Malignant Carcinoid Syndrome Treatment & Management

  • Author: Luigi Santacroce, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Jan 27, 2012
 

Medical Care

Systemic therapy should be used to control humorally mediated symptoms when the cancer spreads elsewhere. Initially, interferons and octreotide are useful in approximately 40% of patients.[32] Histamine blockers may also be useful. Diarrhea generally responds to standard antidiarrheal medications, but serotonin antagonists should be administered, if necessary, to control diarrhea and malabsorption. Severe and prolonged carcinoid crises associated with bronchial or stomach carcinoids may respond to corticosteroid treatment. Therapy with MIBG has recently been considered but is only experimental; however, administering a radioactive somatostatin analogue (In-111 DTPA-D-Phe1 octreotide) is a form of internal radiation therapy, which is hopefully strong enough to kill the tumor cells.

  • Somatostatin or its analogue may prevent flushing and other endocrine manifestations. Octreotide is a synthetic somatostatin analogue with high affinity for somatostatin receptors. Octreotide should be preferred to native somatostatin because of a longer half-life (average half-life of somatostatin is 2 min; that of octreotide is 2 h). Octreotide has demonstrated the ability to relieve symptoms in most patients, but tumor reduction is rarely observed.
  • The PROMID Study Group evaluated the ability of somatostatin analogs to control the growth of well-differentiated metastatic gastroenteropancreatic neuroendocrine tumors (NETs).[33] The phase IIIB study randomized 85 treatment-naive patients with mid-gut NETs to receive either placebo or octreotide LAR 30 mg IM monthly until tumor progression or death.
    • The primary efficacy endpoint was median time to tumor progression, which was found to be significantly longer in treatment with octreotide LAR compared with placebo (14.3 months vs 6 months, hazard ratio [HR] = 0.34; 95% confidence interval [CI], 0.20-0.59; p = 0.000072). Secondary endpoints included tumor response and survival time. At 6 months of treatment, more patients had stable disease in the octreotide LAR group compared with placebo (66.7% vs 37.2%) with similar responses in functionally active and inactive tumors. Survival analysis was reported as not confirmatory due to the low number of deaths.
    • Octreotide LAR significantly extends the time to tumor progression compared with placebo for patients with midgut NETs.
    • A randomized, placebo-controlled phase 3 trial found that everolimus plus octreotide LAR improved progression-free survival in patients with advanced NETs associated with carcinoid syndrome.[34]
  • Patients benefit from specific drugs that either suppress production of vasoactive amines or block the peripheral effects. These agents include alpha-adrenergic blocking drugs, cyproheptadine, and H2-receptor blockers.
  • Interferon-alpha may help control carcinoid symptoms or arrest tumor growth and reportedly may be effective in patients in whom octreotide treatment has failed; however, benefits are generally transient and accompanied by adverse effects.
  • Radiotherapy or chemotherapy with streptozotocin, cisplatin, etoposide, and doxorubicin, either alone or in combination, has been used, and reports show some success; a good response occurs in only 20-30% of cases. The role of radiation therapy in the management of carcinoid tumors with distant metastasis is restricted to symptomatic palliation of the painful bone metastases. This therapy is not useful for treating liver metastases or for other nonskeletal tissues.
    • Little evidence suggests that chemotherapy, either traditional or by continuous infusion, helps improve patient survival rates.
    • Failure to respond to one chemotherapy combination does not necessarily mean another combination will also be ineffectual.
    • The combination of interferon-alpha and continuous infusion of 5-fluorouracil (5-FU) has demonstrated antitumoral and antihormonal activity and can provide symptom palliation.
Next

Surgical Care

Complete surgical removal of all tumor tissues, when feasible, is the best treatment because it may result in a complete and permanent cure. The aim of surgical therapy is to reduce the tumor mass and obtain symptom remission. Performing a curative resection, mass debulking, or hepatic embolization is possible.

