Materiały źródłowe

• #1 Carcinoid Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448096/

  Carcinoid syndrome is a rare clinical condition caused by metastatic, well-differentiated neuroendocrine tumors, primarily originating in the midgut and associated with liver metastases. These tumors secrete biogenic amines, particularly serotonin, leading to hallmark symptoms such as flushing, diarrhea, bronchospasm, and systemic complications like carcinoid heart disease. Flushing, often triggered by stress, food, or alcohol, and diarrhea, is frequently chronic and debilitating. […] Management includes medications to control hormone secretion and surgical interventions to reduce tumor burden. This activity for healthcare professionals is designed to enhance the learner’s competence in recognizing the clinical presentation of carcinoid syndrome, performing the recommended evaluation, and implementing an appropriate interprofessional management approach to improve patient outcomes.

• #1 Supportive care for neuroendocrine tumours (NETs) | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/neuroendocrine-tumours/supportive-care

  Supportive care helps people meet the physical, practical, emotional and spiritual challenges of neuroendocrine tumours (NETs). It is an important part of cancer care. There are programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended. […] Carcinoid syndrome is a group of symptoms caused by gastrointestinal (GI) or lung NETs releasing large amounts of serotonin and other substances into the blood. Only about 10% of people with a GI or lung NET will develop carcinoid syndrome. It usually happens with NETs of the small intestine or appendix that have spread to the liver (liver metastases). Most people with carcinoid syndrome will have flushing of the skin and diarrhea. Other symptoms include wheezing and difficulty breathing, a fast or irregular heartbeat, low blood pressure and heart damage.

• #1 FF #137Carcinoid Syndrome: Symptom Management | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/carcinoid-syndrome-symptom-management/

  Carcinoid syndrome (CS) is a symptom complex resulting from hormone secretion in patients with carcinoid tumors. CS becomes manifested only when sufficient concentration of hormones reaches the systemic circulation, most commonly in the presence of liver metastases. This Fast Fact will focus on managing the symptoms of CS. […] The CS includes the complex of: flushing, diarrhea, abdominal cramping, cyanosis, bronchoconstriction, and symptoms of right heart failure. […] Drugs that block the hormonal secretion can help to control the symptoms of carcinoid syndrome. […] Somatostatin Analogs are the treatment of choice for CS. […] 50-70% of patients experience a significant reduction of diarrhea and flushing episodes within seven days. […] Interferon alpha is effective in controlling both diarrhea and flushing, although it is inferior to the somatostatin analogs.

• #1 Carcinoid Syndrome: Symptoms, Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/22103-carcinoid-syndrome

  Carcinoid syndrome may be a complication of neuroendocrine tumors (NETs). […] Carcinoid syndrome symptoms include diarrhea, flushing and wheezing. […] Carcinoid syndrome is a rare condition that happens if you have neuroendocrine tumors. […] Neuroendocrine tumors cause carcinoid syndrome, so treating the tumors also treats the syndrome. […] If you have carcinoid syndrome, you probably also have a neuroendocrine tumor. […] The three main carcinoid syndrome symptoms are flushing, wheezing and diarrhea. […] If diarrhea is an issue, talk to your healthcare provider about ways to reduce its frequency and severity. There are medications specifically designed to slow down diarrhea from carcinoid syndrome. […] You should see your healthcare provider if your carcinoid syndrome symptoms get worse. […] Carcinoid syndrome symptoms get worse over time if untreated and can become a life-threatening condition called carcinoid crisis. […] If you have a carcinoid syndrome diagnosis, ask your healthcare provider about next steps to confirm potential NETs.

• #1 Supportive care for neuroendocrine tumours (NETs) | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/neuroendocrine-tumours/supportive-care

  Other things that may trigger flushing and other symptoms of carcinoid syndrome include: some drugs for allergies, cold and flu, and depression that contain epinephrine (adrenaline); eating large meals; stress, anger or embarrassment; vigorous exercise. […] Talk to your doctor about what to avoid or limit to help control the symptoms of carcinoid syndrome.

• #1 Late-stage diagnosis of carcinoid heart disease due to lack of access to health care | Cardio-Oncology | Full Text

  https://cardiooncologyjournal.biomedcentral.com/articles/10.1186/s40959-023-00176-z

