88. Feldman JM. Urinary serotonin in the diagnosis of carcinoid tumors. Clin Chem 1986;32:840–4.

    PubMed  Google Scholar 

  89. Alumets J, Hakanson R, Ingemansson S, Sundler F. Substance P and 5-HT in granules isolated from an intestinal argentaffin carcinoid. Histochemistry 1977;52:217–22.

    PubMed  Google Scholar 

  90. Oates JA, Pettinger WA, Doctor RB. Evidence for the release of bradykinin in carcinoid syndrome. J Clin Invest 1966;45:173–8.

    PubMed  Google Scholar 

  91. Feldman JM. Serotonin metabolism in patients with carcinoid tumors: incidence of 5-hydroxytryptophan-secreting tumors. Gastroenterology 1978;75:1109–14.

    PubMed  Google Scholar 

  92. Pernow B, Waldenstrom J. Determination of 5-hydroxytryptamine, 5 hydroxyindoleacetic acid and histamine in 33 cases of carcinoid tumor (argentaffinoma). Am J Med 1957;23:16–25.

    PubMed  Google Scholar 

  93. Feldman JM. Increased dopamine production in patients with carcinoid tumors. Metabolism 1985;34:255–60.

    PubMed  Google Scholar 

  94. Lucas KJ, Feldman JM. Flushing in the carcinoid syndrome and plasma kallikrein. Cancer 1986;58:2290–3.

    PubMed  Google Scholar 

  95. Strodel WE, Vinik AI, Jaffe BM, Eckhauser FE, Thompson NW. Substance P in the localization of a carcinoid tumor. J Surg Oncol 1984;27:106–11.

    PubMed  Google Scholar 

  96. Wilander E, Grimelius L, Portela-Gomes G, Lundqvist G, Skoog V, Westermark P. Substance P and entero-glucagon-like immunoreactivity in argentaffin and argyrophil midgut carcinoid tumours. Scand J Gastroenterol Suppl 1979;53:19–25.

    PubMed  Google Scholar 

  97. Sandler M, Karim SM, Williams ED. Prostaglandins in amine-peptide-secreting tumours. Lancet 1968;2:1053–4.

    PubMed  Google Scholar 

  98. Theodorsson Norheim E, Norheim I, Oberg K,et al. Neuropeptide K: a major tachykinin in plasma and tumor tissues from carcinoid patients. Biochem Biophys Res Commun 1985;131:77–83.

    PubMed  Google Scholar 

  99. Peart WS, Robertson JI. The effect of a serotonin antagonist (UML 491) in carcinoid disease. Lancet 1961;2:1172–4.

    PubMed  Google Scholar 

  100. Cassidy MA. Abdominal carcinomatosis, with probable adrenal involvement. J R Soc Med 1930;24:139–41.

    Google Scholar 

  101. Thorson Å, Biörck G, Björkman G, Waldenström J. Malignant carcinoid of the small intestine with metastases to the liver, valvular disease of the right side of the heart (pulmonary stenosis and tricuspid regurgitation without septal defects), peripheral vasomotor symptoms, bronchoconstriction, and an unusual type of cyanosis: A clinical and pathologic syndrome. Am Heart J 1954;47:795–817.

    PubMed  Google Scholar 

  102. Thorson Å, Nordenfelt O. Development of valvular lesions in metastatic carcinoid disease. Br Heart J 1959;21:243–8.

    PubMed  Google Scholar 

  103. Wright PW, Mulder DG. Carcinoid heart disease: report of a case treated by open heart surgery. Am J Cardiol 1963;12:863–8.

    Google Scholar 

  104. Roberts WC, Sjoerdsma A. The cardiac disease associated with the carcinoid syndrome (carcinoid heart disease). Am J Med 1964;36:5–34.

    PubMed  Google Scholar 

  105. Chatterjee K, Heather JC. Carcinoid heart disease from primary ovarian carcinoid tumors: a case report and review of the literature. Am J Med 1968;45:643–8.

    PubMed  Google Scholar 

  106. Carpena C, Kay JH, Mendez AM, Redington JV, Zubiate P, Zucker R. Carcinoid heart disease: surgery for tricuspid and pulmonary valve lesions. Am J Cardiol 1973;32:229–33.

    PubMed  Google Scholar 

  107. Stephan E, Wit J. Carcinoid heart disease from primary carcinoid tumour of the ovary: haemodynamic and cine coronary angiocardiographic study after operation. Br Heart J 1974;36:613–6.

