Carcinoid syndrome (flushing, diarrhea)

Description Occurs when a carcinoid tumor produces serotonin in excess. Only 10% o...

Description

Occurs when a carcinoid tumor produces serotonin in excess. Only 10% of carcinoid tumors cause this syndrome. The symptoms of carcinoid syndrome include abdominal pain, facial flushing, racing heart and other symptoms that can be caused by activity or certain foods. The carcinoid tumors grow slowly and typically involve the stomach, intestines or lungs. It is more common for large tumors and tumors not in the intestines to cause the syndrome since the blood supply from the intestines flows to the liver. The liver neutralizes the serotonin, which prevents the symptoms. Complications include heart disease, intestinal blockage and carcinoid crisis. Carcinoid crisis involves flushing, low blood pressure, confusion and breathing problems.

Symptoms

Some patients have no symptoms. Only 10% of carcinoid tumors cause carcinoid syndrome. The symptoms of carcinoid syndrome include intermittent abdominal pain, flushing of the face, sudden and severe diarrhea, heart racing (palpitations), near fainting, weak pulse, wheezing. Sometimes the symptoms are caused by exercise, or consuming blue cheese, chocolate, or red wine.

Tests

Common tests used for diagnosis and treatment

Workup:
A history and physical exam will be done. The tumors can be found incidentally during surgery. Imaging tests such as CT scans and MRIs can detect the cancer. Blood tests for chromogranin A, or urine tests for 5-HIAA can detect the abnormal levels of serotonin.

Specialists:
General Surgery, Endocrinology, Surgical Oncology

Treatment

Surgery to remove all or as much of the tumor as possible is typically performed. Other treatment options include: octreotide injections, interferon injections, blocking the blood supply to the cancer (hepatic artery embolization), radiofrequency ablation of the tumor, and chemotherapy.