  Carcinoid syndrome (CS) is a unique constellation of symptoms caused by release of vasoactive substances from neuroendocrine tumors. Up to 50% of patients with these tumors will develop carcinoid syndrome, which is characterized by symptoms caused by elevated levels of serotonin and most commonly include fatigue, flushing, wheezing, and non-specific gastrointestinal symptoms such as diarrhea and malabsorption. Over time, patients with carcinoid syndrome can develop carcinoid heart disease (CHD). CHD refers to the cardiac complications that occur when the vasoactive substances, such as serotonin, tachykinins, and prostaglandins, secreted from the carcinoid tumors reach the right side of the heart, causing destruction of the right-sided cardiac valves. Common complications include coronary artery damage, arrhythmias congestive heart failure, and direct myocardial injury. While CHD is not typically an initial feature of carcinoid syndrome, it does eventually occur in up to 70% of patients with carcinoid tumors. CHD is associated with significant morbidity and mortality due to the risk of progressive heart failure. Once the diagnosis of CS is made, prompt treatment with somatostatin analogues, most commonly octreotide, should be initiated. Regular screening for CHD should also be performed in all patients with CS. Guidelines recommend screening with TTE annually for patients without cardiac involvement and semiannually for those with cardiac involvement. Once CHD is diagnosed, patients should be evaluated every 6-12 months for progression with TTE, NT-pro-BNP, chromogranin A, and urinary 5-HIAA levels to assess for valvular disease, heart failure, and recurrence or worsening of carcinoid malignancy. Timely diagnosis and treatment of CS are imperative for prevention of CHD. This case highlights the importance of adequate access to healthcare for timely diagnosis and treatment of CS, appropriate screening for CHD once CS is diagnosed, and appropriate monitoring and therapy when CHD develops.

• #1 Carcinoid syndrome: Causes and Management – DermNet

  https://dermnetnz.org/topics/carcinoid-syndrome

  Carcinoid syndrome can cause carcinoid crisis, which involves cutaneous flushing, hypotension, tachycardia/arrhythmias, bronchospasm, and/or sometimes hyperthermia. […] Patients with carcinoid syndrome may experience long-term complications such as carcinoid heart disease, causing valve fibrosis, nutritional deficiencies (deficiency of niacin leading to pellagra), and neuropsychiatric manifestations. […] Carcinoid syndrome is a paraneoplastic phenomenon, and therefore treating the underlying neuroendocrine tumour is key. […] Symptomatic treatment with medications such as somatostatin receptor analogues (eg, octreotide) and/or interferon alfa may be used for symptoms associated with amine secretion. […] Carcinoid crisis can be treated with intravenous octreotide, intravenous hydrocortisone, and/or intravenous chlorpheniramine.

• #1 Malignant Carcinoid Syndrome Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/282515-treatment

  Complete surgical removal of all tumor tissues, when feasible, is the best treatment for carcinoid syndrome because it may result in a complete and permanent cure. […] Patients with severe diarrhea may develop dehydration, which usually manifests as dark brown or intensely yellow urine. Intravenous fluid infusion may be needed to keep up with the fluid loss from diarrhea. Replacement of essential dietary elements and vitamins may be necessary. Along with potassium, magnesium, and iron, supplemental niacin is especially important, as decreased ingestion and absorption can be compounded by increased serotonin production by the tumor, which depletes stores of tryptophan that would otherwise be used to generate niacin. […] Systemic therapy should be used to control humorally mediated symptoms when the cancer spreads elsewhere. Initially, somatostatin analogs (SSAs) are useful in approximately 40% of patients.

• #1 Carcinoid Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448096/

  Somatostatin analogs (SSA) are the cornerstone of medical management. Two commonly used analogs, octreotide and lanreotide, mimic the action of somatostatin, an inhibitory peptide hormone that regulates the release of gastrointestinal and endocrine hormones. These drugs inhibit the secretion of biogenic amines, thereby controlling symptoms such as flushing and diarrhea. […] The management of carcinoid syndrome centers on suppressing biogenic amine release and reducing tumor burden using multiple modalities. […] Consultations are a vital component of the comprehensive management of carcinoid syndrome, requiring a multidisciplinary approach to address the condition’s complexities. […] Deterrence and patient education play a critical role in managing carcinoid syndrome, a condition caused by hormone-secreting neuroendocrine tumors. Early diagnosis and tailored treatment are key to preventing severe complications. Patients should be educated about recognizing symptoms, such as flushing, diarrhea, and wheezing, to seek timely medical intervention. […] Managing carcinoid syndrome requires a cohesive interprofessional healthcare team to deliver patient-centered care, enhance outcomes, ensure safety, and optimize team performance.

• #1 FF #137Carcinoid Syndrome: Symptom Management | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/carcinoid-syndrome-symptom-management/

  Telotristat: this medication is an oral tryptophan hydroxylas inhibitor. […] Patients should be counseled to identify and eliminate stressors that reproducibly cause symptoms—this may include specific stressful situations, foods, or alcohol. […] Other treatments for refractory symptoms include systemic chemotherapy, hepatic artery embolization, hepatic chemoembolization, or debulking surgery of hepatic metastases.

• #1 Malignant Carcinoid Syndrome Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/282515-treatment

  Diarrhea generally responds to standard antidiarrheal medications, but serotonin antagonists should be administered, if necessary, to control diarrhea and malabsorption. […] In patients with symptoms specifically related to increased histamine production, such as angioedema, histamine blockers may also be useful. […] Severe flushing may be treated with clonidine. […] Patients benefit from specific drugs that either suppress production of vasoactive amines or block the peripheral effects. These agents include alpha-adrenergic blocking drugs, the serotonin and histamine antagonist cyproheptadine, and H2-receptor blockers. […] Surgery should also be considered for resection of hepatic recurrence, even after previous resection, but only if the lesions are in a site where resection can be performed with minimal morbidity.

