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Carcinoid Tumor

Carcinoid tumors are rare, slow-growing neuroendocrine tumors.

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Presentation

  • Small intestinal carcinoid: The most common presentation of this disease is the abdominal pain caused by fibrosis of the mesentery, or intestinal obstruction.
  • Ectopic adenocorticotropic hormone (ACTH) and Cushing’s disease: These symptoms are observed in foregut carcinoid tumors and must be differentiated with that observed in other tumors. Carcinoid tumors can cause rare acromegaly, which must be differentiated from pituitary tumors.
  • Carcinoid crisis: The symptoms such as intense flushing, diarrhea, tachycardia, hyper- or hypotension can happen spontaneously in carcinoid tumors or as a response to chemotherapy or anesthesia.
  • Cutaneous flushing: In 94% of the cases, the symptom of carcinoid tumors is cutaneous flushing, which affects the head and neck. Some of the triggers of the flushing are exercise, stress and some food.
  • Most of the patients with carcinoid tumor suffer from diarrhea and malabsorption. In these patients, the stool is frothy, watery and bulky.
  • Asthma-like syndrome or wheezing is caused by the constriction of the bronchi. There are some tremors which are relatively indolent resulting in chronic symptoms such as cough and shortness of breath.
  • Valvular heart lesions, fibrosis of endocardium on the right side is observed in such patients, though pulmonic valve fibrosis is relatively uncommon. Lesion on the cardiac tissues can cause heart failure.
  • Often carcinoid tumors occur in association with the genetic disorders such as multiple endocrine neoplasia type I and Peutz-Jeghers syndrome.
  • In carcinoid tumor, multicentric tumors in more than one organ have been reported [1] [4].
Weight Loss
  • We hereby report a case of a very rare presentation of tuberculosis (TB) in a patient who presented with a dry cough and significant weight loss for 3 months.[ncbi.nlm.nih.gov]
  • Clinical features WDHA syndrome (Watery Diarrhea, Hypokalemia, Achlorhydria ) Weight loss Abdominal pain, nausea, vomiting Achlorhydria iron and B 12 absorption anemia Diagnosis Serum VIP concentration ( 75 pg/mL) Hypokalemia, hypercalcemia, hyperglycemia[amboss.com]
  • Signs and symptoms of GI carcinoid tumors in the jejunum and ileum may include: Abdominal pain Weight loss for no known reason Feeling very tired Feeling bloated Diarrhea Nausea Vomiting Colon Signs and symptoms of GI carcinoid tumors in the colon may[cancer.osu.edu]
  • Typically, carcinoid tumors of the colon present in the sixth to seventh decade of life during evaluation for anorexia, abdominal pain, and unintentional weight loss.[endocrinediseases.org]
  • This can include: flushing severe diarrhoea loss of appetite weight loss increased heart rate wheezing sudden changes in your blood pressure. Remember, carcinoid is rare and these symptoms can all be caused by other medical conditions.[cancervic.org.au]
Pallor
  • On examination, she was well nourished with stable vital signs, and no pallor, jaundice, or significant lymphadenopathy. Abdominal examination revealed no tenderness, organomegaly, or abnormal mass.[wjso.biomedcentral.com]
  • Striking color changes range from pallor or erythema to cyanosis. Episodes are often associated with an unpleasant warm feeling, itching, palpitation, upper-body erythema and edema, salivation, diaphoresis, lacrimation, and diarrhea.[emedicine.medscape.com]
Lower Extremity Pain
  • We report a case of a 33-year-old man, presenting with a five-month history of bilateral lower extremity pain, as well as paresthesia, and mild weakness in one lateral lower extremity.[ncbi.nlm.nih.gov]
Cough
  • We hereby report a case of a very rare presentation of tuberculosis (TB) in a patient who presented with a dry cough and significant weight loss for 3 months.[ncbi.nlm.nih.gov]
  • When symptoms are present, usually there is coughing or wheezing. The cough might produce blood in the phlegm or sputum. If the tumor is large enough to block an air passage, a person might develop an infection called post-obstructive pneumonia.[my.clevelandclinic.org]
  • Coughing up blood Wheezing Difficulty breathing Skin flushing, where the skin on the face and upper chest turns pinkish, red, or purple, and feels hot Causes of Carcinoid Tumors As with many cancers, it is unclear exactly what causes carcinoid tumors[bmc.org]
Dyspnea
  • We describe the case of a female patient, 21 years old, complaining of dyspnea attacks and wheezing 2 years ago. Chest radiography showed volume loss in the left lower lobe and ipsilateral retrocardiac triangular basal opacity.[ncbi.nlm.nih.gov]
