Advertisement
Review Article| Volume 45, ISSUE 1, P285-300, September 2011

Recent Advances in the Diagnosis and Treatment of Gastrointestinal Carcinoids

      Carcinoid tumors were first described by Lubarsch in 1888 [
      • Lubarsch O.
      Uber den pimaeren krebs des ileum nebst Bemerkungen ueber das gleichzeitige Vorkommen von krebs und Tuberculos.
      ]. In 1907, Oberndorfer [
      • Oberndorfer S.
      Karzinoide tumoren des dunndarms.
      ] was the first to recognize these tumors as distinct from carcinomas and coined the term, Karzinoide, to describe the carcinoma-like appearance of these tumors as well as what was originally thought a relatively benign course. Since that time, the malignant potential of carcinoid tumors has become apparent. Currently, carcinoid tumors account for 0.49% of all malignancies [
      • Modlin I.M.
      • Lye K.D.
      • Kidd M.
      A 5-decade analysis of 13,715 carcinoid tumors.
      ]. Although these tumors are relatively uncommon, their incidence has been increasing. A recent database analysis of 13,715 carcinoid tumors revealed a 43.1% increase in carcinoid tumors compared proportionally with other cancers [
      • Modlin I.M.
      • Lye K.D.
      • Kidd M.
      A 5-decade analysis of 13,715 carcinoid tumors.
      ]. The most common location for carcinoid tumors is the gastrointestinal tract followed by the pulmonary system. Within the gastrointestinal tract, the highest frequency of tumors occurs in the small intestine followed by the rectum, colon, and appendix [
      • Modlin I.M.
      • Lye K.D.
      • Kidd M.
      A 5-decade analysis of 13,715 carcinoid tumors.
      ].
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Advances in Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lubarsch O.
        Uber den pimaeren krebs des ileum nebst Bemerkungen ueber das gleichzeitige Vorkommen von krebs und Tuberculos.
        Virchows Arch. 1888; 111 ([in German]): 280-317
        • Oberndorfer S.
        Karzinoide tumoren des dunndarms.
        Frankf Z Pathol. 1907; 1 ([in German]): 425-429
        • Modlin I.M.
        • Lye K.D.
        • Kidd M.
        A 5-decade analysis of 13,715 carcinoid tumors.
        Cancer. 2003; 97: 934-959
        • Kulke M.H.
        • Mayer R.J.
        Carcinoid tumors.
        N Engl J Med. 1999; 340: 858-868
        • Modlin I.M.
        • Oberg K.
        • Chung D.C.
        • et al.
        Gastroenteropancreatic neuroendocrine tumours.
        Lancet Oncol. 2008; 9: 61-72
      1. Solcia E, Kloppel G, Sobin LH, et al. Histological typing of endocrine tumours. In: WHO international histological classification of tumours. 2nd edition. Springer (Berlin); 2000.

        • Modlin I.M.
        • Kidd M.
        • Latich I.
        • et al.
        Current status of gastrointestinal carcinoids.
        Gastroenterology. 2005; 128: 1717-1751
        • Woodside K.J.
        • Townsend Jr., C.M.
        • Mark Evers B.
        Current management of gastrointestinal carcinoid tumors.
        J Gastrointest Surg. 2004; 8: 742-756
        • Scherubl H.
        • Cadiot G.
        • Jensen R.T.
        • et al.
        Neuroendocrine tumors of the stomach (gastric carcinoids) are on the rise: small tumors, small problems?.
        Endoscopy. 2010; 42: 664-671
        • Schindl M.
        • Kaserer K.
        • Niederle B.
        Treatment of gastric neuroendocrine tumors: the necessity of a type-adapted treatment.
        Arch Surg. 2001; 136: 49-54
        • Bell H.K.
        • Poston G.J.
        • Vora J.
        • et al.
        Cutaneous manifestations of the malignant carcinoid syndrome.
        Br J Dermatol. 2005; 152: 71-75
        • Druce M.
        • Rockall A.
        • Grossman A.B.
        Fibrosis and carcinoid syndrome: from causation to future therapy.
        Nat Rev Endocrinol. 2009; 5: 276-283
        • Bhattacharyya S.
        • Davar J.
        • Dreyfus G.
        • et al.
        Carcinoid heart disease.