• #1 Malignant Carcinoid Syndrome Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/282515-treatment

  For any patient with controlled carcinoid symptoms and heart involvement, cardiac surgery must be considered for symptomatic carcinoid heart disease and must be performed by an experienced team (including medical, surgical, and anesthesiology experts) in order to provide the best management of this condition. […] Surgical resection can provide effective palliation in carefully selected patients. […] Debulking hepatic metastases may palliate systemic symptoms, and intestinal resection is highly effective in relieving symptoms of intestinal obstruction and ischemia. […] In patients with malignant carcinoid syndrome, diarrhea and weight loss are severe problems that need to be controlled. […] Patients with severe diarrhea should be careful to avoid dehydration or vitamin deficiency. Nicotinamide and niacin supplements are very useful and must be prescribed, along with potassium, magnesium, iron, and essential elements.

• #1 Carcinoid Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18867

  Surgery is critical in managing patients with disease that is amenable to cytoreduction. […] For patients with inoperable hepatic metastases, liver-directed therapies can reduce morbidity and improve quality of life. […] Consultations are a vital component of the comprehensive management of carcinoid syndrome, requiring a multidisciplinary approach to address the condition’s complexities. […] Deterrence and patient education play a critical role in managing carcinoid syndrome, a condition caused by hormone-secreting neuroendocrine tumors. […] Managing carcinoid syndrome requires a cohesive interprofessional healthcare team to deliver patient-centered care, enhance outcomes, ensure safety, and optimize team performance.

• #1 Optimizing the Management of Carcinoid Syndrome to Reduce the Impact of Diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7668882/

  Patients should be empowered to be participants in their care through education on the importance of keeping a record or diary of diarrhea, stool consistency, frequency, and accompanying symptoms and dietary triggers in order to have more productive discussions with health-care providers. […] The role of the APP in understanding the impact of carcinoid syndrome symptoms on patient QOL and oversight of care is critical. […] Coordination within the treatment team, patient education, monitoring of adherence to therapy, monitoring laboratory studies, and adjusting therapy based on individual response can improve the management of carcinoid syndrome diarrhea and patient QOL.

• #1 Malignant Carcinoid Syndrome Follow-up: Inpatient & Outpatient Medications, Deterrence/Prevention, Complications

  https://emedicine.medscape.com/article/282515-followup

  Always assess the color of the urine. Dark-brown or intensely yellow urine usually indicates dehydration, and fluids must sometimes be given intravenously to keep up with the fluid loss from diarrhea. […] Weigh the patient daily and replace the essential elements and vitamins, either by diet or by commercial supplements. […] Other clinical problems associated with carcinoid syndrome, such as tachycardia and asthmalike attacks, should be managed by a cardiologist and pulmonologist. […] Severe flushes may be treated with clonidine. […] Patients need to avoid conditions or substances that cause flushing (eg, stress, alcohol, epinephrine, epinephrinelike drugs). […] Patients must avoid any physical and emotional stress and any food or drug that may trigger a crisis. For example, monamine oxidase inhibitors should be avoided because they can exacerbate the syndrome by inhibiting serotonin degradation.

• #1 Optimizing the Management of Carcinoid Syndrome to Reduce the Impact of Diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7668882/

  Diarrhea is often a presenting symptom in patients with neuroendocrine tumors (NETs). […] This article will review the diagnostic work-up for neuroendocrine tumors and etiology and management of NET-related carcinoid syndrome diarrhea and provide guidance for advanced practitioners, including nurse practitioners, physician assistants, pharmacists, and dieticians, focusing on their role in patient and caregiver education regarding disease, symptom monitoring and management, development of patient-specific treatment, and survivorship plans. […] Carcinoid syndrome diarrhea places a significant burden on affected patients, leading to long-term suffering due to diagnosis delays and misdiagnoses. […] Advanced practice providers (APPs) have an opportunity to improve patient care by incorporating supportive measures to complement the pharmacologic and interventional management of carcinoid syndrome symptoms.

• #1 Supportive care for neuroendocrine tumours (NETs) | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/neuroendocrine-tumours/supportive-care

  The main treatment to manage the symptoms of carcinoid syndrome is octreotide (Sandostatin). It is a drug called a somatostatin analogue that lowers the amount of hormones and other substances made and released by the NET. Octreotide is available in fast-acting and long-acting forms and given by injection. […] Additional drugs may be used to manage specific symptoms. For example, loperamide (Imodium) or cholestyramine can be used to control diarrhea. […] Eating certain foods that contain high levels of amines can trigger the symptoms of carcinoid syndrome. Amines, such as tyramine and histamine, are substances found naturally in foods as they ripen or ferment. Along with getting octreotide injections, it can also be helpful to avoid or limit the following foods and drinks with amines that may make symptoms worse: aged cheeses, such as blue cheese; alcohol, especially wine; cured, smoked or processed meats, such as sausage; smoked or pickled fish; tofu and soy sauce; sauerkraut; chocolate; yeast extracts and brewers yeast; avocados; bananas.