  • […] prostaglandins) from a functional neuroendocrine tumor (particularly from the midgut), typically manifesting with increased bowel movements and diarrhea, episodic vasoactive flushes (particularly of the face), hypotension, tachycardia, venous telangiectasia, dyspnea[orpha.net]
  • The cancer also leads to intestinal bleeding, which in turn reduces the RBC level and causes anemia along with fatigue and dyspnea. The appendix : People with tumors in the appendix usually do not show symptoms.[news-medical.net]
  • It is characterized by the sudden onset of prolonged cutaneous flushing, peripheral cyanosis, confusion, dyspnea, and tachycardia.[visualdx.com]
Tracheal Deviation
  • A new chest x-ray showed complete collapse of the left lung, with remarkable tracheal deviation. Computed tomography revealed a large endobronchial lesion causing occlusion of the left main bronchus and significant mediastinal shift to the left.[ncbi.nlm.nih.gov]
Diarrhea
  • BACKGROUND Carcinoid tumor, benign, low-grade malignant, and high-grade malignant, can be associated with the release of vasoactive substances that cause symptoms including cutaneous flushing, diarrhea, and bronchospasm.[ncbi.nlm.nih.gov]
  • In a patient presenting with secretory diarrhea, episodic flushing, wheezing, and cardiac valvular abnormalities, consider a carcinoid tumor ![amboss.com]
  • This may be counterintuitive as the body loses bicarbonate during diarrhea, but if the diarrhea is chronic there are other mechanisms in the body.[lecturio.com]
  • Carcinoid crisis: The symptoms such as intense flushing, diarrhea, tachycardia, hyper- or hypotension can happen spontaneously in carcinoid tumors or as a response to chemotherapy or anesthesia.[symptoma.com]
Abdominal Pain
  • A 52 years old lady presented with the symptoms of recurrent upper abdominal pain, burning sensation of whole body and passage of loose stool. On endoscopy of upper GIT, there was a duodenal polyp.[ncbi.nlm.nih.gov]
  • However, some patients may experience symptoms such as facial flushing, diarrhea, abdominal pain, asthma, a rash, and dark-colored stools (which indicate intestinal bleeding).[mskcc.org]
Chronic Diarrhea
  • This causes chronic diarrhea and concomitant dehydration, metabolic alkalosis, and elevated bicarbonate.[lecturio.com]
  • Carcinoid syndrome causes redness or a feeling of warmth in your face and neck (skin flushing), chronic diarrhea, and difficulty breathing, among other signs and symptoms. Carcinoid heart disease.[mayoclinic.org]
  • Complications Carcinoid tumors secrete chemicals which can lead to complications such as carcinoid syndrome (skin flushing, chronic diarrhea, problems in breathing), carcinoid heart disease (leaky heart valves, and heart failure) and Cushing syndrome.[symptoma.com]
  • For example, carcinoid tumors in the rectum and colon are incidentally found during colonoscopy performed for colon cancer screening, for iron deficiency anemia, or for chronic diarrhea.[medicinenet.com]
Steatorrhea
  • Following the procedure, through 1996, he kept suffering from abdominal pain, chronic diarrhea, steatorrhea, tearing, and mild flush (carcinoid-like syndrome). He also developed cholelithiasis, skin pigmentation and exophthalmos.[scielo.isciii.es]
  • Stools are watery, frothy, bulky, or in the form of steatorrhea. Diarrhea may or may not be associated with abdominal pain, flushing, and cramps. It may be profuse and often colicky.[emedicine.medscape.com]
  • The NETs of the duodenal ampulla rarely cause functional syndrome associated with the over production of somatostatin, which can trigger diabetes mellitus, gallstones and steatorrhea; in this condition, the NET is named as somatostatinoma [ 11, 23, 24[pancreas.imedpub.com]
Bulky Stool
  • stools, gastrointestinal (GI) bleed or steatorrhea; may or may not be associated with abdominal pain, flushing, and cramps Cardiac manifestations (60%): Valvular heart lesions, fibrosis of the endocardium; may lead to heart failure with tachycardia and[emedicine.medscape.com]
Heart Failure
  • The patient was evaluated for valve replacement surgery, but surgery was not performed due to the degree of heart failure.[ncbi.nlm.nih.gov]
  • Heart failure management General measures for the treatment of heart failure include salt and water restriction, and monitoring of fluid balance and weight.[doi.org]
  • Early recognition and surgical valve replacement before advanced heart failure is established may improve the clinical outcome.[hungary.pure.elsevier.com]