Cytoreductive surgery has been reported to have the best impact on symptom regression and overall survival.[35]

  • An extensive surgical excision, including the adjacent mesentery, must be performed.
    • Surgery should always be considered in patients with large or extensive hepatic metastases involving surgically accessible areas of the liver.
    • For lesions in the distal ileum, a right hemicolectomy is necessary to remove the lymphatic drainage adequately.
    • For tumors located in the appendix that are smaller than 1.5 cm in diameter, appendectomy is suitable and curative in 100% of patients. The involvement of the mesoappendix does not alter the patient's prognosis, but invasion of the cecum mandates more radical surgery (eg, right hemicolectomy with regional lymphadenectomy). Carcinoids in children usually occur in the appendix, and the appendectomy results in a complete cure.
    • Rectal carcinoids, if smaller than 1.5 cm in diameter, should be treated with local excision; if rectal carcinoids are larger than 1.5 cm, they must be considered malignant, and abdominoperineal resection (Miles operation) or low anterior resection should be performed.
  • Hepatic transplantation has also been attempted in selected patients, with promising results; however, generalization for this treatment option, because it is extremely expensive and debilitating, is not possible without more long-term studies.
  • Surgery should also be considered for resection of hepatic recurrence, even after previous resection, but only if the lesions are in an area where resection can be performed with minimal morbidity.
    • The whole intestine should be examined at the time of surgery to detect eventual multiple lesions.[36]
    • Chemoembolization with hepatic artery infusion of 5-FU or doxorubicin, combined with embolization of the hepatic artery with collagen fibers, causes substantial tumor necrosis. This procedure reportedly decreases tumor bulk of liver metastases from carcinoid tumors by more than 50% in as many as 60% of patients.[37]
    • Adverse effects of embolization are frequent and may be severe (see Tumor Lysis Syndrome).
  • Other surgical techniques, ablative but nonresective, include cryosurgery and percutaneous alcohol injections.
  • For any patient with controlled carcinoid symptoms and heart involvement, cardiac surgery must be considered for symptomatic carcinoid heart disease and must be performed by an experienced team (including medical, surgical, and anesthesiology experts) in order to provide the best management of this condition.[38, 39]
  • For patients with silent disease and symptomatic carcinoid heart disease, valve replacement should be considered.
  • Surgical resection can provide effective palliation in carefully selected patients. Debulking hepatic metastases may palliate systemic symptoms, and intestinal resection is highly effective in relieving symptoms of intestinal obstruction and ischemia.[40] Palliative surgery may be associated with substantial morbidity, and the effects are often transient. However, a retrospective nonrandomized study suggests that patients with carcinoid heart disease who undergo hepatic resection have decreased cardiac progression and improved prognosis.[41]
Previous
Next

Consultations

Consult with either a cardiologist or pneumologist for cardiac and respiratory assessment.

Previous
Next

Diet

In patients with malignant carcinoid syndrome, diarrhea and weight loss are severe problems that need to be controlled.

  • The major nutrients are absorbed easily and do not exacerbate the diarrhea, while most vegetables are very irritating.
  • Patients with severe diarrhea should be careful to avoid dehydration or vitamin deficiency. Nicotinamide and niacin supplements are very useful and must be prescribed, along with potassium, magnesium, iron, and essential elements.
  • Always recommend increased protein in the diet.
Previous
Next

Activity

Mild (not stressful) physical activity is not harmful and is possible if desired. No intense physical activities are allowed.

Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Luigi Santacroce, MD  Assistant Professor, Medical School, State University at Bari, Italy

Disclosure: Nothing to disclose.

Coauthor(s)

Laura Diomede  University of Bari School of Medicine, Italy

Disclosure: Nothing to disclose.

Lodovico Balducci, MD  Professor of Oncology and Medicine, University of South Florida College of Medicine; Division Chief, Senior Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute

Disclosure: Nothing to disclose.

Specialty Editor Board

Sanjiv S Agarwala, MD  Chief of Oncology and Hematology, St Luke's Cancer Center, St Luke's Hospital and Health Network; Professor, Temple University Shool of Medicine

Sanjiv S Agarwala, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Head and Neck Surgery, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, and European Society for Medical Oncology

Disclosure: BMS Honoraria Speaking and teaching; Novartis Consulting fee Consulting; Merck Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

References

  1. Bendelow J, Apps E, Jones LE, et al. Carcinoid syndrome. Eur J Surg Oncol. Mar 2008;34(3):289-96. [Medline].

  2. Feldman JM. Carcinoid tumors and syndrome. Semin Oncol. Sep 1987;14(3):237-46. [Medline].

  3. Feldman JM. Carcinoid tumors and the carcinoid syndrome. Curr Probl Surg. Dec 1989;26(12):835-85. [Medline].

  4. Lubarsch O. Ueber den primaren Krebs des Ileum, nebst Bemerhunge uber das gleichzeitge Vorkommen von Krebs und Tuberculose. Virchows Arch. 1888;111:280-317.