        Circulation. 2007; 116: 2860-2865
        • Norheim I.
        • Oberg K.
        • Theodorsson-Norheim E.
        • et al.
        Malignant carcinoid tumors. An analysis of 103 patients with regard to tumor localization, hormone production, and survival.
        Ann Surg. 1987; 206: 115-125
        • Bernheim A.M.
        • Connolly H.M.
        • Hobday T.J.
        • et al.
        Carcinoid heart disease.
        Prog Cardiovasc Dis. 2007; 49: 439-451
        • Borch K.
        • Ahren B.
        • Ahlman H.
        • et al.
        Gastric carcinoids: biologic behavior and prognosis after differentiated treatment in relation to type.
        Ann Surg. 2005; 242: 64-73
        • Boudreaux J.P.
        • Putty B.
        • Frey D.J.
        • et al.
        Surgical treatment of advanced-stage carcinoid tumors: lessons learned.
        Ann Surg. 2005; 241 ([discussion: 845–6]): 839-845
        • Connor S.J.
        • Hanna G.B.
        • Frizelle F.A.
        Appendiceal tumors: retrospective clinicopathologic analysis of appendiceal tumors from 7,970 appendectomies.
        Dis Colon Rectum. 1998; 41: 75-80
        • Waisberg D.R.
        • Fava A.S.
        • Martins L.C.
        • et al.
        Colonic carcinoid tumors: a clinicopathologic study of 23 patients from a single institution.
        Arq Gastroenterol. 2009; 46: 288-293
        • Sauven P.
        • Ridge J.A.
        • Quan S.H.
        • et al.
        Anorectal carcinoid tumors. Is aggressive surgery warranted?.
        Ann Surg. 1990; 211: 67-71
        • Tormey W.P.
        • FitzGerald R.J.
        The clinical and laboratory correlates of an increased urinary 5-hydroxyindoleacetic acid.
        Postgrad Med J. 1995; 71: 542-545
        • Nobels F.R.
        • Kwekkeboom D.J.
        • Coopmans W.
        • et al.
        Chromogranin A as serum marker for neuroendocrine neoplasia: comparison with neuron-specific enolase and the alpha-subunit of glycoprotein hormones.
        J Clin Endocrinol Metab. 1997; 82: 2622-2628
        • Gladdy R.A.
        • Strong V.E.
        • Coit D.
        • et al.
        Defining surgical indications for type I gastric carcinoid tumor.
        Ann Surg Oncol. 2009; 16: 3154-3160
        • Modlin I.M.
        • Latich I.
        • Zikusoka M.
        • et al.
        Gastrointestinal carcinoids: the evolution of diagnostic strategies.
        J Clin Gastroenterol. 2006; 40: 572-582
        • Horton K.M.
        • Kamel I.
        • Hofmann L.
        • et al.
        Carcinoid tumors of the small bowel: a multitechnique imaging approach.
        AJR Am J Roentgenol. 2004; 182: 559-567
        • Wong M.
        • Kong A.
        • Constantine S.
        • et al.
        Radiopathological review of small bowel carcinoid tumours.
        J Med Imaging Radiat Oncol. 2009; 53: 1-12
        • Reubi J.C.
        • Waser B.
        • Schaer J.C.
        • et al.
        Somatostatin receptor sst1-sst5 expression in normal and neoplastic human tissues using receptor autoradiography with subtype-selective ligands.
        Eur J Nucl Med. 2001; 28: 836-846
        • Kwekkeboom D.J.
        • Kam B.L.
        • van Essen M.
        • et al.
        Somatostatin-receptor-based imaging and therapy of gastroenteropancreatic neuroendocrine tumors.
        Endocr Relat Cancer. 2010; 17: R53-R73
        • Virgolini I.
        • Britton K.
        • Buscombe J.
        • et al.
        In- and Y-DOTA-lanreotide: results and implications of the MAURITIUS trial.
        Semin Nucl Med. 2002; 32: 148-155
        • Kwekkeboom D.J.
        • Krenning E.P.
        • Scheidhauer K.
        • et al.
        ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: somatostatin receptor imaging with (111)In-pentetreotide.
        Neuroendocrinology. 2009; 90: 184-189
        • Krausz Y.
        • Freedman N.
        • Rubinstein R.
        • et al.