Tachycardia
  • […] polypeptides, vasoactive amines, and prostaglandins) from a functional neuroendocrine tumor (particularly from the midgut), typically manifesting with increased bowel movements and diarrhea, episodic vasoactive flushes (particularly of the face), hypotension, tachycardia[orpha.net]
  • It is characterized by the sudden onset of prolonged cutaneous flushing, peripheral cyanosis, confusion, dyspnea, and tachycardia.[visualdx.com]
  • Bronchospasm, wheezing, tachycardia and hypotension are less common. Up to 50% of patients with carcinoid syndrome develop carcinoid heart disease.[healio.com]
  • Carcinoid crisis: The symptoms such as intense flushing, diarrhea, tachycardia, hyper- or hypotension can happen spontaneously in carcinoid tumors or as a response to chemotherapy or anesthesia.[symptoma.com]
Hypotension
  • Nevertheless, the primary treatment for hypotension in patients with carcinoid syndrome should be IV fluids, ocreotide, and phenylephrine (if necessary).[openanesthesia.org]
  • Calls for shortness of breath, wheezing, hypotension, profound flushing, or confusion should prompt urgent bedside evaluation as these symptoms may reflect carcinoid crisis.[cancertherapyadvisor.com]
  • […] including polypeptides, vasoactive amines, and prostaglandins) from a functional neuroendocrine tumor (particularly from the midgut), typically manifesting with increased bowel movements and diarrhea, episodic vasoactive flushes (particularly of the face), hypotension[orpha.net]
  • Bronchospasm, wheezing, tachycardia and hypotension are less common. Up to 50% of patients with carcinoid syndrome develop carcinoid heart disease.[healio.com]
Hypertension
  • Intraoperative handling of tumor Histamine releasing drugs (probably should be avoided in patients with carcinoid tumors, although these drugs have been used frequently in the past without complications) Diagnosis Severe hypotension/hypertension Flushing[openanesthesia.org]
  • Serotonin, for example, can lead to tachycardia and hypertensive crisis refractory to conventional treatment. DIAGNOSIS Basic screening with a 12 lead ECG and chest x ray is of limited value.[doi.org]
  • This condition may be triggered by stress, chemotherapy, anesthesia, hypothermia, or hypertension, and may even occur without any apparent triggers.[visualdx.com]
  • Redness and flushing of the face Perspiration Diarrhea Dyspnea Heavy breathing and asthma-like symptoms Increased heartbeat Murmuring of heart Unexpected rapid weight gain Feebleness Induced diabetes Uncontrolled hair growth in body and face Hypertension[news-medical.net]
  • […] for PDX1 (duodenal homeobox factor 1, Am J Surg Pathol 2009;33:626 ) Rarely PAP Electron microscopy description Well formed, membrane bound, dense core secretory granules with dense (osmophilic) cores Board review question #1 A 58 year old man with hypertension[pathologyoutlines.com]
Palpitations
  • Carcinoid syndrome comprises the presence of cutaneous flushing, diarrhea, abdominal pain, wheezing, and palpitations. It is usually seen in the setting of an ileal tumor that has metastasized to the liver. Lung carcinoid may also be responsible.[visualdx.com]
  • […] appendectomy Rectum – 1.5 cm abdominoperineal resection Chemoembolization of liver lesions Anesthetic Considerations History Some develop right heart problems due to tricuspid stenosis from serotonin action Other common problems – Asthma, wheezing, palpitations[openanesthesia.org]
  • These symptoms may include: Palpitations ("racing heart") Sweating Flushing (turning red in the face) Diarrhea High blood pressure How are neuroendocrine/carcinoid tumors diagnosed? When you see your physician, you will have a routine examination.[hopkinsmedicine.org]
  • […] cases) Possible triggers: alcohol consumption, food intake, stress In severe cases, may be accompanied by tachycardia and fluctuating blood pressure D yspnea, wheezing ( asthma -like attacks) (25% of cases) Possible weight loss despite normal appetite Palpitations[amboss.com]
Otalgia
  • A 38-year-old woman presenting with otalgia, aural fullness, and decreased hearing was found to have a recurrent EAC carcinoid tumor, 8-years after initial resection at an outside facility.[ncbi.nlm.nih.gov]
Arthritis
  • Skin hyperkeratosis and pigmentation and arthritis are also relatively uncommon.[emedicine.medscape.com]
  • […] chromogranin A levels include the following: chronic atrophic gastritis, liver cirrhosis, chronic hepatitis, pancreatitis, inflammatory bowel disease, heart failure, renal failure, hyperthyroidism, chronic obstructive pulmonary disease (COPD), and rheumatoid arthritis[cancertherapyadvisor.com]
