Materiały źródłowe

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

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

  No, it cant be prevented. Carcinoid syndrome is linked to neuroendocrine tumors, and as there isnt a known way to prevent NETs, theres no way to prevent its symptoms.

• #1 Gastrointestinal Carcinoid Tumor Causes, Risk Factors, and Prevention | American Cancer Society

  https://www.cancer.org/cancer/types/gastrointestinal-carcinoid-tumor/causes-risks-prevention.html

  At this time, there is no known way to prevent gastrointestinal carcinoid tumors. […] Since smoking might increase the risk of carcinoid tumors of the small intestine, not starting or quitting smoking may reduce the risk for this disease.

• #1 Carcinoid syndrome – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/carcinoid-syndrome/

  Carcinoid crisis is a potentially life-threatening complication that is typically triggered by general anesthesia and/or perioperative manipulation of the NEN due to an efflux of vasoactive substances; prevention involves perioperative somatostatin analogue infusion. […] Prophylaxis: periprocedural infusion of a somatostatin analogue.

• #1 ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Pre- and Perioperative Therapy in Patients with Neuroendocrine Tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5637287/

  Patients with carcinoid syndrome should receive octreotide prophylaxis to prevent the development of carcinoid crisis during surgery. […] If patients already receive octreotide or other somatostatin analogs, this medication should be continued while awaiting surgery. […] Patients who have not received octreotide can be given 100-200 g 3 times/day subcutaneously for 2 weeks prior to surgery. […] If more acute operation is needed, octreotide is given as an intravenous infusion for 1-2 days before surgery. […] Perioperative treatment is recommended with intravenous octreotide; infusion is started 12 h before anesthesia at a dose of 50-100 g/h using dose titration until resolution of the symptoms (mean dose 100-200 g/h). […] In case of a carcinoid crisis reaction with hypotension during anesthesia, adrenergic drugs should be used cautiously and further octreotide infusion should be given even at doses as high as 500 g/h. […] Patients previously treated with somatostatin analogs may require even higher doses.

• #1 Prevention and Management of Carcinoid Crisis – Neuroendocrine Cancer Irish Patient Support Group

  https://neuroendocrinecancer.ie/prevention-and-management-of-carcinoid-crisis/

  To prevent the carcinoid crisis, prophylactic intravenous octreotide should be administered prior to invasive procedures. The octreotide should be diluted in normal saline and given in a dose of 1000 mcg over 24 hours. It should be started 12 hours before, and continue for 24 to 48 hours after the procedure. Timing and dose adjustments of intravenous octreotide doses depend on the procedure type and the severity of the patients carcinoid syndrome. […] In some cases, prophylaxis with small subcutaneous octreotide doses is possible. In minor procedures, for example dental procedures and ingrown toenails, prophylaxis is not needed.

• #1 Perioperative Carcinoid Crisis: A Systematic Review and Meta-Analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9221110/

  Intraoperative carcinoid crisis (CC) is thought to be a potentially lethal complication for patients with neuroendocrine tumors (NET). Though perioperative octreotide is often recommended for prevention, recent NET society guidelines raised concerns regarding limited data supporting the use of perioperative octreotide to prevent CC. […] Our findings did not show a decreased risk in CC with prophylactic octreotide and questioned the advantage of routine prophylactic octreotide. […] The predominant strategy for carcinoid crisis prevention has therefore been the use of perioperative octreotide, a somatostatin receptor analog used to treat carcinoid syndrome. […] However, there is no standard scheme for the dose, timing, or administration method of octreotide to prevent carcinoid crisis.

• #1 Carcinoid Syndrome – OpenAnesthesia

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

  The primary goals during the perioperative period are to prevent the release of bioactive mediators by avoiding factors that trigger the release of these bioactive mediators, thereby avoiding a carcinoid crisis. […] Preoperative assessment should include a history and physical examination that is focused on determining the presence and severity of any symptoms of CS, such as flushing, diarrhea, bronchospasm, and valvular heart disease. […] Octreotide can be given subcutaneously for symptomatic relief and for the prevention of perioperative hypotension. […] Due to concern for carcinoid crisis, an octreotide infusion (up to 300g/hour) may be required and is continued for up to 48hours after surgery.