• #1 Carcinoid syndrome and carcinoid tumours | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-adults/carcinoid-syndrome-and-carcinoid-tumours/

  Symptoms of carcinoid syndrome can be treated with injections of octreotide and lanreotide. […] You may also be given medication to widen your airways (to relieve wheezing and breathlessness) and anti-diarrhoea medication. […] There are things you can do yourself to manage some of the symptoms of carcinoid syndrome. […] Generally, you should avoid triggers of flushing, such as: alcohol, large meals, spicy foods, foods containing the substance tyramine, such as aged cheese and salted or pickled meats, stress. […] If you have diarrhoea, its important to keep drinking little and often to avoid dehydration.

• #1 Carcinoid Crisis and Anaesthesia: Signs, Risks, Triggers & More

  https://neuroendocrine.org.au/treatments/carcinoid-crisis-and-anaesthesia/

  Sometimes, individuals with NETs experience a severe bout of something called carcinoid syndrome. […] Your NET specialist will ensure you are monitored during a procedures (including dental work and anaesthetics), in which you may be susceptible to these symptoms and may give you medication to prevent such a crisis occurring (e.g. an infusion of a somatostatin (octreotide) analogue). […] If youre at risk for carcinoid crisis, it is important to inform your clinician and you can carry a small card from the NeuroEndocrine Cancer Australia website. […] The key is having an anaesthesia team thats familiar with managing a carcinoid crisis. […] Thats why choosing medical centres experienced in treating NET patients is crucial. […] Its hard to predict which patients might be at risk for a carcinoid crisis during surgery. So, the anaesthesia team has to be ready for it just in case.

• #1 Gastrointestinal Carcinoid Tumors | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/gastrointestinal-neuroendocrine/gastrointestinal-carcinoid-tumors

  Carcinoid tumors usually grow slowly over many years. […] Many carcinoid tumors produce a hormone called serotonin, which can lead to a variety of symptoms known as carcinoid syndrome. One or more of the following symptoms may indicate carcinoid syndrome: […] Patients with carcinoid syndrome who undergo surgery, anesthesia, or chemotherapy are at risk of experiencing a carcinoid crisis, which is a life-threatening condition caused by a sudden surge of serotonin into the bloodstream. Treatment with the hormone octreotide before any medical procedure can help prevent a carcinoid crisis from occurring. […] People with carcinoid syndrome are advised to wear a medical bracelet in the event of an emergency. […] Patients with gastrointestinal carcinoid tumors that cannot be surgically removed may benefit from monthly injections of a synthetic hormone, octreotide, which controls hormone-related symptoms and may have the potential to slow tumor growth.

• #1 Carcinoid Crisis and Anaesthesia: Signs, Risks, Triggers & More

  https://neuroendocrine.org.au/treatments/carcinoid-crisis-and-anaesthesia/

  To help prevent and manage a carcinoid crisis, a medicine called octreotide is used. […] Octreotide can be delivered in one injection or as a steady drip medication to get the best results. […] People who are already taking long-acting octreotide treatments like Sandostatin LAR or Lanreotide might need higher doses of octreotide during surgery. […] Patients who are at risk of carcinoid crisis should engage in open and proactive communication with their healthcare team to ensure their safety and well-being. […] Establish a clear action plan with your healthcare team, which includes instructions on how to recognise the early signs of a carcinoid crisis and what immediate steps to take if one occurs.

• #1 Carcinoid Syndrome – OpenAnesthesia

  https://www.openanesthesia.org/keywords/carcinoid-syndrome/

  Treatment of patients with CS is aimed at symptomatic relief, delaying the progression of the disease, and improving survival. […] The main pillar of treatment for CS is the use of somatostatin analogs, such as octreotide and lanreotide. […] Octreotide and lanreotide bind to somatostatin receptors and inhibit the secretion of several hormones and vasoactive substances, thus improving flushing and diarrhea symptoms in over 80% of patients with CS. […] The treatment of CHD includes the management of heart failure, treatment of the NE tumor, reduction in the production of related hormones (with the use of somatostatin analogs), and heart valve repair surgery. […] Valve surgery for CHD should be considered in symptomatic patients with controlled CS. […] In right-sided CHD, Tricuspid valve replacement is the operation of choice.

• #1 Living as a Gastrointestinal Carcinoid Tumor Survivor | American Cancer Society

  https://www.cancer.org/cancer/types/gastrointestinal-carcinoid-tumor/after-treatment/follow-up.html

  For some people with gastrointestinal (GI) carcinoid tumor, treatment may remove or destroy the cancer. […] Learning to live with cancer that does not go away can be difficult and very stressful. […] It is very important to go to all of your follow-up appointments. During these visits, your doctors will ask if you are having any problems and will examine you and may order lab tests or x-rays and scans to look for signs of cancer or treatment side effects. […] Its important for all GI carcinoid tumor survivors, to let their health care team know about any new symptoms or problems, because they could be caused by the cancer coming back or by a new disease or a second cancer. […] Standard recommendations for doctor visits and follow-up tests have not yet been defined for GI carcinoid tumors.