  • Bad news — degenerative disk disease and arthritis. Also, met with oncologist University of Colorado Cancer Center for a second opinion.[cyrilfb.com]
  • Allen HB, Shaver CM, Etzler CA, Joshi SG (2015) Autoimmune Diseases of the Innate and Adaptive Immune System including Atopic Dermatitis, Psoriasis, Chronic Arthritis, Lyme Disease, and Alzheimer's Disease. ImmunochemImmunopathol 1: 112.[omicsonline.org]
Right Shoulder Pain
  • Unresolved right shoulder pain manifesting as the first clinical presentation of carcinoid tumor with unknown primary origin is a rare clinical entity.[ncbi.nlm.nih.gov]
Flushing
  • Cutaneous flushing: In 94% of the cases, the symptom of carcinoid tumors is cutaneous flushing, which affects the head and neck. Some of the triggers of the flushing are exercise, stress and some food.[symptoma.com]
  • Related topic: Non-carcinoid flushing.[visualdx.com]
  • A drug called octreotide can relieve flushing symptoms. Other treatments for flushing include phenothiazines (such as prochlorperazine) and histamine-blocking drugs such as ranitidine.[merckmanuals.com]
  • A drug called octreotide can relieve flushing symptoms. Other treatments for flushing include phenothiazines (such as prochlorperazine ) and histamine-blocking drugs such as ranitidine.[msdmanuals.com]
Erythema
  • Her physical examination revealed no erythema or swelling of the right shoulder. However, tenderness was noted on the right subacromial bursa and the right acromioclavicular joint. Her drop arm test was positive.[ncbi.nlm.nih.gov]
  • Striking color changes range from pallor or erythema to cyanosis. Episodes are often associated with an unpleasant warm feeling, itching, palpitation, upper-body erythema and edema, salivation, diaphoresis, lacrimation, and diarrhea.[emedicine.medscape.com]
  • With endoscopy, local erythema, edema, white patches, and ulcerations can all be seen. Typically, the distal third of the esophagus is most often affected. Biopsy results reveal mucosal invasion of yeast and pseudohyphae.[cancertherapyadvisor.com]
Pruritus
  • Case report We report the case of a 19 years-old woman with history of pruritus, jaundice, weight loss, and anorexia. Physical examination revealed only mild scleral jaundice.[scielo.isciii.es]
  • In January 1998, he presented with flushing, pruritus, and watery diarrhea.[bcmj.org]
Hyperkeratosis
Hyperpigmentation
  • Thymic carcinoid with cutaneous hyperpigmentation. Arch Intern Med 1985; 145 : 361–363. 32. Lokich JJ, Li F. Carcinoid of the thymus with hereditary hyperparathyroidism. Ann Intern Med 1978; 89 : 364–365. 33. Loon G, Schiby G, Milo S.[nature.com]
Lacrimation
  • Imaging studies revealed a large left intraocular tumor, a mass in the left medial rectus muscle, and right lacrimal gland enlargement. The OS was enucleated, and incisional biopsies were performed from the other 2 lesions.[ncbi.nlm.nih.gov]
  • Episodes are often associated with an unpleasant warm feeling, itching, palpitation, upper-body erythema and edema, salivation, diaphoresis, lacrimation, and diarrhea.[emedicine.medscape.com]
  • Lancet 352 : 799 – 805 32 1982 Metastatic carcinoid unresponsive to radiation therapy presenting as a lacrimal fossa mass. Ophthalmology 89 : 516 – 520 33 1980 Orbital carcinoid tumor metastatic from the colon.[academic.oup.com]
Facial Redness
Facial Numbness
  • We describe the case of a 65-year-old female with active chemotherapy-treated neuroendocrine carcinoma who presented with left-sided facial numbness, headaches, and blurry vision.[ncbi.nlm.nih.gov]
Confusion
  • It is characterized by the sudden onset of prolonged cutaneous flushing, peripheral cyanosis, confusion, dyspnea, and tachycardia.[visualdx.com]
  • Unfortunately, infectious and inflammatory conditions can also cause increased activity and this may be confusing if the tumor has caused pneumonia and lymph nodes that are reactive to the infection may be misinterpreted as showing evidence of metastasis[endocrinediseases.org]
  • A 65-year-old right-handed man was transferred to this hospital because of the recent onset of confusion and memory loss. MRI scans of the brain showed symmetric abnormalities involving the temporal lobes, left basal forebrain, and insular regions.[content.nejm.org]
  • Article Figures/Media A 65-year-old right-handed man was transferred to this hospital because of the recent onset of confusion and memory loss.[doi.org]
Altered Mental Status
  • Symptoms may include intense flushing, diarrhea, abdominal pain, tachycardia, hypertension or hypotension, altered mental status, and coma.[emedicine.medscape.com]