• #1 Anesthetic management of carcinoid syndrome: is octreotide enough? A case report

  http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0484-79032019000200133

  No standard octreotide regimen has proven to be completely reliable and several recommendations have been proposed so far. According to the European guidelines for the octreotide-naive patient, a 50 g/h perfusion was started 12 hours before surgery, supplemented with intraoperative boluses and continued over the postoperative period. Considering anaesthesia duration (~3 hours) and octreotide plasma half-life (2 hours), a continuous infusion is likely a more effective approach than a single dose at the beginning of surgery. […] Intraoperative monitoring is crucial to anticipate and manage carcinoid crisis and patient instability. Despite the lack of temperature monitoring, warming devices were used in order to prevent a hypothermia-triggered carcinoid crisis. Likewise, an arterial catheter was placed before potential induction-triggered hypotension. In a patient with unrecognized liver metastasis and unknown cardiac function at the time of surgery, intraoperative transesophageal echocardiography could be an excellent tool for management decisions. General anesthesia without a neuraxial technique was chosen to avoid sympathetic blockade, which would possibly require sympathomimetic drugs known to trigger the release of bioactive mediators. A balanced technique was preferred because of its minimal cardiovascular effects.

• #1 Anesthetic management of carcinoid syndrome: is octreotide enough? A case report

  http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0484-79032019000200133

  It is important to maintain close hemodynamic monitoring in the postoperative period, as vasoactive mediators might be secreted from residual disease. Hypovolemia, pain and other sympathetic stimuli should be avoided, as should histamine-releasing opioids. Accordingly, fentanyl was chosen for postoperative analgesia, however a small dose of meperidine was initially needed for shivering. […] Carcinoid tumors pose special anesthetic challenges and require the intervention of a multidisciplinary team so that risks can be minimized and patients outcomes improved. Anesthetic management begins with preoperative optimization, includes anticipation and management of hemodynamic instability during surgery, and continues throughout the postoperative period, where special attention to the analgesic approach must be given. In this regard octreotide is an important but insufficient measure. Establishing and improving an anesthetic management protocol can make the difference. Additionally, effective communication between surgeon and anesthesiologist is critical when managing intraoperative complications. Finally, given the rarity of this condition and the limited evidence available, discussion of cases and their pitfalls and, most importantly, conducting prospective research is expected to improve the management of these patients.

• #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 heart disease (CHD) is a major cause of morbidity and mortality in patients with carcinoid syndrome (CS). […] However, as the understanding of this rare syndrome improves, there is growing evidence that highlights ways that CHD can be prevented, one of which is to identify and treat CS in a timely manner. […] Our patients case highlights the importance of improved access to healthcare and timely diagnosis and treatment of CS as ways to prevent development of CHD. […] Once the diagnosis of CS is made, prompt treatment with somatostatin analogues, most commonly octreotide, should be initiated. […] While expert consensus opinion recommends octreotide therapy in patients with metastatic carcinoid tumors for prevention of CHD, data is lacking to support this notion. […] Regular screening for CHD should also be performed in all patients with CS.

• #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. Approximately 80% of well-differentiated tumors express somatostatin receptors in the NET cell surface. […] 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. […] Telotristat ethyl, a tryptophan hydroxylase inhibitor, decreases the production of serotonin; thus, reducing the levels of 5-HIAA in 24-hour urine tests. It is a promising treatment to prevent or delay the onset of CHD. […] Valve surgery for CHD should be considered in symptomatic patients with controlled CS. Furthermore, operation early in the onset of cardiac symptoms is preferable, as a delay can result in the worsening of right-sided heart failure and increases the risk of surgery.

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

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

  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. […] Eating certain foods that contain high levels of amines can trigger the symptoms of carcinoid syndrome. […] 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. […] Talk to your doctor about what to avoid or limit to help control the symptoms of carcinoid syndrome.

