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Management of midgut carcinoids
Göran Akerström1, Per Hellman, Ola Hessman
1Department of Surgery, University Hospital, Uppsala, Sweden. goran.akerstrom@sursci.uu.se
Journal of Surgical Oncology
|February 19, 2005
Summary
Midgut carcinoids, a common cause of carcinoid syndrome, are best managed with surgery and biotherapy. This combined approach improves survival and quality of life for patients with advanced disease.
Area of Science:
- Gastroenterology
- Oncology
- Endocrinology
Background:
- Midgut carcinoids in the small intestine are the primary cause of carcinoid syndrome, characterized by flush, diarrhea, and cardiac issues.
- Tumor identification relies on chromogranin A/synaptophysin immunostaining and serotonin reactivity, indicating midgut origin.
Purpose of the Study:
- To review the diagnosis, surgical management, and biotherapy for midgut carcinoids and carcinoid syndrome.
- To highlight the importance of surgical intervention for primary tumors, metastases, and symptom palliation.
Main Methods:
- Histological identification using chromogranin A and synaptophysin immunostaining.
- Biochemical tumor markers: urinary 5-HIAA and serum chromogranin A.
- Surgical removal of primary tumors, mesenteric, and liver metastases.
- Biotherapy with somatostatin analogues and interferon.
Main Results:
- Surgery aims to remove primary and metastatic tumors, preventing complications like bowel ischemia and abdominal issues.
- Surgical debulking of liver metastases can significantly palliate carcinoid syndrome symptoms.
- Combined surgery and biotherapy lead to symptom alleviation, disease stabilization, and slow progression.
Conclusions:
- Surgical management is crucial for midgut carcinoids, addressing both tumor burden and potential complications.
- The combination of surgery and biotherapy offers favorable survival and improved quality of life for advanced midgut carcinoid patients.