  5. Oberndorfer S. Uber die "kleinen Dunndarm Carcinome". Verh Dtsch Ges Pathol. 1907;11:113—6.

  6. Erspamer V, Asero B. Identification of enteramine, the specific hormone of the enterochromaffin cell system, as 5-Hydroxytryptamine. Nature. 1952;169:800-1.

  7. Gosset A, Masson P. Tumeurs endocinne de l'appendice. Presse Med. 1914;22:237-40.

  8. Masson, P. Carcinoids (argentaffin-cell tumors) and nerve hyperplasia of appendicular mucosa. Am J Patholol. 1928;4:181-212.

  9. Ahlman H. Midgut carcinoid tumors. Surg Annu. 1986;18:65-93. [Medline].

  10. Papadogias D, Makras P, Kossivakis K, et al. Carcinoid syndrome and carcinoid crisis secondary to a metastatic carcinoid tumour of the lung: a therapeutic challenge. Eur J Gastroenterol Hepatol. Dec 2007;19(12):1154-9. [Medline].

  11. Bonaros N, Muller S, Bonatti J, et al. Primary ovarian carcinoid heart disease curatively treated with a two-stage procedure. Thorac Cardiovasc Surg. Oct 2007;55(7):467-9. [Medline].

  12. Chaowalit N, Connolly HM, Schaff HV, et al. Carcinoid heart disease associated with primary ovarian carcinoid tumor. Am J Cardiol. May 15 2004;93(10):1314-5. [Medline].

  13. Bhattacharyya S, Davar J, Dreyfus G, et al. Carcinoid heart disease. Circulation. Dec 11 2007;116(24):2860-5. [Medline].

  14. Cunningham JL, Janson ET, Agarwal S, Grimelius L, Stridsberg M. Tachykinins in endocrine tumors and the carcinoid syndrome. Eur J Endocrinol. Sep 2008;159(3):275-82. [Medline].

  15. Russo S, Boon JC, Kema IP, Willemse PH, den Boer JA, Korf J, et al. Patients with carcinoid syndrome exhibit symptoms of aggressive impulse dysregulation. Psychosom Med. May-Jun 2004;66(3):422-5. [Medline]. [Full Text].

  16. Quaedvlieg PF, Visser O, Lamers CB, Janssen-Heijen ML, Taal BG. Epidemiology and survival in patients with carcinoid disease in The Netherlands. An epidemiological study with 2391 patients. Ann Oncol. Sep 2001;12(9):1295-300. [Medline]. [Full Text].

  17. Berge T, Linell F. Carcinoid tumours. Frequency in a defined population during a 12-year period. Acta Pathol Microbiol Scand A. Jul 1976;84(4):322-30. [Medline].

  18. Wilson HM. Chronic subacute bowel obstruction caused by carcinoid tumour misdiagnosed as irritable bowel syndrome: a case report. Cases J. Jan 22 2009;2(1):78. [Medline].

  19. Metcalfe DD. Differential diagnosis of the patient with unexplained flushing/anaphylaxis. Allergy Asthma Proc. 2000;21(1):21-4. [Medline].

  20. Kleyn CE, Lai-Cheong JE, Bell HK. Cutaneous manifestations of internal malignancy: diagnosis and management. Am J Clin Dermatol. 2006;7(2):71-84. [Medline].

  21. Monsegu J, Algayres JP, Ciribilli JM, et al. [Tricuspid insufficiency disclosing carcinoid syndrome]. Rev Med Interne. 1994;15(9):593-6. [Medline].

  22. Shah GM, Shah RG, Veillette H, Kirkland JB, Pasieka JL, Warner RR. Biochemical assessment of niacin deficiency among carcinoid cancer patients. Am J Gastroenterol. Oct 2005;100(10):2307-14. [Medline].

