Carcinoid Tumor

The exact cause of carcinoid tumours is unknown, but several genetic and environmental factors have been linked to their development. The following are some of the possible reasons for carcinoid tumours-

Genetic mutations- Researchers have associated the development of carcinoid tumours with several genetic mutations, including mutations in genes such as MEN1, SDHB, and SDHD. These mutations can disrupt the normal functioning of neuroendocrine cells and lead to their uncontrolled proliferation.

Environmental factors- Exposure to certain environmental toxins, such as pesticides and heavy metals, has been linked to an increased risk of carcinoid tumours. Moreover, experts consider a high-fat diet and obesity as potential factors that may cause this ailment.

Age and gender- These tumours are more common in individuals over the age of 50 and in women, although the reasons for these gender and age differences are not entirely clear.

Other medical conditions- Certain medical conditions, such as chronic atrophic gastritis and Zollinger-Ellison syndrome, may also increase the risk of developing this disease.

Familial syndromes- Several familial syndromes, such as multiple endocrine neoplasia type 1 (MEN1) and neurofibromatosis type 1 (NF1), also increase the risk of carcinoid tumours.

Viral infections- Some researchers suggest that an increased risk of developing carcinoid tumours may be associated with viral infections, such as human papillomavirus (HPV) and hepatitis B virus (HBV).

One can find several carcinoid tumours based on location, behaviour, and histology. Below is the list.

Pulmonary Carcinoid Tumour- These tumours originate in the lungs and can be further divided into typical and atypical carcinoid tumours in the lungs. Typical carcinoid tumours are low-grade malignant tumours with a good prognosis, while atypical carcinoid tumours are intermediate-grade malignant tumours with a higher risk of metastasis. The carcinoid tumour lung treatment will depend on its type.

Gastrointestinal Carcinoid Tumour- These tumours occur in the gastrointestinal tract, primarily in the small intestine, rectum, and appendix. They can be classified into three types based on location-** foregut, midgut, and hindgut. The carcinoid tumour can also be classified based on its histology, which refers to its tissue structure study. This classification includes three types of tumours-** well-differentiated, moderately differentiated, and poorly differentiated.

Pancreatic Carcinoid Tumour- These tumours are rare and originate in the pancreas. One can classify them into functioning and non-functioning tumours. Functioning tumours produce hormones that can cause specific symptoms, while non-functioning tumours do not produce hormones.

Other Carcinoid Tumours- These tumours can also occur in other locations, such as the thymus gland, ovaries, and testes. Such tumours are rare and are often treated similarly to other carcinoid tumours.

Lung Carcinoid Tumour Symptoms

• Diarrhoea

• Skin flushing

• Chest pain

• Wheezing

• Shortness of breath

• Purple- or pink-coloured patches on the skin resembling stretch marks

• Weight gain; in most patients, fat accumulates around the upper back and midsection

Digestive Tract Carcinoid Tumours Symptoms

• Abdominal pain

• Bowel obstruction

• Diarrhoea

• Vomiting

• Nausea

• Rectal pain

• Rectal bleeding

• Skin flushing

Pancreatic Carcinoid Tumour Symptoms

• Abdominal pain

• Jaundice

• Diarrhea

• Nausea and vomiting

• Unexplained weight loss

• Fatigue

• Elevated blood sugar levels

• Skin flushing and redness

• Difficulty breathing

• Palpable mass in the abdomen.

It is important to note that some carcinoid tumours may not cause any symptoms and are only discovered during imaging tests for other conditions.

Carcinoid tumours, like any other cancerous disease, progress through four stages that we have described below.

It is important to note that not all carcinoid tumours follow this progression, and the symptoms and treatment options may vary depending on the individual case. Consulting with a healthcare professional for proper diagnosis and treatment planning is also crucial.

Stage 1

The 5-year survival rate for this stage of carcinoid tumours is approximately 96%.

Stage 2

The 5-year survival rate for stage 2 tumours is approximately 87%.

Stage 3

The 5-year survival rate for stage 3 carcinoid tumours is approximately 64%.

Stage 4

The 5-year survival rate for stage 4 is approximately 20%.

It is important to note that these survival rates are estimates and can vary based on individual factors such as age, overall health, and the specific characteristics of the tumour.

Carcinoid tumours can occur in anyone, but certain factors may increase a person's susceptibility.

These tumours are more common in people over the age of 60 and in women. Individuals with a family history of these tumours or other endocrine tumours may be more susceptible to developing them. In addition, some inherited conditions also increase the risk of developing carcinoid tumours.

Lifestyle factors, including smoking, heavy alcohol consumption, and obesity, also make one susceptible to this disease.

Carcinoid tumour diagnosis typically involves a combination of clinical evaluation, imaging studies, and laboratory tests. The following is a general overview of the diagnostic process for a suspected carcinoid tumour**

1.Clinical Evaluation The medical professional will perform a thorough physical examination, taking note of any symptoms the patient may be experiencing, such as abdominal pain, diarrhoea, flushing, wheezing, or weight loss. They will also take a detailed medical history, including any previous surgeries or medical conditions that may be relevant.