        (68)Ga-DOTA-NOC PET/CT Imaging of Neuroendocrine Tumors: comparison with (111)In-DTPA-Octreotide (OctreoScan(R)).
        Mol Imaging Biol. 2010; (Available at:) (Accessed March 16, 2011)
        • Quigley A.M.
        • Buscombe J.R.
        • Shah T.
        • et al.
        Intertumoural variability in functional imaging within patients suffering from neuroendocrine tumours. An observational, cross-sectional study.
        Neuroendocrinology. 2005; 82: 215-220
        • Ruszniewski P.
        • Delle Fave G.
        • Cadiot G.
        • et al.
        Well-differentiated gastric tumors/carcinomas.
        Neuroendocrinology. 2006; 84: 158-164
        • Zyromski N.J.
        • Kendrick M.L.
        • Nagorney D.M.
        • et al.
        Duodenal carcinoid tumors: how aggressive should we be?.
        J Gastrointest Surg. 2001; 5: 588-593
        • Mullen J.T.
        • Wang H.
        • Yao J.C.
        • et al.
        Carcinoid tumors of the duodenum.
        Surgery. 2005; 138 ([discussion: 977–8]): 971-977
        • Makhlouf H.R.
        • Burke A.P.
        • Sobin L.H.
        Carcinoid tumors of the ampulla of Vater: a comparison with duodenal carcinoid tumors.
        Cancer. 1999; 85: 1241-1249
        • Hatzitheoklitos E.
        • Buchler M.W.
        • Friess H.
        • et al.
        Carcinoid of the ampulla of Vater. Clinical characteristics and morphologic features.
        Cancer. 1994; 73: 1580-1588
        • Makridis C.
        • Oberg K.
        • Juhlin C.
        • et al.
        Surgical treatment of mid-gut carcinoid tumors.
        World J Surg. 1990; 14 ([discussion: 384–5]): 377-383
        • Stinner B.
        • Kisker O.
        • Zielke A.
        • et al.
        Surgical management for carcinoid tumors of small bowel, appendix, colon, and rectum.
        World J Surg. 1996; 20: 183-188
        • Moertel C.G.
        • Weiland L.H.
        • Nagorney D.M.
        • et al.
        Carcinoid tumor of the appendix: treatment and prognosis.
        N Engl J Med. 1987; 317: 1699-1701
        • Anderson J.R.
        • Wilson B.G.
        Carcinoid tumours of the appendix.
        Br J Surg. 1985; 72: 545-546
        • Syracuse D.C.
        • Perzin K.H.
        • Price J.B.
        • et al.
        Carcinoid tumors of the appendix. Mesoappendiceal extension and nodal metastases.
        Ann Surg. 1979; 190: 58-63
        • Landry C.S.
        • Brock G.
        • Scoggins C.R.
        • et al.
        Proposed staging system for colon carcinoid tumors based on an analysis of 2,459 patients.
        J Am Coll Surg. 2008; 207: 874-881
        • Konishi T.
        • Watanabe T.
        • Kishimoto J.
        • et al.
        Prognosis and risk factors of metastasis in colorectal carcinoids: results of a nationwide registry over 15 years.
        Gut. 2007; 56: 863-868
        • Onozato Y.
        • Kakizaki S.
        • Iizuka H.
        • et al.
        Endoscopic treatment of rectal carcinoid tumors.
        Dis Colon Rectum. 2010; 53: 169-176
        • Soga J.
        Early-stage carcinoids of the gastrointestinal tract: an analysis of 1914 reported cases.
        Cancer. 2005; 103: 1587-1595
        • Yamaguchi N.
        • Isomoto H.
        • Nishiyama H.
        • et al.
        Endoscopic submucosal dissection for rectal carcinoid tumors.
        Surg Endosc. 2010; 24: 504-508
        • Jetmore A.B.
        • Ray J.E.
        • Gathright Jr., J.B.
        • et al.
        Rectal carcinoids: the most frequent carcinoid tumor.
        Dis Colon Rectum. 1992; 35: 717-725
        • Kwaan M.R.
        • Goldberg J.E.
        • Bleday R.
        Rectal carcinoid tumors: review of results after endoscopic and surgical therapy.
        Arch Surg. 2008; 143: 471-475
        • Tsai B.M.