  23. Banzali FM Jr, Tiwari AK, Frantz R, et al. Valvular heart disease caused by carcinoid syndrome: emphasis on the use of intraoperative transesophageal echocardiography. J Cardiothorac Vasc Anesth. Dec 2007;21(6):855-7. [Medline].

  24. Kulke MH, Freed E, Chiang DY, Philips J, Zahrieh D, Glickman JN, et al. High-resolution analysis of genetic alterations in small bowel carcinoid tumors reveals areas of recurrent amplification and loss. Genes Chromosomes Cancer. Jul 2008;47(7):591-603. [Medline].

  25. Granerus G, Lindell SE, Waldenstrom J, et al. Histamine metabolism in carcinoidosis. Lancet. Jun 4 1966;1(7449):1267-8. [Medline].

  26. Campana D, Nori F, Piscitelli L, Morselli-Labate AM, Pezzilli R, Corinaldesi R, et al. Chromogranin A: is it a useful marker of neuroendocrine tumors?. J Clin Oncol. May 20 2007;25(15):1967-73. [Medline].

  27. Bhattacharyya S, Toumpanakis C, Caplin ME, Davar J. Usefulness of N-terminal pro-brain natriuretic peptide as a biomarker of the presence of carcinoid heart disease. Am J Cardiol. Oct 1 2008;102(7):938-42. [Medline].

  28. Sinzinger H, Renner F, Granegger S. Unsuccessful iodine-131 MIBG imaging of carcinoid tumors and apudomas. J Nucl Med. Jul 1986;27(7):1221-2. [Medline].

  29. Garg S, Bourantas CV, Nair RK, Alamgir F. Carcinoid syndrome diagnosed by echocardiography. Int J Cardiol. Feb 11 2009;[Medline].

  30. Bastarrika G, Cao MG, Cano D, et al. Magnetic resonance imaging diagnosis of carcinoid heart disease. J Comput Assist Tomogr. Nov-Dec 2005;29(6):756-9. [Medline].

  31. Sinha V, Dyer P, Shuvro RC, Geh JI, Karandikar S. Case of carcinoid crisis following a fine-needle biopsy of hepatic metastasis. Eur J Gastroenterol Hepatol. Jan 2009;21(1):101-3. [Medline].

  32. Joensuu H, Kumpulainen E, Grohn P. Treatment of metastatic carcinoid tumour with recombinant interferon alfa. Eur J Cancer. 1992;28A(10):1650-3. [Medline].

  33. [Best Evidence] Rinke A, Müller HH, Schade-Brittinger C, Klose KJ, Barth P, Wied M, et al. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol. Oct 1 2009;27(28):4656-63. [Medline].

  34. Pavel ME, Hainsworth JD, Baudin E, et al. Everolimus plus octreotide long-acting repeatable for the treatment of advanced neuroendocrine tumours associated with carcinoid syndrome (RADIANT-2): a randomised, placebo-controlled, phase 3 study. Lancet. Dec 10 2011;378(9808):2005-12. [Medline].

  35. Hodul P, Malafa M, Choi J, et al. The role of cytoreductive hepatic surgery as an adjunct to the management of metastatic neuroendocrine carcinomas. Cancer Control. Jan 2006;13(1):61-71. [Medline].

  36. Eller R, Frazee R, Roberts J. Gastrointestinal carcinoid tumors. Am Surg. Jul 1991;57(7):434-7. [Medline].

  37. Farndon JR. The carcinoid syndrome: methods of treatment and recent experience with hepatic artery ligation and infusion. Clin Oncol. Dec 1977;3(4):365-75. [Medline].

  38. Codd JE, Drozda J, Merjavy J. Palliation of carcinoid heart disease. Arch Surg. Sep 1987;122(9):1076-7. [Medline].

  39. Bhattacharyya S, Davar J, Dreyfus G, Caplin ME. Carcinoid heart disease. Circulation. Dec 11 2007;116(24):2860-5. [Medline].