Workup

Laboratory studies

Diagnosis of carcinoid tumors depends on the characteristic biomarker of the disease. Measuring the biogenic amine (such as serotonin, histamine, and catecholamines) levels as well their metabolites in the plasma is important to diagnose the carcinoid tumor.

  • Urinary 5-HIAA levels: The increased levels of 5-HIAA in the urine helps in the assessment of carcinoid tumors. These levels, though, may not help in the detection of tumors at the early stage.
  • Fasting plasma 5-HIAA assay: This is a more stable and convenient test.
  • CDX2 and TTF-1 are indicative of the GI carcinoid tumors and pulmonary tumors respectively.

Imaging

Imaging techniques that can diagnose carcinoid tumors are as follows:

  • Upper and lower gastrointestinal tract radiography
  • CT
  • MRI
  • MIBG (metaiodobenzylguanidine) scan
  • PET

Depending on the type and location of the tumor, a combination of either of these can be used. For chest tumors, CT along with scintigraphy is used. Large bowel disease is often diagnosed by colonoscopy. Mesenteric invasion and liver metastasis can be detected by CT scans. For hepatic disease, MRI can be helpful in the diagnosis of the condition. PET scanning is helpful for the diagnosis and follow-up of the tumors. Radionuclide imaging has proven to be the best diagnostic tool for the diagnosis of carcinoid tumors. Somatostatin-receptor scintigraphy (SRS) and CT scanning can help detect localized tumors [1] [5] [6].