    PubMed  Google Scholar 

  108. Lund HG, Cleveland RJ, Greenberg LH, Lippmann M, Dollinger MR. Tricuspid valve replacement in carcinoid heart disease. West J Med 1974;120:412–5.

    PubMed  Google Scholar 

  109. Honey M, Paneth M. Carcinoid heart disease: successful tricuspid valve replacement. Thorax 1975;30:464–9.

    PubMed  Google Scholar 

  110. Hendel N, Leckie B, Richards J. Carcinoid heart disease: eight-year survival following tricuspid valve replacement and pulmonary valvotomy. Ann Thorac Surg 1980;30:391–5.

    PubMed  Google Scholar 

  111. Sworn MJ, Edlin GP, McGill DA, Mousley JS, Monro JL. Tricuspid valve replacement in carcinoid syndrome due to ovarian primary. BMJ 1980;280:85–6.

    PubMed  Google Scholar 

  112. Miller BR, Vohr FH, Christian FV, Singh AK. Cardiac valvular replacement in carcinoid heart disease. Am J Med 1983;75:896–8.

    PubMed  Google Scholar 

  113. Attanoos R, Williams GT. Epithelial and neuroendocrine tumors of the duodenum. Semin Diagn Pathol 1991;8:149–62.

    PubMed  Google Scholar 

  114. Knott Craig CJ, Schaff HV, Mullany CJ,et al. Carcinoid disease of the heart: surgical management of ten patients. J Thorac Cardiovasc Surg 1992;104:475–81.

    PubMed  Google Scholar 

  115. Ross EM, Roberts WC. The carcinoid syndrome: comparison of 21 necropsy subjects with carcinoid heart disease to 15 necropsy subjects without carcinoid heart disease. Am J Med 1985;79:339–54.

    PubMed  Google Scholar 

  116. Lundin L, Norheim I, Landelius J, Oberg K, Theodorsson Norheim E. Carcinoid heart disease: relationship of circulating vasoactive substances to ultrasound-detectable cardiac abnormalities. Circulation 1988;77:264–9.

    PubMed  Google Scholar 

  117. Jacobsen MB, Nitter Hauge S, Bryde PE, Hanssen LE. Cardiac manifestations in mid-gut carcinoid disease. Eur Heart J 1995;16:263–8.

    PubMed  Google Scholar 

  118. Schweizer W, Gloor F, Bertrab RV, Dubach UC. Carcinoid heart disease with left-sided lesions. Circulation 1964;29:253–7.

    PubMed  Google Scholar 

  119. Sjoerdsma A, Weissbach H, Udenfriend H. Simple test for diagnosis of metastatic carcinoid (argentaffinoma). JAMA 1955;159:397.

    Google Scholar 

  120. Hussain MN, Sole MJ. A simple, specific, radioenzymatic assay for picogram quantities of serotonin or acetylserotonin in biological fluids and tissues. Anal Biochem 1981;111:105–10.

    PubMed  Google Scholar 

  121. Feldman JM, Davis JA. Radioenzymatic assay of platelet serotonin, dopamine and norepinephrine in subjects with normal and increased serotonin production. Clin Chim Acta 1981;109:275–83.

    PubMed  Google Scholar 

  122. Feldman JM, O'Dorisio TM. Role of neuropeptides and serotonin in the diagnosis of carcinoid tumors. Am J Med 1986;81:41–8.

    PubMed  Google Scholar 

  123. Conlon JM, Deacon CF, Richter G, Stockmann F, Creutzfeldt W. Circulating tachykinins (substance P, neurokinin A, neuropeptide K) and the carcinoid flush. Scand J Gastroenterol 1987;22:97–105.

    PubMed  Google Scholar 

  124. Norheim I, Theodorsson Norheim E, Brodin E, Oberg K. Tachykinins in carcinoid tumors: their use as a tumor marker and possible role in the carcinoid flush. J Clin Endocrinol Metab 1986;63:605–12.

    PubMed  Google Scholar 

  125. Ahlman H, Dahlstrom A, Gronstad K, Jaffe BM, Nilsson O, Oberg K. The pentagastrin test in the diagnosis of the carcinoid syndrome. J Cardiovasc Pharmacol 1985;7(Suppl 7):S86–8.

    Google Scholar 

  126. Yoshikane H, Tsukamoto Y, Niwa Y,et al. Carcinoid tumors of the gastrointestinal tract: evaluation with endoscopic ultrasonography. Gastrointest Endosc 1993;39:375–83.