• #1 Carcinoid syndrome | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/carcinoid-syndrome

  Carcinoid syndrome typically occurs in people who have carcinoid tumors that are advanced. […] Treatment for carcinoid syndrome usually involves treating the cancer. However, because most carcinoid tumors don’t cause carcinoid syndrome until they’re advanced, a cure may not be possible. Medications may be recommended to relieve your carcinoid syndrome symptoms and make you more comfortable. […] Treating carcinoid syndrome involves treating your cancer and may also involve using medications to control your specific signs and symptoms. […] Self-care measures can’t replace treatment, but they may complement it. […] Talk to your doctor about self-care measures that may improve your signs and symptoms.

• #1 Malignant Carcinoid Syndrome Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/282515-treatment

  Mild (not stressful) physical activity is not harmful and is possible if desired. No intense physical activities are allowed. […] In patients with malignant carcinoid syndrome who are cured with surgery, follow-up care does not need to be intensive. For patients with advanced disease, follow-up care should be scheduled on a regular basis.

• #1 Carcinoid Syndrome Symptoms — The Healing NET Foundation

  https://www.thehealingnet.org/net-medical-care/2021/6/29/managing-carcinoid-syndrome-the-5-es

  Finding ways to cope with the anxiety and worry that can accompany carcinoid syndrome may aid in decreasing symptoms and how much they affect your life. Incorporating self care activities to reduce stress, such as journaling, enjoying your favorite hobby, spending quality time with loved ones, meditation and/or just resting and pausing when needed, can make a difference. […] Inform providers of your carcinoid syndrome diagnosis so they are aware and can consider alternatives. […] Patients with carcinoid syndrome should work to reduce stress levels.

• #1 Carcinoid syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/carcinoid-syndrome/diagnosis-treatment/drc-20370672

  Your doctor will assess your signs and symptoms to rule out other causes of skin flushing and diarrhea. If no other causes are found, your doctor may suspect carcinoid syndrome. […] Treating carcinoid syndrome involves treating your cancer and may also involve using medications to control your specific signs and symptoms. […] Self-care measures can’t replace treatment, but they may complement it. Ask your doctor if you should: […] Talk to your doctor about self-care measures that may improve your signs and symptoms. […] You may be relieved to finally find an answer to what’s been causing your signs and symptoms, but a diagnosis of a rare disease, such as carcinoid syndrome, can be stressful. […] As you develop your way of coping with a cancer diagnosis, talk with your health care team about how you feel and consider trying to:

• #1 Carcinoid syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/carcinoid-syndrome/diagnosis-treatment/drc-20370672

  Find out enough about carcinoid syndrome to make decisions about your care. […] Knowing about your condition may enable you to better participate in decisions about your care. […] Talk to other people with carcinoid syndrome. […] Support groups for people with carcinoid syndrome put you in touch with those who have faced the same challenges you are facing. […] Take care of yourself. […] Do what you can to maintain a healthy lifestyle. […] Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. […] In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask other questions as they occur to you.

• #1 Living as a Gastrointestinal Carcinoid Tumor Survivor | American Cancer Society

  https://www.cancer.org/cancer/types/gastrointestinal-carcinoid-tumor/after-treatment/follow-up.html

  Talk with your doctor about developing a survivorship care plan for you. […] Even after treatment, its very important to keep health insurance. […] If you have (or have had) a GI carcinoid tumor, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. […] Adopting healthy behaviors such as not smoking, eating well, getting regular physical activity, and staying at a healthy weight is important. […] If cancer does come back at some point, your treatment options will depend on where the cancer is, what treatments youve had before, and your health. […] Some amount of feeling depressed, anxious, or worried is normal when GI carcinoid is a part of your life.

• #1 Malignant Carcinoid Syndrome Follow-up: Inpatient & Outpatient Medications, Deterrence/Prevention, Complications

  https://emedicine.medscape.com/article/282515-followup

  In patients with malignant carcinoid syndrome who are cured with surgery, follow-up care does not need to be intensive. For patients with advanced disease, follow-up care should be scheduled on a regular basis. The frequency of follow-up care depends on the general condition of patients and their disease. In each follow-up session, blood tests, x-ray films, and other studies may need to be performed complementary to patient examination. […] For many patients, the treatment options for carcinoid syndromes have prolonged life, but it is very important to understand the patients perception of symptoms and the influence of treatment, which may affect quality of life as well as disease progression. […] Avoidance of any physical and emotional stress and any food or drug that may trigger a crisis is mandatory.

