Symptoms:

Most carcinoid tumors have no symptoms. When symptoms do occur, they may include:

• Abdominal pain that comes and goes
• Bright red flushing of the face, neck, or upper chest
• Diarrhea
• Heart palpitations
• Low blood pressure
• Wheezing

Sometimes symptoms are brought on by physical exertion, or eating or drinking things such as blue cheeses, chocolate, or red wine.

Signs and tests:

Most of these tumors are found when tests or procedures are done for other reasons, such as during abdominal surgery.

A physical examination may show:

• Heart valve lesions
• Signs of niacin-deficiency disease (pellagra)

Tests may include:

• 5-HIAA levels in urine
• Blood tests (including serotonin blood test)
• CT and MRI scan of the chest or abdomen
• Octreotide radiolabelled scan

Treatment:

Surgery to remove the tumor is usually the first treatment. It can permanently cure the condition if the tumor is completely removed.

If the tumor has spread to the liver, treatment involves destroying the local blood supply of the tumor or giving chemotherapy directly into the liver.

When the entire tumor cannot be removed, removing large portions of the tumor ("debulking") can help relieve the symptoms.

Octreotide injections are sometimes given to people with advanced carcinoid tumors that cannot be removed with surgery. Interferon is often given with octreotide to help stop tumor growth. Patients whose carcinoid tumor secretes histamine will benefit from treatment with antihistamine drugs.

People with carcinoid syndrome should avoid alcohol, large meals, and foods high in tyramine (aged cheeses, avocado, many processed foods), because they may trigger symptoms.

Some common medicines, like selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil) and fluoxetine (Prozac), may make symptoms worse by increasing levels of serotonin. However, do not stop taking these medicines unless your doctor tells you to do so.

Support Groups:

Learn more about carcinoid syndrome and get support from:

• The Carcinoid Cancer Foundation
• The Caring for Carcinoid Foundation

Expectations (prognosis):

The outlook in patients with carcinoid syndrome is different from the outlook in patients who have carcinoid tumors without the syndrome.

In people with the syndrome, the tumor has usually spread to the liver, which lowers the survival rate. People with carcinoid syndrome are also more likely to have a separate cancer (second primary tumor) at the same time.

The outlook is more favorable thanks to new treatment methods, such as Sandostatin.

Complications:

• Increased risk of falls and injury (from low blood pressure)
• Bowel obstruction (from tumor)
• Gastrointestinal bleeding
• Heart valve failure

Calling your health care provider:

Call for an appointment with your health care provider if you have symptoms of carcinoid syndrome.

Prevention:

Treating the tumor reduces the risk of carcinoid syndrome.