    PubMed  Google Scholar 

  127. Picus D, Glazer HS, Levitt RG, Husband JE. Computed tomography of abdominal carcinoid tumors. AJR Am J Roentgenol 1984;143:581–4.

    PubMed  Google Scholar 

  128. Laurent F, Raynaud M, Biset JM, Boisserie Lacroix M, Grelet P, Drouillard J. Diagnosis and categorization of small bowel neoplasms: role of computed tomography. Gastrointest Radiol 1991;16:115–9.

    PubMed  Google Scholar 

  129. Woodard PK, Feldman JM, Paine SS, Baker ME. Midgut carcinoid tumors: CT findings and biochemical profiles. J Comput Assist Tomogr 1995;19:400–5.

    PubMed  Google Scholar 

  130. Sugimoto E, Lorelius LE, Eriksson B, Oberg K. Midgut carcinoid tumours: CT appearance. Acta Radiol 1995;36:367–71.

    PubMed  Google Scholar 

  131. Eriksson B, Lilja A, Ahlstrom H,et al. Positron-emission tomography as a radiological technique in neuroendocrine gastrointestinal tumors. Ann N Y Acad Sci 1994;733:446–52.

    PubMed  Google Scholar 

  132. Pauwels S, Leners N, Fiasse R, Jamar F. Localization of gastroenteropancreatic neuroendocrine tumors with 111indium-pentetreotide scintigraphy. Semin Oncol 1994;21:15–20.

    Google Scholar 

  133. Krenning EP, Kwekkeboom DJ, Bakker WH,et al. Somatostatin receptor scintigraphy with [111In-DTPA-D-Phe1]- and [123I-Tyr3]-octreotide: the Rotterdam experience with more than 1000 patients. Eur J Nucl Med 1993;20:716–31.

    PubMed  Google Scholar 

  134. Kwekkeboom DJ, Krenning EP, Bakker WH, Oei HY, Kooij PP, Lamberts SW. Somatostatin analogue scintigraphy in carcinoid tumours. Eur J Nucl Med 1993;20:283–92.

    PubMed  Google Scholar 

  135. Krenning EP, Kwekkeboom DJ, Oei HY,et al. Somatostatin receptor scintigraphy in carcinoids, gastrinomas and Cushing's syndrome. Digestion 1994;55(Suppl 3):54–9.

    PubMed  Google Scholar 

  136. Modlin IM, Cornelius E, Lawton GP. Use of an isotopic somatostatin receptor probe to image gut endocrine tumors. Arch Surg 1995;130:367–73.

    PubMed  Google Scholar 

  137. Ahlman H, Tisell LE, Wangberg B, Nilsson O, Forssell-Aronsson E, Fjalling M. Somatostatin receptor imaging in patients with neuroendocrine tumors: preoperative and postoperative scintigraphy and intraoperative use of a scintillation detector. Semin Oncol 1994;21(5 Suppl 13):21–8.

    Google Scholar 

  138. Wiedenmann B, Bader HM, Scherubl H,et al. Gastroenteropancreatic tumor imaging with somatostatin receptor scintigraphy. Semin Oncol 1994;21:29–32.

    Google Scholar 

  139. Moertel CG. Treatment of the carcinoid tumor and the malignant carcinoid syndrome. J Clin Oncol 1983;1:727–40.

    PubMed  Google Scholar 

  140. Soreide O, Berstad T, Bakka A,et al. Surgical treatment as a principle in patients with advanced abdominal carcinoid tumors. Surgery 1992;111:48–54.

    PubMed  Google Scholar 

  141. Moertel CG, Johnson CM, McKusick MA,et al. The management of patients with advanced carcinoid tumors and islet cell carcinomas. Ann Intern Med 1994;120:302–9.

    PubMed  Google Scholar 

  142. Hajarizadeh H, Ivancev K, Mueller CR, Fletcher WS, Woltering EA. Effective palliative treatment of metastatic carcinoid tumors with intra-arterial chemotherapy/chemoembolization combined with octreotide acetate. Am J Surg 1992;163:479–83.

    PubMed  Google Scholar 

  143. Norton JA. Surgical management of carcinoid tumors: role of debulking and surgery for patients with advanced disease. Digestion 1994;55(Suppl 3):98–103.

