Clinical aspects of invasive carcinoid tumors

In a retrospective study at the University of Louisville Affiliated Hospitals, 42 patients with carcinoid tumors not arising in the anorectal area were identified in ten years (1962-1972). The ileum was the organ most frequently involved with primary tumor (28%). The nonappendiceal gastrointestinal tumors were multiple in 28%, metastatic in 66%, and associated with a second malignancy in 25%. Of the symptomatic small-bowel tumors, 83% were metastatic at the time of diagnosis. Carcinoid syndrome was observed in only two patients, both of whom had liver metastases and elevated urinary 5-HIAA levels. Resections for cure were done on 25 patients, palliative resections on six, and biopsy on six. Six tumors were from autopsy meterial. Among the 24 patients treated and followed up for five years, the survival rate was only 16%. In those patients having resection for cure, the five-year survival rate was 39%, exculding appendiceal tumors. The advanced stage of disease at time of discovery and the dismal prognosis for invasive carcinoids are contrary to many clinicians' impressions of the nature of carcinoid tumors but entirely consistent with several other recent reports (James Ewing Society meeting, April 1973).