  40. Chambers AJ, Pasieka JL, Dixon E, Rorstad O. The palliative benefit of aggressive surgical intervention for both hepatic and mesenteric metastases from neuroendocrine tumors. Surgery. Oct 2008;144(4):645-51; discussion 651-3. [Medline].

  41. Bernheim AM, Connolly HM, Rubin J, Møller JE, Scott CG, Nagorney DM, et al. Role of hepatic resection for patients with carcinoid heart disease. Mayo Clin Proc. Feb 2008;83(2):143-50. [Medline].

  42. Gregor M. Therapeutic principles in the management of metastasising carcinoid tumors: drugs for symptomatic treatment. Digestion. 1994;55 Suppl 3:60-3. [Medline].

  43. Kleyn CE, Lai-Cheong JE, Bell HK. Cutaneous manifestations of internal malignancy: diagnosis and management. Am J Clin Dermatol. 2006;7(2):71-84. [Medline].

  44. Ramage JK, Davies AH, Ardill J, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (includingcarcinoid) tumours. Gut. Jun 2005;54 Suppl 4:iv:1-16. [Medline].

  45. Patients, Caregivers, and Friends. The Carcinoid Foundation. Available at www.carcinoid.org/index.shtml. Accessed September 27, 2009.

  46. Jabbour-Khoury S, Dabbous A, al-Jazzar M, et al. Anesthetic management of a patient having a carcinoid syndrome. Middle East J Anesthesiol. Oct 2003;17(3):435-47. [Medline].

  47. Anderson AS, Krauss D, Lang R. Cardiovascular complications of malignant carcinoid disease. Am Heart J. Oct 1997;134(4):693-702. [Medline].

  48. Anthony LB, Martin W, Delbeke D, et al. Somatostatin receptor imaging: predictive and prognostic considerations. Digestion. 1996;57 Suppl 1:50-3. [Medline].

  49. Bhattacharyya S, Toumpanakis C, Caplin ME, et al. Analysis of 150 patients with carcinoid syndrome seen in a single year at one institution in the first decade of the twenty-first century. Am J Cardiol. Feb 1 2008;101(3):378-81. [Medline].

  50. Bourgault C, Bergeron S, Bogaty P, et al. A most unusual acute coronary syndrome. Can J Cardiol. Apr 2006;22(5):429-32. [Medline].

  51. de Diego C, Marcos Alberca P, Cabrera JA, et al. Pathognomonic echocardiographic features of carcinoid syndrome. Clin Cardiol. Mar 2006;29(3):134. [Medline].

  52. [Guideline] de Herder WW, O'Toole D, Rindi G. ENETS Consensus Guidelinesfor the Diagnosis and Treatment of Neuroendocrine Gastrointestinal TumorsPart 2 - Midgut and Hindgut Tumors. Neuroendocrinology. 2008;87.

  53. Di Lucca J, Mahé E, Saiag P. [Severe acrocyanosis in carcinoid syndrome]. Ann Dermatol Venereol. Nov 2007;134(11):895-6. [Medline].

  54. Farling PA, Durairaju AK. Remifentanil and anaesthesia for carcinoid syndrome. Br J Anaesth. Jun 2004;92(6):893-5. [Medline].

  55. Feldman JM. Histaminuria from histamine-rich foods. Arch Intern Med. Nov 1983;143(11):2099-102. [Medline].

  56. Frilling A, Rogiers X, Knofel WT, et al. Liver transplantation for metastatic carcinoid tumors. Digestion. 1994;55 Suppl 3:104-6. [Medline].

  57. González O, Alberca MT, Santonja C. Echocardiographic diagnosis of carcinoid disease: exceptional evolution after ovarian tumor resection without cardiac surgery. Eur J Echocardiogr. Dec 2007;8(6):497-500. [Medline].

  58. Hodgson HJ. Controlling the carcinoid syndrome. BMJ. Nov 12 1988;297(6658):1213-4. [Medline].

  59. Jaber WA, Klarich KW. Images in cardiovascular medicine. Carcinoid heart disease. Circulation. Feb 21 2006;113(7):e160-1. [Medline].

  60. Jagernauth S, Patel A, Baig K, et al. Fungal endocarditis of the eustachian valve in carcinoid heart disease: a case report. J Heart Valve Dis. Nov 2007;16(6):631-3. [Medline].