2.Imaging Studies Doctors may use various imaging studies to visualise the tumour and assess its size, location, and spread. These may include

Computed Tomography (CT) scan It is a type of X-ray that produces detailed images of the body's internal structures.

Magnetic Resonance Imaging (MRI) scan This test uses magnetic fields and radio waves to create detailed images of the body's internal structures.

Positron Emission Tomography (PET) scan It is a type of nuclear imaging test that uses a radioactive substance to visualise metabolic activity in the body.

Endoscopy A flexible tube with a camera on end is inserted through the mouth or rectum to view the digestive tract.

3.Laboratory Tests Blood and urine tests may also assist in measuring several markers, such as serotonin and chromogranin A, which can be elevated in carcinoid tumours.

4.Biopsy A tissue sample may be taken from the suspected tumour and examined under a microscope to confirm the diagnosis of a carcinoid tumour. Medical professionals may perform this through endoscopy, laparoscopy, or open surgery.

Once a diagnosis of carcinoid tumour is confirmed, further tests may be done to determine the stage and extent of the tumour, including imaging studies and biopsies of any suspected metastases.

However, it is critical to note that the diagnostic process for a carcinoid tumour can be complex and may involve several medical professionals, including gastroenterologists, oncologists, and radiologists.

Here are some common treatments for carcinoid tumours:

Surgery: Surgical removal of the tumour is often the preferred treatment for localised carcinoid tumours that have not spread to other body parts. The extent of the surgery will depend on the size and location of the tumour.

In some cases, only the tumour and a small margin of healthy tissue around it are subject to removal. In more advanced cases, the removal of a significant section of the affected organ or tissue is necessary.

Radiation Therapy: Doctors may use radiation therapy to destroy cancer cells that are impossible to remove through surgery. They typically recommend this treatment for larger or more advanced carcinoid tumours that have spread to nearby lymph nodes or other body parts.

The method of radiation therapy, whether it is administered externally or internally, depends on the tumour's location.

Chemotherapy: It is the process where doctors use drugs to kill cancer cells. They may recommend this treatment for more advanced or aggressive carcinoid tumours.

Doctors usually administer chemotherapy intravenously, although few drugs can be given orally. They may use it alone or in conjunction with other treatments like radiation therapy.

Somatostatin analogues: They are drugs that mimic the actions of somatostatin, a hormone that inhibits the release of several other hormones, including those that carcinoid tumours may produce, such as carcinoid tumour serotonin treatment.

These medications can help relieve symptoms like flushing, diarrhoea, and wheezing. They may also slow the tumour's growth.

Targeted Therapy: Targeted therapy is a newer treatment option that uses drugs to target specific molecules involved in the growth and spread of cancer cells.

For carcinoid tumours, doctors may use targeted therapy to block the action of certain hormones or growth factors produced by the tumour.

Patients with this disease may also benefit from supportive care, such as nutrition counselling and pain management, to help manage symptoms and improve their quality of life

No specific preventive measures can guarantee the complete prevention of these tumours. But, some general lifestyle changes might reduce the risk of developing them.

Avoid obesity: Obesity increases the risk of carcinoid cancer and various types of cancer. Therefore, engaging in regular physical activity, eating a healthy diet, and avoiding high-fat foods can be beneficial.

Refrain from smoking: Avoiding exposure to known carcinogens such as tobacco smoke, certain chemicals, and radiation may also help reduce the risk of developing carcinoid tumours. It is crucial to quit smoking and limit exposure to second-hand smoke.

Medical screenings: Regular check-ups and screenings can also aid in carcinoid tumour detection at an early stage when they are easier to treat. People with a family history of this disease or other neuroendocrine tumours, in particular, should consult their doctors about appropriate screening measures.

A patient's future suffering from a carcinoid tumour depends on several factors, including the tumour's location, size, and stage. Many patients can achieve long-term remission and live normal and healthy lives with proper treatment, which includes surgery, chemotherapy, and radiation.

However, the prognosis for tumours that have spread to other organs or are inoperable may be less promising. It is critical to have regular check-ups with a healthcare professional to look for signs of recurrence or progression.

Carcinoid tumour management necessitates advanced medical care facilities, especially if the tumour has progressed to an advanced stage. The surgery cost for this disease at a standard hospital may begin at Rs 1,50,000 and go up to several lakhs depending on its severity.

One needs to spend on consultation fees, diagnostic tests, prescription charges, and multiple pre and post-hospital expenses. However, with the Tata AIG health insurance plan, policyholders can be relieved of the financial burden of treating carcinoid tumours.

Health insurance with a critical illness add-on covers the costs for chemotherapies, daycare procedures, and much more. Furthermore, medical insurance provides several tax benefits on premiums paid for self or family floater plans.

The health insurance tax benefits are prescribed under section 80D and allow for a tax deduction of ₹25,000 (up to 60 years of age) and ₹50,000 (for senior citizens) on individual medical insurance policies. Suppose a senior citizen buys a policy for themselves and their family and a separate policy for their dependent parents. In that case, they can enjoy a combined benefit of ₹1,00,000 (₹50,000 + ₹50,000), subject to prevailing tax guidelines.