CARCINOID TUMOUR

Carcinoid Tumour

Definition

• A carcinoid tumour is a slow-growing, malignant neuroendocrine tumour that originates from the neuroendocrine system.
• It is most commonly found in the gastrointestinal tract, particularly in the appendix.

Types

• Carcinoid tumours are classified based on their location and histological characteristics:
  • Bronchial carcinoids: Originate from the bronchi and are the most common type
  • Gastrointestinal carcinoids: Originate from the gastrointestinal tract, including the stomach, small intestine, and rectum
  • Pancreatic carcinoids: Originate from the pancreas
  • Thymic carcinoids: Originate from the thymus
  • Gastric carcinoids: Originate from the stomach

Pathology

• Carcinoid tumours are composed of neuroendocrine cells that produce and secrete various hormones and peptides.
• They are characterized by their ability to produce serotonin, which can lead to carcinoid syndrome.
• The tumours are typically well-differentiated, with a low mitotic rate and minimal cellular atypia.

Causes

• The exact cause of carcinoid tumours is unknown, but several factors contribute to their development:
  • Genetic predisposition: Family history and genetic mutations can increase the risk
  • Environmental factors: Exposure to certain chemicals and radiation may contribute
  • Hormonal influences: Hormonal imbalances and changes may play a role

Clinical Features

• Carcinoid tumours can present with a range of symptoms, depending on their location and the hormones produced:
  • Carcinoid syndrome: Diarrhea, flushing, wheezing, and heart valve abnormalities due to high serotonin levels
  • Abdominal pain and bleeding due to gastrointestinal involvement
  • Respiratory symptoms due to bronchial involvement

Investigations

• Diagnostic tests for carcinoid tumours include:
  • Imaging studies: CT, MRI, and PET scans to locate the tumour
  • Blood tests: Chromogranin A and 5-HIAA (5-hydroxyindoleacetic acid) levels to detect carcinoid syndrome
  • Biopsy: Tissue sample for histological examination

Complications

• Carcinoid tumours can lead to various complications, including:
  • Metastasis: Spread to lymph nodes, liver, and other organs
  • Carcinoid syndrome: Symptoms due to high serotonin levels
  • Hormonal imbalances: Changes in hormone production and secretion

Management and Treatment

• Treatment options for carcinoid tumours depend on the tumour's location, size, and aggressiveness:
  • Surgery: Resection of the primary tumour and involved lymph nodes
  • Chemotherapy and targeted therapy: To control tumour growth and symptoms
  • Radiofrequency ablation: To destroy the tumour
  • Palliative care: To manage symptoms and improve quality of life

Blood Supply

• The blood supply to carcinoid tumours is typically from the:
  • Superior mesenteric artery (SMA) for gastrointestinal carcinoids
  • Bronchial arteries for bronchial carcinoids
  • Pancreaticoduodenal arteries for pancreatic carcinoids

Nerve Supply

• The nerve supply to carcinoid tumours varies depending on their location:
  • Vagus nerve for gastrointestinal carcinoids
  • Bronchial nerves for bronchial carcinoids
  • Pancreatic nerves for pancreatic carcinoids

Clinical Anatomy

• Knowledge of the anatomical structures surrounding carcinoid tumours is crucial for surgical planning:
  • Gastrointestinal tract anatomy for gastrointestinal carcinoids
  • Thoracic cavity anatomy for bronchial carcinoids
  • Pancreatic anatomy for pancreatic carcinoids

Homoeopathic Therapeutic Medicines

• Some homoeopathic medicines that may be used to treat carcinoid tumours include:
  • Lachesis: For symptoms related to carcinoid syndrome
  • Belladonna: For symptoms such as flushing and sweating
  • Arsenicum album: For symptoms such as diarrhea and abdominal pain