Chest X-Ray Abnormal
  • There is no way to tell if a chest x-ray abnormality is cancer, and infection, old scar tissue, or nothing at all without doing additional testing. Find Internists near you With a few exceptions, the next best test for you to get is a chest CT scan.[zocdoc.com]
Mediastinal Shift
  • Computed tomography revealed a large endobronchial lesion causing occlusion of the left main bronchus and significant mediastinal shift to the left. Despite the collapse of the left lung, no symptoms of bronchial obstruction were evident.[ncbi.nlm.nih.gov]

Treatment

Medical care: In case where the surgical excision is not suitable in patients with carcinoid tumor, the following chemotherapy drugs are recommended. Alkylating agents, doxorubicin, actinomycin D, cisplatin, interferon-alfa and streptozocin are some of the drugs that are used to manage the condition. In most of the cases, a combination of the agents is used.

Chemoembolization is one of the strategies for the management of carcinoid tumors. Though octreotide has been found to be very effective in reducing the symptoms, its use in pediatric population is still debated, as it reduces the level of growth factor which is produced impairing growth [7] [8].

Surgical care: The surgical excision as a treatment choice depends on the feasibility of the condition. Surgical technique depends on the location and the stage of the tumor. Simple appendectomy is the treatment option in most of the cases.

Block resection of the tumor (with the adjacent lymph nodes) is a surgical treatment adopted for intestinal carcinoids, while in case of bronchial tumor, surgical resection is opted. In most of the localized tumor, surgical resection works. For managing rectal tumor, endoscopic resection is sufficient. Debulking can provide symptomatic relief in patients when total resection is not possible [9] [10] [11].

Prognosis

Prognosis in the patients with carcinoid tumors depends on some important factors such as the location and size of the tumor, if the tumor has spread to other parts of the body, or if the tumor can be removed completely by surgery or if it recurred or was diagnosed for the first time.

Complications

Carcinoid tumors secrete chemicals which can lead to complications such as carcinoid syndrome (skin flushing, chronic diarrhea, problems in breathing), carcinoid heart disease (leaky heart valves, and heart failure) and Cushing syndrome.

Etiology

Though the etiology of the carcinoid tumor is not known, genetic abnormalities are often suspected. Changes in the chromosomal abnormalities can be defined as the loss of heterogeneity or numerical alterations of the chromosomes [1].

Epidemiology

Carcinoids are the most common neuroendocrine tumors. The true incidence of this type of tumor is still not clear. Though it is estimated to be around 1 every 100,000 individuals, there are some studies that have shown necropsies in approximately 1% of the population [2].

Sex distribution
Age distribution

Pathophysiology

The carcinoid tumors are of neuroendocrine origin. These tumors are derived from the primitive stem cells, giving rise to the multiple cell lineages. These tumors develop in the mucosa of the intestinal tract and grow slowly, extending to the submucosa and mucosal surface, resulting in the formation of small nodules.

The tumors are yellow, or gray-brown in color, due to the accumulation of cholesterol and lipids. Metastases can also occur in the liver, spleen, peritoneum, liver and the ovaries. Five distinct patterns of the carcinoid tumors are observed upon histological examination.

Some of the products of the carcinoid tumors are amylin, dopamine, gastrin, bombesin, catecholamines, motilin, pancreatic polypeptide, prostaglandins, serotonin, somatostatin and substance-P. The carcinoid tumors are found to be argyrophilic and argentaffinic, with somatostatin receptors. There is a high potential for metastasis in carcinoid tumors as these cells produce betacatenin [1] [3].