• #1 Carcinoid Cancer: Definition, Symptoms, Prognosis, and More

  https://www.verywellhealth.com/carcinoid-syndrome-overview-and-more-5213355

  Carcinoid tumors can’t be prevented, but not smoking may lower your risk. Treating carcinoid tumors if they do arise may help prevent the symptoms of carcinoid syndrome. […] Treatments for carcinoid syndrome may include: Hormone therapy with a somatostatin analog, Octreotide or lanreotide, Interferon therapy, Medications for specific symptoms. […] People with carcinoid syndrome may find it helpful to avoid things that may cause flushing or increasing breathing difficulty, such as: Alcohol, Nuts, Certain cheeses, Foods with capsaicin (such as chili peppers). […] Avoiding stressful situations and engaging in certain types of physical activity may also help with carcinoid syndrome.

• #1 Neuroendocrine tumours, carcinoid syndrome & diet – Sunnybrook Hospital

  https://sunnybrook.ca/content/?page=neuroendocrine-tumour-carcinoid-syndrome-diet

  If you have been diagnosed with a neuroendocrine tumour or carcinoid syndrome, you may be experiencing symptoms like: […] The following foods and/or eating habits are often triggers and may make these symptoms worse: […] Everyone is unique and you may be able to tolerate nearly all or very few of the trigger foods. […] If you have symptoms, you should follow the suggestions below. Remember, you only need to avoid foods that bother you. […] Eat 4 to 6 small meals daily, instead of 3 large meals. […] Choose a diet high in protein. Include meat and alternatives such as nuts, beans, lentils and legumes at each meal and snack. […] Follow a low fat diet. […] Avoid foods containing moderate or high amounts of amines. Dietary amines come from protein breakdown in foods. Levels increase in protein foods (meat, fish, cheese) as they age or mature, and in fruits as they ripen (e.g. bananas, tomatoes).

• #1 Neuroendocrine tumours, carcinoid syndrome & diet – Sunnybrook Hospital

  https://sunnybrook.ca/content/?page=neuroendocrine-tumour-carcinoid-syndrome-diet

  To prevent niacin deficiency, include in your diet: Protein-rich foods at every meal and snack: meat, poultry, fish, eggs, milk, peanut butter, beans, lentils, tofu; Grain products: breads and cereals. […] Your doctor may also prescribe a niacin supplement. […] Eat smaller, more frequent meals and snacks throughout the day. […] Limit greasy, fried, spicy, or very sweet foods. […] Avoid simple sugars such as sweets/desserts, fruit juices and sodas: add water to juice to make less sweet. […] Limit or avoid stimulants such as alcohol and caffeine. […] Include binding foods: applesauce, bananas, tapioca, barley, oats, white rice, noodles, peanut butter, baked potato without the skin. […] Avoid foods that are natural laxatives, such as prunes, prune juice, rhubarb, and papaya. […] Rehydration solutions can be used to keep you hydrated.

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

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

  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. […] Patients need to avoid conditions or substances that cause flushing (eg, stress, alcohol, epinephrine, epinephrinelike drugs).

• #1 Explore Carcinoid Tumor Prevention Risk factors and Prevention Measures at HCG Oncology

  https://www.hcgoncology.com/types-of-cancers/carcinoid-tumours-prevention/

  Smoking increases the risk of carcinoid tumors, as the smoke contains several harmful carcinogens that cause genetic mutations, which in turn can lead to tumor formation. Thus, quitting or not initiating smoking reduces the risk of carcinoid tumors. […] Stress may not increase the risk of carcinoid tumors. However, it may worsen the symptoms in patients with carcinoid tumors. The patients should manage their stress effectively through various techniques. […] Patients with carcinoid tumors should provide detailed information about their medical history and the medications they are taking. Certain medications may worsen the symptoms of carcinoid tumors. These include asthma inhalers, decongestants, and antidepressants. […] Certain mind-body exercises, such as meditation and yoga, help reduce stress and the severity of symptoms. Further, these techniques and other measures enhance immunity and reduce the risk of various cancers.