• #1 Diagnosing and Treating Patients with Neuroendocrine Tumors and Carcinoid Syndrome

  https://www.oncnursingnews.com/view/diagnosing-and-treating-patients-with-neuroendocrine-tumors-and-carcinoid-syndrome

  Some people with NETs develop carcinoid syndrome, which is most often marked by debilitating diarrhea and facial flushing. […] I believe it’s important for oncology nurses to encourage our patients to accurately describe their life-disrupting symptoms. […] The good news is that with proper diagnosis and treatment, these symptoms can be successfully managed and our patients’ lives can be significantly prolonged. […] Carcinoid syndrome is real. Sadly, many patients are referred to psychiatrists because their healthcare provider does not believe their symptoms are occurring. […] Although NETs are usually slow-growing, patients more often succumb to electrolyte imbalance due to severe diarrhea or bowel obstruction as opposed to the cancer itself. […] Quality of life can be dramatically improved for NET and carcinoid syndrome patients.

• #1 Diagnosing and Treating Patients with Neuroendocrine Tumors and Carcinoid Syndrome

  https://www.oncnursingnews.com/view/diagnosing-and-treating-patients-with-neuroendocrine-tumors-and-carcinoid-syndrome

  Nevertheless, many of the treatments for NETs are administered differently than what the typical oncology nurse is accustomed to, so again, it’s important to consult with a specialist and review all administration instructions carefully before beginning new treatments. […] It’s also important to tailor a treatment plan based on the patient’s specific symptoms and then work collaboratively with all relevant care team members to treat the whole patient.

• #1 Carcinoid Syndrome: Symptoms, Causes, Diagnosis, and Treatments

  https://www.webmd.com/cancer/carcinoid-syndrome

  Carcinoid syndrome is a group of symptoms you might have with a type of cancer called carcinoid tumors. These tumors start in cells that make certain chemicals, and they release more of those chemicals into your bloodstream. […] Treatments can help you live longer and better. You can also take steps to relieve the symptoms and feel more comfortable. […] To treat carcinoid syndrome, your doctor will need to treat your tumors. You could have just one treatment or a combination of them. […] Injected drugs such as lanreotide (Somatuline) and octreotide (Sandostatin) can help with skin flushing. They may also have a small effect on tumor growth. […] You can make smaller changes to curb the effects of carcinoid syndrome. For instance, avoid certain foods and drinks that can trigger symptoms: […] Try to eat a healthy diet, and ask your doctor whether you need to take vitamins or supplements. […] If your treatment stops working, you can focus on making sure you’re as comfortable as possible. This is called palliative care.

• #1 Management of carcinoid syndrome: a systematic review and meta-analysis in: Endocrine-Related Cancer Volume 26 Issue 3 (2019)

  https://erc.bioscientifica.com/view/journals/erc/26/3/ERC-18-0495.xml

  Carcinoid syndrome (CS) is a debilitating disease caused by functional neuroendocrine tumors. Several treatment options are available to alleviate the hormonal symptoms, but their relative efficacy is unknown. […] The somatostatin analogs octreotide and lanreotide induced symptomatic improvement in 65-72% and biochemical response in 45-46% of patients. An increase in dose or frequency or interclass switch led to a reduction of flushes and/or diarrhea in 72-84% of cases. […] The management of CS thus forms an important part of palliative care in this patient subset. […] Treatment of individual patients should consider the patients performance status and severity of complaints as well as tumor grade, stage and primary location. […] The international guidelines recommend SSAs as first-line therapy in CS in stage IV NET patients.

• #1 Exploring Carcinoid Syndrome in Neuroendocrine Tumors: Insights from a Multidisciplinary Narrative Review

  https://www.mdpi.com/2072-6694/16/22/3831

  This multifaceted approach underscores the importance of effective personalized treatment plans in managing carcinoid syndrome. […] The first-line treatment for controlling the symptoms of CS is represented by long-acting release somatostatin analogs (SSAs), such as octreotide (30 mg/4 weeks) and lanreotide (60 mg, 90 mg, and 120 mg/4 weeks), which provide substantial symptom relief in CS. […] The management of complications related to prolonged serotonin release and malnutrition as a result of exocrine pancreatic insufficiency, post-surgical conditions, vitamin deficit, and chronic diarrhea often requires early detection to mitigate symptoms and improve the quality of life in these patients. […] Carcinoid syndrome presents a significant challenge in clinical management due to its debilitating symptoms. […] The treatment of carcinoid syndrome is complex and requires a comprehensive approach that includes medical therapy, locoregional treatments, and surgical interventions when appropriate.

• #1 Exploring Carcinoid Syndrome in Neuroendocrine Tumors: Insights from a Multidisciplinary Narrative Review

  https://www.mdpi.com/2072-6694/16/22/3831

  Carcinoid syndrome in patients with neuroendocrine tumors is a challenging condition that requires accurate diagnostic and therapeutic management by a multidisciplinary team. […] The management of CS requires a multidisciplinary approach due to its complex clinical manifestations, including flushing, diarrhea, bronchospasm, and carcinoid heart disease. Optimal care involves collaboration between several professional figures like oncologists, endocrinologists, gastroenterologists, surgeons, and dietitians. […] The complexity of CS necessitates individualized care and continuous coordination among specialists to optimize outcomes and enhance patient well-being. […] The primary treatment modality involves somatostatin analogs, such as octreotide and lanreotide, which have been shown to provide substantial symptom relief in many cases.

