Download - Carcinoid Tumour
Carcinoid Carcinoid TumoursTumours
Dr. Ahmed AlmumtinDr. Ahmed Almumtin
IntroductionIntroduction
The term The term ““carcinoidcarcinoid””
““Carcinoid syndromeCarcinoid syndrome”” vs vs ““carcinoid tumourcarcinoid tumour””
EpidemiologyEpidemiology
Carcinoids are relatively rare tumors.Carcinoids are relatively rare tumors.
incidence 4.7:100,000incidence 4.7:100,000
median age 63median age 63
male : femalemale : female
is it really increasing?is it really increasing?
DistributionDistribution
Pathology and gradingPathology and grading
Origin.Origin.
Different behaviour.Different behaviour.
Grading vs differentiation.Grading vs differentiation.
Two sub-Groups:Two sub-Groups:
Well differentiatedWell differentiated
Poorly differentiated Poorly differentiated
Embryonic classificationEmbryonic classification
Based on Embryonic originBased on Embryonic origin
Foregut - stomachForegut - stomach
Midgut - Small intestine, AppendixMidgut - Small intestine, Appendix
Hindgut - Colon, Rectum, Genitourinary, Hindgut - Colon, Rectum, Genitourinary, Ovarian ..Ovarian ..
MetastaticMetastatic
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- Well differentiated:- Well differentiated:• Low gradeLow grade• Intermediate GradeIntermediate Grade
- Poorly differentiated- Poorly differentiated• High gradeHigh grade
WHO ClassificationWHO Classification
Continue classificationContinue classification
European Neuroendocrine Tumour Society European Neuroendocrine Tumour Society (ENTS) vs American Joint Committee on Cancer (ENTS) vs American Joint Committee on Cancer (AJNCC) vs WHO.(AJNCC) vs WHO.
Carcinoid syndromeCarcinoid syndrome
Carcinoid SyndromeCarcinoid Syndrome
DefinitionDefinition
Pathophysiology - mediatorsPathophysiology - mediators
Tryptophan MetabolismTryptophan Metabolism
HistamineHistamine
KillekrienKillekrien
ProstaglandinsProstaglandins
TachykininsTachykinins
Clinical featuresClinical features
Clinical Features of Clinical Features of carcinoid syndromecarcinoid syndrome
Cutaneous flushingCutaneous flushing
Venous Venous telangiectasiatelangiectasia
diarrhoeadiarrhoea
bronchospasmbronchospasm
cardiac valvular cardiac valvular lesionslesions
So, patient presentsSo, patient presents
as a result of the carcinoid as a result of the carcinoid syndromesyndrome
or as a result of tumour growthor as a result of tumour growth
or as incidental findingor as incidental finding
DiagnosisDiagnosisBiochemical testing:Biochemical testing:
Urinary 5-HIAAUrinary 5-HIAA
Urinary SerotoninUrinary Serotonin
serum chromograninserum chromogranin
Serum serotonin Serum serotonin
Tumour localisationTumour localisation
CTCT
MRIMRI
Scintigraphy OctreoScanScintigraphy OctreoScan
PET scanPET scan
EndoscopyEndoscopy
Basic principles of evaluation and Basic principles of evaluation and management of patients with management of patients with carcinoid tumourscarcinoid tumours
Radiographic Staging and LocalisationRadiographic Staging and Localisation
Pathologic assessment of tumour Pathologic assessment of tumour differentiation and/or gradedifferentiation and/or grade
Removal of TumourRemoval of Tumour
Control of carcinoid symptomsControl of carcinoid symptoms
Treatment of Localised Treatment of Localised CarcinoidsCarcinoids
- Appendix- Appendix- Small intestine- Small intestine- Rectum- Rectum- Colon- Colon- Stomach- Stomach
AppendixAppendix
SizeSize
>2 cm>2 cm
< 2cm< 2cm
Appendectomy vs Rt Appendectomy vs Rt hemicolectomyhemicolectomy
Small intestineSmall intestine
Usual location.Usual location.
MatastasisMatastasis
prognosisprognosis
RectumRectum
TreatmentTreatment
< 1 cm mucosa or < 1 cm mucosa or submucosasubmucosa
> 2 cm or beyond > 2 cm or beyond muscolaris propriamuscolaris propria
PrognosisPrognosis
ColonColon
AggressiveAggressive
5 years survival5 years survival
prognosisprognosis
StomachStomach
TypesTypes
optionsoptions
Medical therapy?Medical therapy?
PrognosisPrognosis
Stage and Site of originStage and Site of origin
Tumour differentiationTumour differentiation
Post-treatment F/UPost-treatment F/U
Gastric, Small intestine, Colonic, appendiceal Gastric, Small intestine, Colonic, appendiceal and Rectaland Rectal
3 to 12 months..3 to 12 months..
more than one yearmore than one year
Gastric <= 2 cmGastric <= 2 cm
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Thank youThank you