• #1 Explore Carcinoid Tumor Prevention Risk factors and Prevention Measures at HCG Oncology

  https://www.hcgoncology.com/types-of-cancers/carcinoid-tumours-prevention/

  Emotional stress worsens carcinoid tumor symptoms. Patients should consider managing their emotional stress through music therapy, guided imagery, and meditation. […] Effective carcinoid tumor prevention measures include a high-protein diet, limiting alcohol consumption, stress management, meditation, yoga, music therapy, and avoiding certain medications such as decongestants and antidepressants (as these medications worsen carcinoid tumor symptoms).

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

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

  In extreme cases, it can lead to confusion or even a coma. 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). […] To help prevent and manage a carcinoid crisis, a medicine called octreotide is used. It stops certain hormones from being released and slows down tumour growth. […] 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. If youve had a recent NET diagnosis, it is vital to inform your healthcare providers about your specific medical history, including any previous episodes of carcinoid crisis, triggers, and symptoms youve experienced.

• #1 Carcinoid Crisis – NETRF

  https://netrf.org/old-for-patients/living-with-nets/carcinoid-syndrome/carcinoid-crisis/

  To protect against a carcinoid crisis during surgery, a patient should be treated with a somatostatin analog, such as Octreotide, either before and/or during the procedure. […] Some health care providers may not be aware of the threat of a carcinoid crisis and how to protect against it. Therefore, it is important to talk to all health care providers about a carcinoid syndrome diagnosis to educate them about the risk of carcinoid crisis.

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

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

  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. Regularly follow up with your healthcare team for ongoing monitoring, adjustments to your treatment plan, and to address any concerns or questions.

• #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

  Despite the impressive response rates, the retrospective nature of 21 out of 22 studies renders a serious risk for reporting bias of successful cases. […] 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. […] 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 at 0.40.6 less stools per day on average. […] Consequently, a 3-month trial of telotristat ethyl could be considered in CS patients with frequent diarrhea despite SSA. […] 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.

• #1 Treatment Options – Carcinoid Cancer Foundation

  https://www.carcinoid.org/for-patients/treatment/treatment-options/

  It has been shown that giving niacin supplementation to neuroendocrine cancer patients not only resolves several common symptoms of carcinoid/neuroendocrine tumors(NETs) and pellagra, such as skin lesions and diarrhea/ steatorrhea, but also generally improves the health of the NET patients. Therefore, our results warrant that niacin status should be determined for all NET patients, so that active niacin replacement could be provided to biochemically niacin-deficient patients. In areas of the world where preformed niacin is not added to the food supply and screening of niacin status is not possible, all carcinoid patients should be supplemented with niacin as a preventative therapy. […] We suggest that hypertensive as well as hypotensive carcinoid crises respond to octreotide and that this agent should be considered for prophylactic and emergency use in all carcinoid syndrome patients prior to and during anesthesia and surgery.

• #1 FloridaHealthFinder | Carcinoid syndrome | Health Encyclopedia | FloridaHealthFinder

  https://quality.healthfinder.fl.gov/health-encyclopedia/HIE/1/000347

  Treating the tumor reduces the risk of carcinoid syndrome.

• #1 Can Lung Carcinoid Tumors Be Prevented? | American Cancer Society

  https://www.cancer.org/cancer/types/lung-carcinoid-tumor/causes-risks-prevention/prevention.html

  Because we do not yet know what causes most lung carcinoid tumors, it is not possible to know how to prevent them. […] Smoking has been linked with an increased risk of atypical carcinoids in some studies, so quitting (or not starting) might reduce a persons risk.

• #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 international guidelines recommend SSAs as first-line therapy in CS in stage IV NET patients. […] Initiation of randomized controlled trials with a primary outcome on carcinoid syndrome symptoms is strongly recommended. […] Treatment of individual patients should consider the patients performance status and severity of complaints as well as tumor grade, stage and primary location. […] 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.