        • Finne C.O.
        • Nordenstam J.F.
        • et al.
        Transanal endoscopic microsurgery resection of rectal tumors: outcomes and recommendations.
        Dis Colon Rectum. 2010; 53: 16-23
        • Burke M.
        • Shepherd N.
        • Mann C.V.
        Carcinoid tumours of the rectum and anus.
        Br J Surg. 1987; 74: 358-361
        • Koura A.N.
        • Giacco G.G.
        • Curley S.A.
        • et al.
        Carcinoid tumors of the rectum: effect of size, histopathology, and surgical treatment on metastasis free survival.
        Cancer. 1997; 79: 1294-1298
        • Chamberlain R.S.
        • Canes D.
        • Brown K.T.
        • et al.
        Hepatic neuroendocrine metastases: does intervention alter outcomes?.
        J Am Coll Surg. 2000; 190: 432-445
        • Mayo S.C.
        • de Jong M.C.
        • Pulitano C.
        • et al.
        Surgical management of hepatic neuroendocrine tumor metastasis: results from an international multi-institutional analysis.
        Ann Surg Oncol. 2010; 17: 3129-3136
        • Que F.G.
        • Nagorney D.M.
        • Batts K.P.
        • et al.
        Hepatic resection for metastatic neuroendocrine carcinomas.
        Am J Surg. 1995; 169 ([discussion: 42–3]): 36-42
        • Chambers A.J.
        • Pasieka J.L.
        • Dixon E.
        • et al.
        The palliative benefit of aggressive surgical intervention for both hepatic and mesenteric metastases from neuroendocrine tumors.
        Surgery. 2008; 144 ([discussion: 651–3]): 645-651
        • Gupta S.
        • Yao J.C.
        • Ahrar K.
        • et al.
        Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the M.D. Anderson experience.
        Cancer J. 2003; 9: 261-267
        • Gupta S.
        • Johnson M.M.
        • Murthy R.
        • et al.
        Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors: variables affecting response rates and survival.
        Cancer. 2005; 104: 1590-1602
        • Mazzaglia P.J.
        • Berber E.
        • Milas M.
        • et al.
        Laparoscopic radiofrequency ablation of neuroendocrine liver metastases: a 10-year experience evaluating predictors of survival.
        Surgery. 2007; 142: 10-19
        • Kennedy A.S.
        • Dezarn W.A.
        • McNeillie P.
        • et al.
        Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients.
        Am J Clin Oncol. 2008; 31: 271-279
        • Soreide O.
        • Berstad T.
        • Bakka A.
        • et al.
        Surgical treatment as a principle in patients with advanced abdominal carcinoid tumors.
        Surgery. 1992; 111: 48-54
        • Ohrvall U.
        • Eriksson B.
        • Juhlin C.
        • et al.
        Method for dissection of mesenteric metastases in mid-gut carcinoid tumors.
        World J Surg. 2000; 24: 1402-1408
        • Gulec S.A.
        • Mountcastle T.S.
        • Frey D.
        • et al.
        Cytoreductive surgery in patients with advanced-stage carcinoid tumors.
        Am Surg. 2002; 68 ([discussion: 671–2]): 667-671
        • Moller J.E.
        • Pellikka P.A.
        • Bernheim A.M.
        • et al.
        Prognosis of carcinoid heart disease: analysis of 200 cases over two decades.
        Circulation. 2005; 112: 3320-3327
        • Connolly H.M.
        • Schaff H.V.
        • Mullany C.J.
        • et al.
        Carcinoid heart disease: impact of pulmonary valve replacement in right ventricular function and remodeling.
        Circulation. 2002; 106: I51-I56
        • Nilsson O.
        • Kolby L.
        • Wangberg B.
        • et al.
        Comparative studies on the expression of somatostatin receptor subtypes, outcome of octreotide scintigraphy and response to octreotide treatment in patients with carcinoid tumours.
        Br J Cancer. 1998; 77: 632-637
        • Reubi J.C.
        • Kvols L.K.
        • Waser B.
        • et al.
        Detection of somatostatin receptors in surgical and percutaneous needle biopsy samples of carcinoids and islet cell carcinomas.
        Cancer Res. 1990; 50: 5969-5977
        • Oberg K.
        • Kvols L.