Prevention

Though carcinoid tumor has a genetic component, the risk of such tumors can reduce by taking some of the steps:

  • Maintaining a healthy bodyweight 
  • Regular exercises
  • Annual screening of such tumors
  • Quit smoking

Summary

Carcinoid tumors are derived from primitive stem cells, present in the gut wall, and other organs such as thymus, lungs, liver, ovaries, prostate and kidneys. Among children, carcinoid tumors are seen in the appendix which are benign and asymptomatic.

Most of these tumors are slow-growing and asymptomatic, though some are aggressive and metastatic. Carcinoid tumors can be classified based on the location of the primitive gut giving rise to the tumor such as foregut, midgut and hindgut.

Meckel diverticulum, mesentry and cystic duplications can also lead to the development of carcinoid tumors. These entities have shown distinctive features: clinical, histochemical, and secretory. While both foregut and hindgut carcinoids are argentaffin negative, the midgut carcinoids are argentaffin positive. Foregut tumors can metastasize to the bone and can be associated with acromegaly, Cushing’s disease, and hypertrophy of the skin of the face and the upper neck. In midgut and hindgut carcinoids, the bone metastasis is uncommon, though midgut carcinoid tumors have the rare potential to produce the corticotropic hormone [1].

Patient Information

Carcinoid tumors are derived from primitive stem cells, present in the gut wall, and other organs such as thymus, lungs, liver, ovaries, prostate and kidneys. There are no specific symptoms of the disease, however since there is a genetic component in the pathogenesis of the disease, any family member diagnosed earlier with carcinoid tumor adds to the risk of this disease in the sibling or children. Hence, in such cases, the patient must not neglect any possible signs and symptoms.

References

Article

  1. Maroun J, Kocha W, Kvols L, et al. Guidelines for the diagnosis and management of carcinoid tumors. Part 1: The gastrointestinal tract. A statement from a Canadian National Carcinoid Expert Group. Curr Oncol 2006 13 (2): 67–76.
  2. Melinda A. Maggard, Jessica B. O'Connell, Clifford Y. Ko. Updated Population-Based Review of Carcinoid Tumors. Ann Surg. 2004 July; 240(1): 117–122.
  3. Greenblatt DY, Kunnimalaiyaan M, Chen H. Raf-1 activation in gastrointestinal carcinoid cells decreases tumor cell adhesion. Am J Surg. Mar 2007;193(3):331-5. 
  4. Capovilla M, Kambouchner M, Bernier M, Soulier A, Tissier F, Saintigny P. Late cerebellar relapse of a juvenile bronchial carcinoid. Clin Lung Cancer. Mar 2007;8(5):339-41.
  5. Moertel CG. Karnofsky memorial lecture. An odyssey in the land of small tumors. J Clin Oncol. Oct 1987;5(10):1502-22
  6. Delcore R, Friesen SR. Gastrointestinal neuroendocrine tumors. J Am Coll Surg. Feb 1994;178(2):187-211.
  7. Lefebvre S, De Paepe L, Abs R, et al. Subcutaneous octreotide treatment of a growth hormone-releasing hormone-secreting bronchial carcinoid: superiority of continuous versus intermittent administration to control hormonal secretion. Eur J Endocrinol. Sep 1995;133(3):320-4.
  8. Corleto VD, Angeletti S, Schillaci O, et al. Long-term octreotide treatment of metastatic carcinoid tumor. Ann Oncol. Apr 2000;11(4):491-3
  9. Kwaan MR, Goldberg JE, Bleday R. Rectal carcinoid tumors: review of results after endoscopic and surgical therapy. Arch Surg. May 2008;143(5):471-5
  10. Spunt SL, Pratt CB, Rao BN, et al. Childhood carcinoid tumors: the St Jude Children's Research Hospital experience. J Pediatr Surg. Sep 2000;35(9):1282-6.
  11. Anderson JR, Wilson BG. Carcinoid tumours of the appendix. Br J Surg. Jul 1985;72(7):545-6.

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Last updated: 2019-07-11 21:53