Carcinoid Tumors

Carcinoid tumours — now usually called neuroendocrine tumours (NETs) — are a group of slow-growing cancers arising from hormone-producing cells. They most often occur in the digestive tract, lungs, and pancreas. Many are found incidentally on a scan or endoscopy; some cause striking hormonal symptoms ("carcinoid syndrome"). Outcomes vary widely — some are cured by simple surgery; others are slow-growing cancers that need long-term management.

Symptoms

• Often none — found incidentally.
• Carcinoid syndrome — facial flushing, diarrhoea, wheezing, palpitations; usually when liver is involved.
• Abdominal symptoms — crampy pain, obstruction.
• Cough, wheeze — lung NETs.
• Hormonal syndromes — insulinoma (hypoglycaemia), gastrinoma (ulcers and diarrhoea), VIPoma (profuse diarrhoea), glucagonoma.
• Flush, carcinoid heart disease — from serotonin effects.

Evaluation

• Biopsy with specific markers (chromogranin, synaptophysin, Ki-67 index).
• Blood and urine hormone tests — serotonin, chromogranin A, 5-HIAA, insulin, gastrin, etc., as relevant.
• Imaging — CT, MRI, DOTA-PET (Gallium-68) — the specialised NET scan, available at select Indian centres.
• Echocardiography if carcinoid syndrome — screen for heart involvement.

Treatment

• Surgery — for localised disease; often curative.
• Somatostatin analogues — control symptoms and slow tumour growth.
• Targeted therapies (mTOR-inhibitor and anti-angiogenic classes) — for advanced pancreatic NETs.
• Peptide Receptor Radionuclide Therapy (PRRT) — available at several Indian centres; excellent for selected metastatic NETs.
• Liver-directed therapies (embolisation, ablation) for liver metastases.
• Chemotherapy for poorly differentiated types.
• Care at a centre with NET expertise changes outcomes substantially.