Carcinoid Syndrome

Carcinoid syndrome happens when a rare type of cancer called a carcinoid tumor releases specific chemicals into the bloodstream. These chemicals cause a range of symptoms. This type of cancer, called a neuroendocrine tumor, usually starts in the digestive system or the lungs.

Carcinoid syndrome typically shows up when the carcinoid tumor has grown significantly. Treatment mainly focuses on addressing the cancer itself. Unfortunately, because the syndrome often develops only when the cancer is advanced, a cure might not be possible. Doctors may prescribe medications to lessen the symptoms and improve comfort.

Carcinoid syndrome happens when a tumor releases certain chemicals into your bloodstream. The specific symptoms you experience depend on the type of chemicals released. Here are some common symptoms:

• Redness and warmth in your face and upper chest (flushing): Your skin might turn slightly pink or even purplish, feeling hot to the touch. This flushing can last for a few minutes, a few hours, or even longer. It may happen without any clear reason, but sometimes stress, exercise, or alcohol can trigger it.

• Spider veins on your face: Small, purplish, spider-like veins might appear on your nose and upper lip.

• Frequent watery bowel movements (diarrhea): This can sometimes include abdominal pain or cramping.

• Breathing problems: You might experience wheezing or shortness of breath, much like asthma, along with the flushing.

• Fast heartbeat: Your heart might beat faster than usual, which can be a sign of the syndrome.

These are some of the potential symptoms of carcinoid syndrome. It's important to remember that not everyone with the syndrome will experience all of these symptoms, and the severity can vary. If you're concerned about any of these symptoms, it's best to talk to a doctor.

If you're worried about any health issues, schedule a visit with your doctor.

Carcinoid syndrome happens when a tumor, called a carcinoid tumor, releases chemicals like serotonin into your bloodstream. These tumors are most commonly found in parts of your digestive system, such as your stomach, intestines, appendix, colon, and rectum.

Not all carcinoid tumors cause problems. Only some release these harmful chemicals. Normally, your liver filters out these chemicals before they can travel throughout your body and cause symptoms.

If the tumor grows and spreads to your liver (a process called metastasis), it can release these chemicals without your liver having a chance to filter them. This is often the reason why people develop carcinoid syndrome—the cancer is advanced and has spread to the liver.

Sometimes, even if the tumor isn't widespread, it can still cause carcinoid syndrome. For example, if the tumor is in the lungs, the chemicals enter the bloodstream earlier in the process, before reaching the liver. This means the liver can't filter them out.

Tumors in the intestines, on the other hand, release the chemicals into the bloodstream, which must first pass through the liver. The liver typically breaks down these chemicals, preventing them from causing problems elsewhere in the body.

The exact reason why carcinoid tumors develop is still unknown.

Carcinoid syndrome can lead to several serious health problems.

Heart Problems (Carcinoid Heart Disease): Some people with carcinoid syndrome develop a condition that affects their heart. This is called carcinoid heart disease. It specifically damages the heart valves, making them leaky and unable to work efficiently. This can lead to a weakened heart.

Symptoms of heart problems from carcinoid syndrome include feeling very tired (fatigue) and having trouble breathing. Over time, this can progress to heart failure, where the heart struggles to pump blood efficiently throughout the body. In some cases, surgery to repair the damaged heart valves can help.

Sudden, Severe Episodes (Carcinoid Crisis): In some individuals with carcinoid tumors, a sudden and very serious event called a carcinoid crisis can happen. This involves intense flushing (a sudden redness and warmth in the skin), dangerously low blood pressure, confusion, and trouble breathing. These episodes can be triggered by things like the medicines used during surgery, particularly anesthesia. Carcinoid crisis is a life-threatening complication. To help avoid this, your doctor may prescribe medications before any surgery involving general anesthesia to lower the risk of a crisis occurring.

To diagnose carcinoid syndrome, a doctor first looks for other reasons why you might be experiencing skin flushing and diarrhea. If no other cause is found, the doctor might suspect carcinoid syndrome.