        • Caplin M.
        • et al.
        Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system.
        Ann Oncol. 2004; 15: 966-973
        • Arnold R.
        • Simon B.
        • Wied M.
        Treatment of neuroendocrine GEP tumours with somatostatin analogues: a review.
        Digestion. 2000; 62: 84-91
        • Modlin I.M.
        • Pavel M.
        • Kidd M.
        • et al.
        Review article: somatostatin analogues in the treatment of gastroenteropancreatic neuroendocrine (carcinoid) tumours.
        Aliment Pharmacol Ther. 2010; 31: 169-188
        • Schmid H.A.
        Pasireotide (SOM230): development, mechanism of action and potential applications.
        Mol Cell Endocrinol. 2008; 286: 69-74
        • Rinke A.
        • Muller H.H.
        • Schade-Brittinger C.
        • et al.
        Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group.
        J Clin Oncol. 2009; 27: 4656-4663
        • Valkema R.
        • De Jong M.
        • Bakker W.H.
        • et al.
        Phase I study of peptide receptor radionuclide therapy with [In-DTPA]octreotide: the Rotterdam experience.
        Semin Nucl Med. 2002; 32: 110-122
        • Anthony L.B.
        • Woltering E.A.
        • Espenan G.D.
        • et al.
        Indium-111-pentetreotide prolongs survival in gastroenteropancreatic malignancies.
        Semin Nucl Med. 2002; 32: 123-132
        • Van Essen M.
        • Krenning E.P.
        • De Jong M.
        • et al.
        Peptide Receptor Radionuclide Therapy with radiolabelled somatostatin analogues in patients with somatostatin receptor positive tumours.
        Acta Oncol. 2007; 46: 723-734
        • Kwekkeboom D.J.
        • de Herder W.W.
        • Kam B.L.
        • et al.
        Treatment with the radiolabeled somatostatin analog [177 Lu-DOTA 0, Tyr3]octreotate: toxicity, efficacy, and survival.
        J Clin Oncol. 2008; 26: 2124-2130
        • Kulke M.H.
        Clinical presentation and management of carcinoid tumors.
        Hematol Oncol Clin North Am. 2007; 21 (vii, viii): 433-455
        • Moertel C.G.
        Treatment of the carcinoid tumor and the malignant carcinoid syndrome.
        J Clin Oncol. 1983; 1: 727-740
        • Capurso G.
        • Fazio N.
        • Festa S.
        • et al.
        Molecular target therapy for gastroenteropancreatic endocrine tumours: biological rationale and clinical perspectives.
        Crit Rev Oncol Hematol. 2009; 72: 110-124
        • Hobday T.J.
        • Holen K.
        • Donehower R.
        • et al.
        A phase II trial of gefitinib in patients with progressive metastatic neuroendocrine tumors: a Phase II Consortium study.
        J Clin Oncol. 2006; 24: 4043
        • Terris B.
        • Scoazec J.Y.
        • Rubbia L.
        • et al.
        Expression of vascular endothelial growth factor in digestive neuroendocrine tumours.
        Histopathology. 1998; 32: 133-138
        • Capdevila J.
        • Salazar R.
        Molecular targeted therapies in the treatment of gastroenteropancreatic neuroendocrine tumors.
        Target Oncol. 2009; 4: 287-296
        • Yao J.C.
        • Phan A.
        • Hoff P.M.
        • et al.
        Targeting vascular endothelial growth factor in advanced carcinoid tumor: a random assignment phase II study of depot octreotide with bevacizumab and pegylated interferon alpha-2b.
        J Clin Oncol. 2008; 26: 1316-1323
        • Yao J.C.
        • Phan A.T.
        • Chang D.Z.
        • et al.
        Efficacy of RAD001 (everolimus) and octreotide LAR in advanced low- to intermediate-grade neuroendocrine tumors: results of a phase II study.
        J Clin Oncol. 2008; 26: 4311-4318
      2. National Comprehensive Cancer Network (NCCN) Guidelines for neuroendocrine tumors.
        (Available at:)
        www.nccn.org
        Date: 2010
        (Accessed April 18, 2011)
        • Rorstad O.
        Prognostic indicators for carcinoid neuroendocrine tumors of the gastrointestinal tract.
        J Surg Oncol. 2005; 89: 151-160