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home - Small Bowel - Small Bowel Masses - Treatment of Carcinoid Mets Written by Dr Sebastian Zeki

Treatment of Carcinoid Mets

Written by Dr Sebastian Zeki Metastasises To The Liver Control Symptoms Indications to remove metastases:No diffuse bilobar involvement.No compromised liver function.No extensive extrahepatic metastases (eg, pulmonary, peritoneal).Symptomatic despite medical treatment (can also prolong survival as v slow growing). Yes- then wedge resect/ partial hepatectomy/ RFA Resect-able? No extrahepatic spread Extrahepatic spread For liver mets No- Consider RFA/ chemoembolization/ liver tranplantation/ cytoreduction surgeryEm-bolization and chemoembolizationLiver metastases fed by hepatic artery, normal liver by veinArterial embolization (+/- chemo) therefore destroys mets.Gives improvement in 75% of patients’ flushing and diarrhea for 12 months average.Postembolization complications-Renal failure-Hepatic necrosis-Sepsis.Prophylactic octreotide is indicated prior to embolization.Chemotherapy and novel treatment approaches-Best regime not yet established-No real benefit demonstrated- Novel regimens are being tried eg. inhibitors of angiogenesis (eg, bevacizumab) and small molecule tyrosine kinase inhibitors (eg, sunitinib).RFA and cryoablation +/- surgical debulking.Less morbid than either hepatic resection or hepatic artery embolization.Only for smaller lesionsLong-term efficacy is uncertain.Liver transplantationLargely investigational- not enough cases to determine conclusions Carcinoid Treatment And Liver Mets Treatment

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