To confirm this, several tests can be done:

Looking inside your body (endoscopies):

Doctors use thin, flexible tubes with cameras (endoscopes) to look inside your body. These are important tools for checking different parts of the digestive system and lungs.

• Endoscopy: A tube is passed down your throat to examine your digestive tract (stomach, intestines).
• Bronchoscopy: A tube is passed down your throat and into your lungs to look for tumors.
• Colonoscopy: A tube is passed through your rectum to examine your colon (large intestine). These procedures can help pinpoint where a carcinoid tumor might be located.

Urine and Blood Tests:

• Urine test: When your body breaks down serotonin (a chemical), a certain substance is produced. If your urine shows high levels of this substance, it could suggest your body is processing extra serotonin, which is often released by carcinoid tumors.
• Blood test: Some carcinoid tumors release specific substances into your bloodstream. High levels of these substances in your blood can be a sign of the condition.

Imaging Tests:

• CT scan (Computed Tomography): This common imaging test uses X-rays to create detailed pictures of your organs. It's often the first imaging test used, as carcinoid tumors frequently start in the digestive system (stomach, intestines).
• MRI (Magnetic Resonance Imaging): MRI uses magnetic fields and radio waves to create detailed images. It can be helpful in some cases to get a clearer view of the tumor and surrounding tissues.
• Nuclear medicine scans: These scans use radioactive substances to highlight specific areas in the body. They can be particularly useful for finding tumors or checking if the cancer has spread.

Taking a Tissue Sample (Biopsy):

A small tissue sample (biopsy) from the suspected tumor is taken and sent to a lab for examination. The type of biopsy will depend on where the tumor is located.

All these tests work together to help your doctor determine if you have carcinoid syndrome and, if so, the extent of the condition. This information helps develop the best treatment plan for you.

Carcinoid syndrome treatment focuses on addressing both the cancer itself and the symptoms it causes. This often involves a combination of approaches.

Here are some common treatment options:

• Surgery: Removing the cancer, or as much of it as possible, is sometimes an option. This may be a good choice if the tumor is localized and can be safely removed.

• Targeted Medications: Certain medications, like octreotide (Sandostatin) and lanreotide (Somatuline Depot), can help reduce the effects of carcinoid syndrome by preventing cancer cells from releasing harmful chemicals. These medications can lessen symptoms like skin flushing and diarrhea. A medication called telotristat (Xermelo) can work together with these to specifically control diarrhea.

• Targeted Radiation Therapy (PRRT): This treatment uses a special drug that finds and attaches to cancer cells. This drug carries a tiny radioactive substance that destroys the cancer cells. It's a targeted approach, meaning the radiation is delivered directly to the cancer cells, minimizing harm to healthy tissues. This therapy is often used in advanced cases that haven't responded well to other treatments. Think of it like a guided missile hitting the cancer target.

• Blocking Blood Supply (Hepatic Artery Embolization): If cancer has spread to the liver, doctors can use a procedure called hepatic artery embolization. A thin tube (catheter) is inserted near the groin and guided to the artery that supplies blood to the liver. Tiny particles are then injected to block this artery, starving the cancer cells of their blood supply. Crucially, the healthy liver tissue is still able to get blood from other vessels.

• Heat or Cold Therapy (Ablation): For liver cancer, two techniques, radiofrequency ablation and cryotherapy, can be used. Radiofrequency ablation uses heat to destroy the cancer cells, while cryotherapy freezes them. These procedures are often used when other treatments aren't possible or aren't effective.

• Chemotherapy: Chemotherapy uses powerful drugs to kill cancer cells. These drugs can be given intravenously (into a vein) or taken as pills, or a combination of both. Chemotherapy is a common cancer treatment, but it can have side effects.

It's important to remember that the best treatment plan is tailored to each individual's specific situation, taking into account the type and stage of the cancer, as well as the patient's overall health. A doctor will work with you to create a personalized treatment strategy.