• #2 Carcinoid Tumors Causes, Symptoms, and Treatments | UPMC

  https://www.upmc.com/services/endocrinology/conditions/carcinoid-tumors

  Carcinoid syndrome is a collection of symptoms in some people with carcinoid tumors. […] Carcinoid syndrome occurs in about one out of 10 people with carcinoid tumors. It happens when the cancer cells release hormones into the blood. […] Carcinoid syndrome symptoms include wheezing, flushing, and diarrhea. […] The risk factor for carcinoid syndrome is having a malignant carcinoid tumor. […] Another is developing carcinoid syndrome, which can affect your heart. […] To treat carcinoid syndrome, doctors treat the tumor. Removing the tumor will stop the carcinoid syndrome symptoms, too.

• #2 Carcinoid Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448096/

  Carcinoid syndrome is a rare clinical condition caused by metastatic, well-differentiated neuroendocrine tumors, primarily originating in the midgut and associated with liver metastases. These tumors secrete biogenic amines, particularly serotonin, leading to hallmark symptoms such as flushing, diarrhea, bronchospasm, and systemic complications like carcinoid heart disease. Flushing, often triggered by stress, food, or alcohol, and diarrhea, is frequently chronic and debilitating. […] Management includes medications to control hormone secretion and surgical interventions to reduce tumor burden. This activity for healthcare professionals is designed to enhance the learner’s competence in recognizing the clinical presentation of carcinoid syndrome, performing the recommended evaluation, and implementing an appropriate interprofessional management approach to improve patient outcomes.

• #2 Carcinoid (Neuroendocrine) Tumors: Staging and Treatment | OncoLink

  https://www.oncolink.org/cancers/carcinoid-neuroendocrine-tumors/carcinoid-neuroendocrine-tumors-staging-and-treatment

  Hormone therapy can be used to control carcinoid syndrome by evening out the endocrine system and blocking the release of hormones causing the symptoms. These medications are called somatostatin analogs. Octreotide and lanreotide are examples. They don’t treat the cancer, only the side effects of carcinoid syndrome. […] Carcinoid syndrome is a group of symptoms caused by the release of substances in the body such as serotonin, histamine, and substance P. It most often affects those with carcinoid tumors in the small bowel. Symptoms can be brought on by eating certain foods. These foods include blue cheese and chocolate which contain tyramine, and wine and beer which contain ethanol. Carcinoid syndrome leads to: […] Flushing and Telangiectasia (collections of tiny blood vessels that develop close to the surface of the skin on the face). […] Diarrhea. […] Fast heart rate and lower blood pressure. […] Bronchospasm (closing of the airway making it hard to breathe). […] Pellagra (dry, scaly skin, dry cracked skin at the edges of the mouth, swollen tongue, diarrhea, and mental confusion). […] Right-sided heart disease or failure.

• #2 Carcinoid syndrome and carcinoid tumours | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-adults/carcinoid-syndrome-and-carcinoid-tumours/

  Symptoms of carcinoid syndrome can be treated with injections of octreotide and lanreotide. […] You may also be given medication to widen your airways (to relieve wheezing and breathlessness) and anti-diarrhoea medication. […] There are things you can do yourself to manage some of the symptoms of carcinoid syndrome. […] Generally, you should avoid triggers of flushing, such as: alcohol, large meals, spicy foods, foods containing the substance tyramine, such as aged cheese and salted or pickled meats, stress. […] If you have diarrhoea, its important to keep drinking little and often to avoid dehydration.

• #2 Carcinoid Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18867

  Carcinoid syndrome is a clinical condition caused by metastatic, well-differentiated neuroendocrine tumors, most commonly arising from the midgut with liver metastases, and is characterized by the secretion of biogenic amines, particularly serotonin, leading to symptoms, eg, flushing, diarrhea, bronchospasm, and systemic complications, like carcinoid heart disease. […] An interprofessional approach is essential to optimize outcomes, manage complications like carcinoid heart disease, and improve the quality of life for affected patients. […] The management of carcinoid syndrome centers on suppressing biogenic amine release and reducing tumor burden using multiple modalities. […] Somatostatin analogs (SSA) are the cornerstone of medical management. […] Both somatostatin analogs provide symptomatic relief in 50% to 70% of patients and biochemical improvement in 40% to 60%.

• #2 Management of carcinoid syndrome: a systematic review and meta-analysis in: Endocrine-Related Cancer Volume 26 Issue 3 (2019)

  https://erc.bioscientifica.com/view/journals/erc/26/3/ERC-18-0495.xml

  Carcinoid syndrome (CS) is a debilitating disease caused by functional neuroendocrine tumors. Several treatment options are available to alleviate the hormonal symptoms, but their relative efficacy is unknown. […] The somatostatin analogs octreotide and lanreotide induced symptomatic improvement in 65-72% and biochemical response in 45-46% of patients. An increase in dose or frequency or interclass switch led to a reduction of flushes and/or diarrhea in 72-84% of cases. […] The management of CS thus forms an important part of palliative care in this patient subset. […] Treatment of individual patients should consider the patients performance status and severity of complaints as well as tumor grade, stage and primary location. […] The international guidelines recommend SSAs as first-line therapy in CS in stage IV NET patients.