• #2 Can Lung Carcinoid Tumors Be Prevented? | American Cancer Society

  https://www.cancer.org/cancer/types/lung-carcinoid-tumor/causes-risks-prevention/prevention.html

  Because we do not yet know what causes most lung carcinoid tumors, it is not possible to know how to prevent them. […] Smoking has been linked with an increased risk of atypical carcinoids in some studies, so quitting (or not starting) might reduce a persons risk.

• #2 Anesthetic management of carcinoid syndrome: is octreotide enough? A case report

  http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0484-79032019000200133

  Carcinoid tumors are rare slow-growing neoplasms of neuroendocrine tissues, generally originating from the gastrointestinal and bronchopulmonary systems. Their incidence is around 1/100.000 population-years. Symptoms are frequently related to the secretion of bioactive substances (mostly histamine, serotonin and kinins) to the systemic circulation, especially upon liver metastasis development. Carcinoid syndrome clinical presentation includes hypotension, hypertension, bronchoconstriction, hyperglycemia, cutaneous flushing, and diarrhea. A life-threatening form of carcinoid syndrome, known as carcinoid crisis, is due to a sudden release of mediators and may be triggered by anesthesia induction or tumor manipulation. The mainstay of pharmacological prophylaxis and treatment for carcinoid crisis is octreotide, a synthetic analogue of somatostatin. Optimal dose and interval have not yet been established. The anesthetic management of carcinoid syndrome presents several challenges, with a focus on recognizing and minimizing the increased risk of carcinoid crisis. Preventing it and providing, if needed, the appropriate treatment should also be an anesthetic goal. A high preoperative 5-hydroxyindoleacetic acid (5-HIAA) urine level and the presence of carcinoid heart disease are risk factors for a poor outcome.

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

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

  In extreme cases, it can lead to confusion or even a coma. 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). […] To help prevent and manage a carcinoid crisis, a medicine called octreotide is used. It stops certain hormones from being released and slows down tumour growth. […] 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. If youve had a recent NET diagnosis, it is vital to inform your healthcare providers about your specific medical history, including any previous episodes of carcinoid crisis, triggers, and symptoms youve experienced.

• #2 Prevention and Management of Carcinoid Crisis – Neuroendocrine Cancer Irish Patient Support Group

  https://neuroendocrinecancer.ie/prevention-and-management-of-carcinoid-crisis/

  To prevent the carcinoid crisis, prophylactic intravenous octreotide should be administered prior to invasive procedures. The octreotide should be diluted in normal saline and given in a dose of 1000 mcg over 24 hours. It should be started 12 hours before, and continue for 24 to 48 hours after the procedure. Timing and dose adjustments of intravenous octreotide doses depend on the procedure type and the severity of the patients carcinoid syndrome. […] In some cases, prophylaxis with small subcutaneous octreotide doses is possible. In minor procedures, for example dental procedures and ingrown toenails, prophylaxis is not needed.

• #2 Perioperative Carcinoid Crisis: A Systematic Review and Meta-Analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9221110/

  Despite this variability, none of the individual or pooled data showed a significant decrease in carcinoid crisis with use of prophylactic octreotide. […] These findings provide additional evidence supporting the concept that use of prophylactic octreotide may not prevent carcinoid crisis and hence its routine use must be further studied and reconsidered.

• #2 Anesthetic management of carcinoid syndrome: is octreotide enough? A case report

  http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0484-79032019000200133

  No standard octreotide regimen has proven to be completely reliable and several recommendations have been proposed so far. According to the European guidelines for the octreotide-naive patient, a 50 g/h perfusion was started 12 hours before surgery, supplemented with intraoperative boluses and continued over the postoperative period. Considering anaesthesia duration (~3 hours) and octreotide plasma half-life (2 hours), a continuous infusion is likely a more effective approach than a single dose at the beginning of surgery. […] Intraoperative monitoring is crucial to anticipate and manage carcinoid crisis and patient instability. Despite the lack of temperature monitoring, warming devices were used in order to prevent a hypothermia-triggered carcinoid crisis. Likewise, an arterial catheter was placed before potential induction-triggered hypotension. In a patient with unrecognized liver metastasis and unknown cardiac function at the time of surgery, intraoperative transesophageal echocardiography could be an excellent tool for management decisions. General anesthesia without a neuraxial technique was chosen to avoid sympathetic blockade, which would possibly require sympathomimetic drugs known to trigger the release of bioactive mediators. A balanced technique was preferred because of its minimal cardiovascular effects.

