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home - Colon - Colorectal and Anal Cancer - Carcinoid Symptom Treatment Written by Dr Sebastian Zeki
Knowledge

Knows the pathology of benign and malignant tumours of the colon
and rectum
Has awareness of the molecular genetics of colorectal
carcinogenesis and the adenoma-carcinoma sequence
Knows the range of predisposing conditions including inherited
syndromes and acquired colonic diseases
Knows the range of clinical presentation and the means of
diagnosis, investigation, management and follow-up
Knows the strategy for prevention including procedures for
screening

Skills
Uses clinical assessment and selects investigations to reach a rapid
conclusion as to whether a patient might have colorectal cancer and
arranges timely investigation.
Refers the patient to the multi-disciplinary team CbD, mini-CEX,

Behaviours
Shows ability to react to possible diagnosis of malignancy in a timely
manner

Communicates with patient and family in a sympathetic and
understanding manner, explains next steps, involves other health
professionals (including the GP) as appropriate

Carcinoid Symptom Treatment

Octreotide and lanreotideFlushing and diarrhea are relieved in 80 % with octreotide. May also slow tumor growth.Alternatives: Sandostatin LAR / short-acting octreotide for breakthrough symptoms/ lanreotide.Octreotide side effects: 30%- nausea, abdominal discomfort, bloating, loose stools, and fat malabsorption during the first several weeks of therapy, after which the symptoms subside.25%- asymptomatic cholesterol gallstones/sludge during the first 18 months of therapy as gallbladder contractility is slowed (Give prophylaxis with URSO) Flushing: Avoid alcohol and anything that causes RUQ pressure Refractory Diarrhoea: Cyproheptadine, a serotonin antagonist- also useful for malignant carcinoid syndrome, while gastric carcinoids that elaborate histamine can respond to a histamine blocker.Interferon-alfa (IFNa) Biochemical response in 45%, and to induce tumor stabilization in 30% Surgery/ debulking procedure (RFA/ chemoemboolization)- -Palliative surgery offers 12 month symptomatic relief only by debulking surgery of the liver with or without hepatic arterial embolization Clinical Features-Profound flushing-Extreme changes in blood pressure-Bronchoconstriction-Arrhythmias-Confusion or stupor lasting many hours or even days.Induced ByCan occur spontaneouslyAfter palpation of tumor masses (at the bedside or during surgery)During induction of anesthesiaAfter administration of chemotherapyAfter hepatic arterial embolization, especially if extensiveThe crisis is fatal.Prevention:Give octreotide before procedureCatecholamines used to support blood pressure may make it worseGive infusion of plasma and octreotide. Codeine phosphate, Cholestyramine if ileal resection/ if more severe then for octreotide Wheeze Carcinoid- Control of symptoms Asthma: Theophylline or the beta-2 adrenergic agonist albuterol (which does not precipitate flushing attacks) is useful Carcinoid Crisis Management of refractory symptoms Diarrhoea:

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