• #2 Supportive care for neuroendocrine tumours (NETs) | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/neuroendocrine-tumours/supportive-care

  The main treatment to manage the symptoms of carcinoid syndrome is octreotide (Sandostatin). It is a drug called a somatostatin analogue that lowers the amount of hormones and other substances made and released by the NET. Octreotide is available in fast-acting and long-acting forms and given by injection. […] Additional drugs may be used to manage specific symptoms. For example, loperamide (Imodium) or cholestyramine can be used to control diarrhea. […] Eating certain foods that contain high levels of amines can trigger the symptoms of carcinoid syndrome. Amines, such as tyramine and histamine, are substances found naturally in foods as they ripen or ferment. Along with getting octreotide injections, it can also be helpful to avoid or limit the following foods and drinks with amines that may make symptoms worse: aged cheeses, such as blue cheese; alcohol, especially wine; cured, smoked or processed meats, such as sausage; smoked or pickled fish; tofu and soy sauce; sauerkraut; chocolate; yeast extracts and brewers yeast; avocados; bananas.

• #2 Malignant Carcinoid Syndrome Follow-up: Inpatient & Outpatient Medications, Deterrence/Prevention, Complications

  https://emedicine.medscape.com/article/282515-followup

  Always assess the color of the urine. Dark-brown or intensely yellow urine usually indicates dehydration, and fluids must sometimes be given intravenously to keep up with the fluid loss from diarrhea. […] Weigh the patient daily and replace the essential elements and vitamins, either by diet or by commercial supplements. […] Other clinical problems associated with carcinoid syndrome, such as tachycardia and asthmalike attacks, should be managed by a cardiologist and pulmonologist. […] Severe flushes may be treated with clonidine. […] Patients need to avoid conditions or substances that cause flushing (eg, stress, alcohol, epinephrine, epinephrinelike drugs). […] Patients must avoid any physical and emotional stress and any food or drug that may trigger a crisis. For example, monamine oxidase inhibitors should be avoided because they can exacerbate the syndrome by inhibiting serotonin degradation.

• #2 Carcinoid Syndrome – OpenAnesthesia

  https://www.openanesthesia.org/keywords/carcinoid-syndrome/

  Treatment of patients with CS is aimed at symptomatic relief, delaying the progression of the disease, and improving survival. […] The main pillar of treatment for CS is the use of somatostatin analogs, such as octreotide and lanreotide. […] Octreotide and lanreotide bind to somatostatin receptors and inhibit the secretion of several hormones and vasoactive substances, thus improving flushing and diarrhea symptoms in over 80% of patients with CS. […] The treatment of CHD includes the management of heart failure, treatment of the NE tumor, reduction in the production of related hormones (with the use of somatostatin analogs), and heart valve repair surgery. […] Valve surgery for CHD should be considered in symptomatic patients with controlled CS. […] In right-sided CHD, Tricuspid valve replacement is the operation of choice.

• #2 Management of carcinoid syndrome: a systematic review and meta-analysis in: Endocrine-Related Cancer Volume 26 Issue 3 (2019)

  https://erc.bioscientifica.com/view/journals/erc/26/3/ERC-18-0495.xml

  Importantly, perioperative infusion with octreotide should also be commenced in symptomatic CS patients in order to prevent a carcinoid crisis. […] Multiple strategies have been investigated after clinical symptomatic progression during SSA therapy. […] If tolerated, these therapeutic changes have the potential to control symptoms in up to 84% of patients without added toxicity and thus constitute a valuable alternative. […] Although not part of the meta-analysis, peri-procedural complications and long-term adverse events such as liver failure should be taken into account. […] Current (peri-)procedural safety has advanced considerably from the early studies on hepatic artery ligation and embolization. […] Consequently, liver-directed therapies could be considered in liver-dominant, refractory CS patients, depending on the liver anatomy and tumor localizations.

• #2 Management of carcinoid syndrome: a systematic review and meta-analysis in: Endocrine-Related Cancer Volume 26 Issue 3 (2019)

  https://erc.bioscientifica.com/view/journals/erc/26/3/ERC-18-0495.xml

  Following the pathophysiological relevance of serotonin in CS, several interventions in the serotonin pathway have been investigated. […] The anti-diarrheal effect of telotristat ethyl in patients with less than four bowel movements per day is statistically significant, but clinically limited. […] Consequently, a 3-month trial of telotristat ethyl could be considered in CS patients with frequent diarrhea despite SSA. […] The favorable efficacy-to-toxicity profile of the SSAs octreotide and lanreotide secure them as first-line treatment of CS patients with an unresectable NET. […] In cases of CS that become refractory to first-line therapy, the option of significant hepatic cytoreduction through surgical resection or embolization is a viable strategy in selected patients with liver-dominant disease. […] These strategies have the potential to restrain CS in the majority of patients. However, for those cases with severe, refractory CS, clinicians could consider IFN or PRRT.

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