    PubMed  Google Scholar 

  144. Kvols LK, Reubi JC. Metastatic carcinoid tumors and the malignant carcinoid syndrome. Acta Oncol 1993;32:197–201.

    PubMed  Google Scholar 

  145. Ahlman H, Schersten T, Tisell LE. Surgical treatment of patients with the carcinoid syndrome. Acta Oncol 1989;28:403–7.

    PubMed  Google Scholar 

  146. Akerstrom G, Makridis C, Johansson H. Abdominal surgery in patients with midgut carcinoid tumors. Acta Oncol 1991;30:547–53.

    PubMed  Google Scholar 

  147. Moertel CG, Hanley JA. Combination chemotherapy trials in metastatic carcinoid tumor and the malignant carcinoid syndrome. Cancer Clin Trials 1979;2:327–34.

    PubMed  Google Scholar 

  148. Engstrom P, Lavin P, Folsch E, Moertel C. Streptozotocin plus fluorouracil vs. adriamycin for metastatic carcinoid tumor. Proc Am Assoc Cancer Res 1983;24:139 [abstract].

    Google Scholar 

  149. Legha SS, Valdivieso M, Nelson RS, Benjamin RS, Bodey GP. Chemotherapy for metastatic carcinoid tumors: experiences with 32 patients and a review of the literature. Cancer Treat Rep 1977;61:1699–703.

    PubMed  Google Scholar 

  150. van Hazel GA, Rubin J, Moertel CG. Treatment of metastatic carcinoid tumor with dactinomycin or dacarbazine. Cancer Treat Rep 1983;67:583–5.

    PubMed  Google Scholar 

  151. Kessinger A, Foley JF, Lemon HM. Use of DTIC in the malignant carcinoid syndrome. Cancer Treat Rep 1977;61:101–2.

    PubMed  Google Scholar 

  152. Ritzel U, Leonhardt U, Stockmann F, Ramadori G. Treatment of metastasized midgut carcinoids with dacarbazine. Am J Gastroenterol 1995;90:627–31.

    PubMed  Google Scholar 

  153. Ajani JA, Legha SS, Karlin JA, Hill CS. Combination chemotherapy of metastatic carcinoid tumors with 5-FU, adriamycin, and cytoxan and 5-FU, adriamycin, mitomycin, and methyl CCNU. Proc Am Soc Cl Oncol 1983;2:124 [abstract].

    Google Scholar 

  154. Bukowski RM, Stephens R, Oishi N, Petersen R, Chen T. Phase II trial of 5-FU, adriamycin, cyclophosphamide, and streptozotocin (FAC-S) in metastatic carcinoid. Proc Am Soc Cl Oncol 1983;2:130 [abstract].

    Google Scholar 

  155. Kelsen DP, Cheng E, Kemeny N, Magill GB, Yagoda A. Streptozotocin and adriamycin in the treatment of APUD tumors. Proc Am Assoc Cancer Res 1982;23:111 [abstract].

    Google Scholar 

  156. Oberg K, Eriksson B. The role of interferons in the management of carcinoid tumors. Acta Oncol 1991;30:519–22.

    PubMed  Google Scholar 

  157. Creutzfeldt W, Bartsch HH, Jacubaschke U, Stockmann F. Treatment of gastrointestinal endocrine tumours with interferon-alpha and octreotide. Acta Oncol 1991;30:529–35.

    PubMed  Google Scholar 

  158. Janson ET, Kauppinen HL, Oberg K. Combined alpha- and gamma-interferon therapy for malignant midgut carcinoid tumors: a phase I–II trial. Acta Oncol 1993;32:231–3.

    PubMed  Google Scholar 

  159. Di Bartolomeo M, Bajetta E, Zilembo N,et al. Treatment of carcinoid syndrome with recombinant interferon alpha-2a [published erratum appears in Acta Oncol 1993;32:592]. Acta Oncol 1993;32:235–8.

    PubMed  Google Scholar 

  160. de Vries EG, Kema IP, Slooff MJ,et al. Recent developments in diagnosis and treatment of metastatic carcinoid tumours. Scand J Gastroenterol Suppl 1993;200:87–93.

    PubMed  Google Scholar 

  161. Jacobsen MB, Hanssen LE, Kolmannskog F, Schrumpf E, Vatn MH, Bergan A. Interferon-alpha 2b, with or without prior hepatic artery embolization: clinical response and survival in mid-gut carcinoid patients: The Norwegian Carcinoid Study. Scand J Gastroenterol 1995;30:789–96.

