Carcinoid Tumors: Have you seen this zebra?

Carcinoid tumors are one of cancer’s oddities. “They’re a real zebra, says Renuka Iyer, MD, assistant professor, department of medicine at Roswell Park Cancer Institute (716-845-3099). “They grow slowly, but they do metastasize, they do cause endocrine problems, bowel obstruction, liver failure and death. However, we can treat them effectively and patients can enjoy very long periods of cancer-free or progression-free survival; if found early even cure them.”

As many as 12,000 people are diagnosed each year with carcinoid tumors and that number is rising. Experts suspect many more remain undiagnosed or masquerade as other disorders. The hormone-producing tumors can cause a collection of symptoms, known as carcinoid syndrome, which include flushing, diarrhea, weakness, rapid heartbeat, abdominal pain, hypertension, and anxiety. Symptoms may worsen with foods like nuts and chocolate and patients may believe they’re allergic.

Dr. Iyer says patients with unexplained diarrhea, flushing, long-standing irritable bowel syndrome, newly-diagnosed but difficult-to-manage diabetes and bad asthma with abnormal triggers should undergo a 24-hour urine test and blood work. Red flags include elevated urine 5-HIAA and elevated blood levels of chromogranin-A, insulin, glucagon, or gastrin. Carcinoid tumors are also found through CT scan with IV-contrast or radionuclide scanning (OctreoScan). Suspicious findings should be biopsied or referred to the Gastrointestinal Cancer Care Center at RPCI. “We see thirty to forty new cases a year and follow a number of patients with community oncologists,” says Dr. Iyer. “We can relieve the syndrome and effectively treat the tumors.”