  61. Lee KJ, Connolly HM, Pellikka PA. Carcinoid pulmonary valvulopathy evaluated by real-time 3-dimensional transthoracic echocardiography. J Am Soc Echocardiogr. Apr 2008;21(4):407.e1-2. [Medline].

  62. Majeed F, Porter TR, Tarantolo S, et al. Carcinoid crisis and reversible right ventricular dysfunction after embolization in untreated carcinoid syndrome. Eur J Echocardiogr. Oct 2007;8(5):386-9. [Medline].

  63. Mansencal N, Mitry E, Forissier JF, et al. Assessment of patent foramen ovale in carcinoid heart disease. Am Heart J. May 2006;151(5):1129.e1-6. [Medline].

  64. Maton PN. The carcinoid syndrome. JAMA. Sep 16 1988;260(11):1602-5. [Medline].

  65. Merino J, Zuluaga A, Gutierrez-Tejero F, et al. Pure testicular carcinoid associated with intratubular germ cell neoplasia. J Clin Pathol. Dec 2005;58(12):1331-3. [Medline].

  66. Mignon M. Natural history of neuroendocrine enteropancreatic tumors. Digestion. 2000;62 Suppl 1:51-8. [Medline].

  67. [Best Evidence] Moller JE, Pellikka PA, Bernheim AM, et al. Prognosis of carcinoid heart disease: analysis of 200 cases over two decades. Circulation. Nov 22 2005;112(21):3320-7. [Medline].

  68. Mollet NR, Dymarkowski S, Bogaert J. MRI and CT revealing carcinoid heart disease. Eur Radiol. Dec 2003;13 Suppl 4:L14-8. [Medline].

  69. Park SB, Kim JK, Cho KS. Imaging findings of a primary bilateral testicular carcinoid tumor associated with carcinoid syndrome. J Ultrasound Med. Mar 2006;25(3):413-6. [Medline].

  70. Robertson RG, Geiger WJ, Davis NB. Carcinoid tumors. Am Fam Physician. 2006;74(3):429-34. [Full Text].

  71. Rorstad O. Prognostic indicators for carcinoid neuroendocrine tumors of the gastrointestinal tract. J Surg Oncol. Mar 1 2005;89(3):151-60. [Medline].

  72. Rosenberg JM, Welch JP. Ileal tumor causing carcinoid syndrome without hepatic metastases. Arch Surg. Apr 1984;119(4):485. [Medline].

  73. Shapiro RS, Shafir M, Sung M, et al. Cryotherapy of metastatic carcinoid tumors. Abdom Imaging. May-Jun 1998;23(3):314-7. [Medline].

  74. Somak R, Shramana M, Vijay S, et al. Primary carcinoid tumor of the ovary: a case report. Arch Gynecol Obstet. Jan 2008;277(1):79-82. [Medline].

  75. Stella M, Decian F, Mithieux F, et al. Ileal carcinoid with liver metastasis presenting after ten years with abdominal mass and right heart failure: report of a case. Tumori. Jan-Feb 2006;92(1):83-5. [Medline].

  76. van der Horst-Schrivers AN, Wymenga AN, Links TP, et al. Complications of midgut carcinoid tumors and carcinoid syndrome. Neuroendocrinology. 2004;80 Suppl 1:28-32. [Medline].

  77. Yeo CJ, Couse NF, Zinner MJ. Serotonin and substance P stimulate intestinal secretion in the isolated perfused ileum. Surgery. Jan 1989;105(1):86-92. [Medline].

  78. Zeitlin IJ. Kinin release in the carcinoid syndrome. Lancet. Nov 1971;2(7732):1040. [Medline].

 
Previous
Next
 
A section (on the right) of an intestinal carcinoid mass arising from the mucosa (150 X). Image courtesy of Professor Pantaleo Bufo, University of Foggia, Italy.
A section of a carcinoid mass (350 X). Image courtesy of Professor Pantaleo Bufo, University of Foggia, Italy.
A section of a rare lymph node metastasis from adenocarcinoid tumor (250 X). Image courtesy of Professor Pantaleo Bufo, University of Foggia, Italy.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.