    PubMed  Google Scholar 

  162. Kvols LK, Moertel CG, O'Connell MJ, Schutt AJ, Rubin J, Hahn RG. Treatment of the malignant carcinoid syndrome: evaluation of a long-acting somatostatin analogue. N Engl J Med 1986;315:663–6.

    PubMed  Google Scholar 

  163. Arnold R, Neuhaus C, Benning R,et al. Somatostatin analog sandostatin and inhibition of tumor growth in patients with metastatic endocrine gastroenteropancreatic tumors. World J Surg 1993;17:511–9.

    PubMed  Google Scholar 

  164. Wiedenmann B, Rath U, Radsch R, Becker F, Kommerell B. Tumor regression of an ileal carcinoid under the treatment with the somatostatin analogue SMS 201–995. Klin Wochenschr 1988;66:75–7.

    PubMed  Google Scholar 

  165. Arnold R, Benning R, Neuhaus C, Rolwage M, Trautmann ME. Gastroenteropancreatic endocrine tumours: effect of Sandostatin on tumour growth—The German Sandostatin Study Group. Digestion 1993;54(Suppl 1):72–5.

    PubMed  Google Scholar 

  166. Gorden P, Comi RJ, Maton PN, Go VL. NIH conference. Somatostatin and somatostatin analogue (SMS 201–995) in treatment of hormone-secreting tumors of the pituitary and gastrointestinal tract and non-neoplastic diseases of the gut. Ann Intern Med 1989;110:35–50.

    PubMed  Google Scholar 

  167. Gronstad KO, Nilsson O, Dahlstrom A, Skolnik G, Ahlman H. Adrenergic control of serotonin release from carcinoid tumor cellsin vitro andin vivo. J Surg Res 1987;42:141–6.

    PubMed  Google Scholar 

  168. Marshak RH, Lindner AE. The radiology corner: carcinoid of the colon. Am J Gastroenterol 1972;58:185–8.

    PubMed  Google Scholar 

  169. Tornebrandt K, Nobin A, Ericsson M, Thomson D. Circulation, respiration and serotonin levels in carcinoid patients during neurolept anaesthesia. Anaesthesia 1983;38:957–67.

    PubMed  Google Scholar 

  170. Mason RA, Steane PA. Carcinoid syndrome: its relevance to the anaesthetist. Anaesthesia 1976;31:228–42.

    PubMed  Google Scholar 

  171. Lippmann M, Cleveland RJ. Anesthetic management of a carcinoid patient undergoing tricuspid valve replacement. Anesth Analg 1973;52:768–71.

    PubMed  Google Scholar 

  172. Stone HH, Donnelly CC. The anesthetic significance of serotonin secreting carcinoid tumors. Anesthesiology 1960;21:203–12.

    PubMed  Google Scholar 

  173. Jones WP. Serotonin release from carcinoid tumours. Can Anaesth Soc J 1962;9:42–50.

    PubMed  Google Scholar 

  174. Burks TF, Long JP. Responses of isolated dog small intestine to analgesic agents. J Pharmacol Exp Ther 1967;158:264–71.

    PubMed  Google Scholar 

  175. Andersen N. Changes in intragastric pressure following administration of suxamethonium. Br J Anaesth 1962;34:363–7.

    PubMed  Google Scholar 

  176. Westgate HD, Gordon JR, Bergen FH. Changes in histamine blood levels following intravenous administered tubocurarine. Anesthesiology 1962;23:65–73.

    PubMed  Google Scholar 

  177. Kelman GR. Applied cardiovascular physiology. London: Butterworth, 1971;154.

    Google Scholar 

  178. Parris WC, Oates JA, Kambam J, Shmerling R, Sawyers JF. Pre-treatment with somatostatin in the anaesthetic management of a patient with carcinoid syndrome. Can J Anaesth 1988;35:413–6.

    PubMed  Google Scholar 

  179. Humphrey PP, Feniuk W, Watts AD. Ketanserin—a novel antihypertensive drug? J Pharm Pharmacol 1982;34:541.

    PubMed  Google Scholar 

  180. Dery R. Theoretical and clinical considerations in anaesthesia for secreting carcinoid tumors. Can Anaesth Soc J 1971;18:245–63.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Supported by an American Cancer Society Career Development Award.

About this article

Cite this article

Memon, M.A., Nelson, H. Gastrointestinal carcinoid tumors. Dis Colon Rectum 40, 1101–1118 (1997). https://doi.org/10.1007/BF02050937

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02050937

Key words

Navigation