Carcinoid Tumour

1. Carcinoid Carcinoid
TumoursTumours
Dr. Ahmed AlmumtinDr. Ahmed Almumtin

2. IntroductionIntroduction
The term The term “carcinoid” “carcinoid”
““Carcinoid syndrome” vs “carcinoid tumour”Carcinoid syndrome” vs “carcinoid tumour”

3. EpidemiologyEpidemiology
Carcinoids are relatively rare tumors.Carcinoids are relatively rare tumors.
incidence 4.7:100,000incidence 4.7:100,000
median age 63median age 63
male : femalemale : female
is it really increasing?is it really increasing?

4. DistributionDistribution

5. Pathology and gradingPathology and grading
Origin.Origin.
Different behaviour.Different behaviour.
Grading vs differentiation.Grading vs differentiation.
Two sub-Groups:Two sub-Groups:
Well differentiatedWell differentiated
Poorly differentiated Poorly differentiated

6. Embryonic classificationEmbryonic classification
Based on Embryonic originBased on Embryonic origin
Foregut - stomachForegut - stomach
Midgut - Small intestine, AppendixMidgut - Small intestine, Appendix
Hindgut - Colon, Rectum, Genitourinary, Hindgut - Colon, Rectum, Genitourinary,
Ovarian ..Ovarian ..
MetastaticMetastatic

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- Well differentiated:- Well differentiated:
•Low gradeLow grade
•Intermediate GradeIntermediate Grade
- Poorly differentiated- Poorly differentiated
•High gradeHigh grade
WHO ClassificationWHO Classification

9. Continue classificationContinue classification
European Neuroendocrine Tumour Society European Neuroendocrine Tumour Society
(ENTS) vs American Joint Committee on (ENTS) vs American Joint Committee on
Cancer (AJNCC) vs WHO.Cancer (AJNCC) vs WHO.

11. Carcinoid syndromeCarcinoid syndrome

12. Carcinoid SyndromeCarcinoid Syndrome
DefinitionDefinition
Pathophysiology - mediatorsPathophysiology - mediators
Tryptophan MetabolismTryptophan Metabolism
HistamineHistamine
KillekrienKillekrien
ProstaglandinsProstaglandins
TachykininsTachykinins
Clinical featuresClinical features

14. Clinical Features of Clinical Features of
carcinoid syndromecarcinoid syndrome
Cutaneous flushingCutaneous flushing
Venous Venous
telangiectasiatelangiectasia
diarrhoeadiarrhoea
bronchospasmbronchospasm
cardiac valvular cardiac valvular
lesionslesions

17. So, patient presentsSo, patient presents
as a result of the carcinoid as a result of the carcinoid
syndromesyndrome
or as a result of tumour growthor as a result of tumour growth
or as incidental findingor as incidental finding

18. DiagnosisDiagnosis
Biochemical testing:Biochemical testing:
Urinary 5-HIAAUrinary 5-HIAA
Urinary SerotoninUrinary Serotonin
serum chromograninserum chromogranin
Serum serotonin Serum serotonin
Tumour localisationTumour localisation
CTCT
MRIMRI
Scintigraphy OctreoScanScintigraphy OctreoScan
PET scanPET scan
EndoscopyEndoscopy

19. Basic principles of evaluation and Basic principles of evaluation and
management of patients with management of patients with
carcinoid tumourscarcinoid tumours
Radiographic Staging and LocalisationRadiographic Staging and Localisation
Pathologic assessment of tumour differentiation Pathologic assessment of tumour differentiation
and/or gradeand/or grade
Removal of TumourRemoval of Tumour
Control of carcinoid symptomsControl of carcinoid symptoms

21. Treatment of Localised Treatment of Localised
CarcinoidsCarcinoids
- Appendix- Appendix
- Small intestine- Small intestine
- Rectum- Rectum
- Colon- Colon
- Stomach- Stomach

22. AppendixAppendix
SizeSize
>2 cm>2 cm
< 2cm< 2cm
Appendectomy vs Rt Appendectomy vs Rt
hemicolectomyhemicolectomy

24. Small intestineSmall intestine
Usual location.Usual location.
MatastasisMatastasis
prognosisprognosis

26. RectumRectum
TreatmentTreatment
< 1 cm mucosa or < 1 cm mucosa or
submucosasubmucosa
> 2 cm or beyond > 2 cm or beyond
muscolaris propriamuscolaris propria
PrognosisPrognosis

27. ColonColon
AggressiveAggressive
5 years survival5 years survival
prognosisprognosis

28. StomachStomach
TypesTypes
optionsoptions
Medical therapy?Medical therapy?

29. PrognosisPrognosis
Stage and Site of originStage and Site of origin
Tumour differentiationTumour differentiation

30. Post-treatment F/UPost-treatment F/U
Gastric, Small intestine, Colonic, appendiceal Gastric, Small intestine, Colonic, appendiceal
and Rectaland Rectal
3 to 12 months..3 to 12 months..
more than one yearmore than one year
Gastric <= 2 cmGastric <= 2 cm

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Thank youThank you