Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Carcinoid 275

management

What to Do First

■obtain 5-HIAA and CT scan of abdomen if carcinoid tumor suspected

based on symptoms

General Measures

■stage disease with CT scan of abdomen and obtain biopsy for con-

firmation

specific therapy

Localized Disease

■resection in all medically operable patients

■hepatic resection in patients with limited liver disease

■liver transplantation in younger patients with extensive liver metas-

tases and no extrahepatic disease (one study of 15 pts with 5 year

survival 69% after liver transplant for carcinoid)

Metastatic or unresectable disease without carcinoid syndrome

■follow with serial CT scans, as many will have indolent courses; treat

only for symptoms or more rapid growth

Carcinoid Syndrome

■octreotide: alleviates carcinoid syndrome in 85% of patients

■progression of tumor, symptomatic disease, or carcinoid syndrome

refractory to octreotide

■liver-dominant disease

➣limited liver lesions: resection or thermal ablation (percutaneous

radiofrequency ablation), or hepatic arterial embolization (with

or without chemotherapy)

■interferon with or without octreotide:

■chemotherapy

➣progressive disease refractory to other treatment

➣active agents: doxorubicin, 5-FU, DTIC, actinomycin D, cisplatin

VP-16, streptozotocin.

➣combination chemotherapy no advantage over single agent

(responses in <30% of patients, duration of response usually

<1 year)

follow-up

■Serial visits with symptom survey for pain, weight loss or symptoms

carcinoid syndrome

■Serial urinalyses for 5-HIAA and abdominal CT scans to determine

stability vs progression