Carcinoid Syndrome

What is Carcinoid Syndrome?

The Carcinoid syndrome is a condition that is composed of a group of symptoms precipitated by carcinoid tumors. As reported, the condition occurs in about 10% of carcinoid tumors that would sprout when precipitated. Those affected of the condition have a history of cardiac abnormalities, garnering about 50% of carcinoid patients. According to studies, the condition commonly affects the digestive system such as the organ parts ileum and liver.


Symptoms

The presenting symptoms of the carcinoid syndrome are the following:

Intermittent abdominal pain or abdominal cramping

This is due to the altered bowel movements. The complication of the disease process which is intestinal obstruction may be likely if the person experiences persistent abdominal pain.

Flushing of the face, neck and the chest

This would indicate for an infectious process. About 90% of people with carcinoid syndrome experiences flushing. This can be found as well at the upper back and legs of the patient. This is characterized by dry flushing.

Loose stools or diarrhea

The affected shall be about 78% of all carcinoid syndrome cases. The loose stools can be mild or severe. It can be considered diarrhea if the episodes are more than three times a day.

Peripheral edema

This is a significant signs that there is an impending or developing cardiac problem. The areas affected are mostly the ankles, arms and legs, and face of the client.

Hypotension and cyanosis

Depleted oxygenation can lead to these conditions.

Wheezing

This is due to the increasing constriction effect of serotonin that makes a person manifest wheezing. The narrowing of the airway passages is due to the increase of serotonin levels.

Heart lesions

Cardiac involvement is likely to about 11 to 66% of the affected. This is due to the excessive serotonin levels that it affects the heart valves. Palpitations may result from this condition.

Complications

These include carcinoid heart disease. This is a condition where the heart or cardiovascular system is affected. The thickening of the heart valves is the usual effect of longterm carcinoid syndrome. Another form of complication is bowel obstruction and carcinoid crisis. The crisis is only possible when the condition has not been controlled. The manifestations of the disease process involve severe flushing, low blood pressure, and changes in sensorium and difficulty in breathing.

Causes

The cause of this condition is due to the development of carcinoid tumors. The tumors serve as a precursor of the series of symptoms. As noted, the tumors are rare in appearance and are slow in growth but are indeed causative of the syndrome. According to statistical report, about 70% of cases are involved with the gastrointestinal tract. Out of 10 people with carcinoid tumors, at least one of them shall develop carcinoid syndrome. The mechanism of the condition is too much release of serotonin. Chemicals that initiate blood vessel dilation also causes for the development of carcinoid syndrome. The tumors are known to produce the substance serotonin, as vasodilator.

Diagnosis

In order that carcinoid syndrome is diagnosed, certain tests are done as follows:

Physical assessment

Acquiring the medical history of the client can assist in the process of diagnosis. When the known manifestations of the client are in congruence with carcinoid syndrome, such as those mentioned above, then this can be considered as the first step in diagnosis.

24-hour urine test

Identifying the levels of 5-HIAA, known as the end product during metabolism of serotonin. As an increased amount of this product, carcinoid syndrome is suggestive.

Octreoscan

This is visualizing of the lesions and for probable metastasis.

CT scan and MRI

These are imaging tests that are also helpful in the diagnostic process.

Treatment

Once a person has been diagnosed with carcinoid syndrome, the doctor’s goal of treatment is to make sure that the patient shall receive the overall wellness and health in the due process. Here are the following remedies indicated for carcinoid syndrome:

Tumor reduction

This is done and believed as the first choice of treatment for carcinoid syndrome. The surgical intervention of decreasing the size of the tumor truly helps and assists in attaining a good outcome from the syndrome. In cases where the carcinoid tumors have spread to neighboring areas such as the liver, another procedure is suggested to be done.

Chemotherapy

This is essential in order to reduce tumor size or to eradicate the tumor cells.

Radiofrequency ablation

This kills directly the tumor or cancer cells by the use of needle with delivering heat to the supposed affected area.

Ocreatide or Sandostatin therapy

This medicine which can be provided through injection forms will slow the rate of growth of the cancer cells or tumor cells. As with this medication, less flushing and diarrhea shall be experienced by the affected.

Hepatic artery embolization

This is the procedure done in order to kill the tumor cells that have accumulated in the liver. The process involves blood supply depletion to the area in order to kill the tumor cells.

Hydration

Diarrhea is one of the presenting symptoms of carcinoid syndrome. We provide intravenous supplementation in order not to lead to dehydration.

Diet

Have a healthful diet. This is needed to be practiced for the digestive system is the usual target of the disease process.

Biochemical monitoring

This is done in order to assess the affectivity of the ongoing treatment process. Measuring the levels of tumor cells can assist us in the success of the given interventions. Here are the following tests:

  • Chromogranin A testing: This test identifies the number of CgA in the bloodstream, a protein found in the famous causative carcinoid tumor cells. This is considered as the available test that monitors the current state of the patient.
  • 5-Hydroxyindoleacetic Acid testing: This test would identify the levels of 5-HIAA which is a specific by-product if the carcinoid tumors. This is a better test compared with CgA testing.

Prognosis

As noted, the prognosis truly depends on the patient themself. Compliance to the treatment regimen provided for is a great influence in the process. 95% of carcinoid syndrome cases are believed to survive. Meaning, they receive a good prognosis. This is also influenced by the support system of the client. As his family or loved ones are there to support him emotionally and financially, then the prognosis shall be in his or her favor. Compliance with the treatment regimen is also a part of attaining a good prognosis.

Worst case scenarios are when the condition has been diagnosed late and that treatment was not provided in time. This can lower the prognosis grade. When metastasis has been identified, the condition shall have a lower percentage of survival rate.

Life expectancy

As discussed, a patient with carcinoid syndrome can survive the disease process. But the condition can put a limited life expectancy once diagnosed. About a 5-year life expectancy is presented to the affected. This is most likely when the condition has developed to metastasis. The main responsibility of the close relatives and friends of the affected is to assist the client in the process of acceptance and adaptation of the disease. Emotional support is essential and can be of help when a person receives such news of life expectancy.

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