0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53
276 Carcinoidcomplications and prognosis
■Overall median survival of years to decades
■Early stage carcinoid tumors (any site): highly curable (>90%) with
surgery alone
■Midgut carcinoid: preferential metastases to liver
■Foregut and hindgut carcinoid: may metastasize to bone
■Metastatic or unresectable carcinoid tmors typically slow-growing
with indolent course
➣regional metastasis: overall 5-yr survival rate of 64% (23% for
stomach, 100% for appendix).
➣distant metastases: overall 5-yr survival∼20% (0% for stomach,
∼10% for rectum and bronchus, 20% for small intestine, 27% for
appendix)
■70% of patients with midgut carcinoids develop carcinoid syndrome,
most often in association with liver metastases
■Carcinoid crisis: immediate and life-threatening complication of
carcinoid
➣spontaneously or with stress, anesthesia, certain foods (e.g.
cheese, alcohol)
➣intense flushing, diarrhea, abdominal pain, mental status
changes from headache to coma, tachycardia, hypertension, or
profound hypotension
■Complications due to carcinoid-induced fibrosis:
➣cardiac fibrosis associated with right heart abnormalities: tricus-
pid regurgitation and pulmonic stenosis with CHF (up to 50%
with carcinoid syndrome).
➣retroperitoneal fibrosis causing ureteral obstruction
➣Peyronies disease
■Causes of death:
■liver failure (extensive metastases), CHF, carcinoid crisis, malnutri-
tion
■Rare complications:
➣pellegra with hyperkeratosis and pigmentation
➣intrabdominal fibrosis and occlusion of mesenteric arteries or
veins
➣sexual dysfunction in men
➣endocrine abnormalities: Cushings syndrome from ectopic
ACTH (most common in foregut carcinoids); acromegaly sec-
ondary to GH release
➣others: rheumatoid arthritis arthralgias, mental status changes,
ophthalmic changes secondary to vessel occlusion