• #2 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

  As illustrated in our patients cause, 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.

• #2 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 heart disease (CHD) is a major cause of morbidity and mortality in patients with carcinoid syndrome (CS). […] However, as the understanding of this rare syndrome improves, there is growing evidence that highlights ways that CHD can be prevented, one of which is to identify and treat CS in a timely manner. […] Our patients case highlights the importance of improved access to healthcare and timely diagnosis and treatment of CS as ways to prevent development of CHD. […] Once the diagnosis of CS is made, prompt treatment with somatostatin analogues, most commonly octreotide, should be initiated. […] While expert consensus opinion recommends octreotide therapy in patients with metastatic carcinoid tumors for prevention of CHD, data is lacking to support this notion. […] Regular screening for CHD should also be performed in all patients with CS.

• #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. Approximately 80% of well-differentiated tumors express somatostatin receptors in the NET cell surface. […] 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. […] Telotristat ethyl, a tryptophan hydroxylase inhibitor, decreases the production of serotonin; thus, reducing the levels of 5-HIAA in 24-hour urine tests. It is a promising treatment to prevent or delay the onset of CHD. […] Valve surgery for CHD should be considered in symptomatic patients with controlled CS. Furthermore, operation early in the onset of cardiac symptoms is preferable, as a delay can result in the worsening of right-sided heart failure and increases the risk of surgery.

• #2 Carcinoid Cancer: Definition, Symptoms, Prognosis, and More

  https://www.verywellhealth.com/carcinoid-syndrome-overview-and-more-5213355

  Carcinoid tumors can’t be prevented, but not smoking may lower your risk. Treating carcinoid tumors if they do arise may help prevent the symptoms of carcinoid syndrome. […] Treatments for carcinoid syndrome may include: Hormone therapy with a somatostatin analog, Octreotide or lanreotide, Interferon therapy, Medications for specific symptoms. […] People with carcinoid syndrome may find it helpful to avoid things that may cause flushing or increasing breathing difficulty, such as: Alcohol, Nuts, Certain cheeses, Foods with capsaicin (such as chili peppers). […] Avoiding stressful situations and engaging in certain types of physical activity may also help with carcinoid syndrome.

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

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

  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. […] Patients need to avoid conditions or substances that cause flushing (eg, stress, alcohol, epinephrine, epinephrinelike drugs).

• #2 Neuroendocrine tumours, carcinoid syndrome & diet – Sunnybrook Hospital

  https://sunnybrook.ca/content/?page=neuroendocrine-tumour-carcinoid-syndrome-diet

  To prevent niacin deficiency, include in your diet: Protein-rich foods at every meal and snack: meat, poultry, fish, eggs, milk, peanut butter, beans, lentils, tofu; Grain products: breads and cereals. […] Your doctor may also prescribe a niacin supplement. […] Eat smaller, more frequent meals and snacks throughout the day. […] Limit greasy, fried, spicy, or very sweet foods. […] Avoid simple sugars such as sweets/desserts, fruit juices and sodas: add water to juice to make less sweet. […] Limit or avoid stimulants such as alcohol and caffeine. […] Include binding foods: applesauce, bananas, tapioca, barley, oats, white rice, noodles, peanut butter, baked potato without the skin. […] Avoid foods that are natural laxatives, such as prunes, prune juice, rhubarb, and papaya. […] Rehydration solutions can be used to keep you hydrated.

• #2 Explore Carcinoid Tumor Prevention Risk factors and Prevention Measures at HCG Oncology

  https://www.hcgoncology.com/types-of-cancers/carcinoid-tumours-prevention/

  Several factors increase the risk of carcinoid tumors. Identifying these carcinoid tumor risk factors and following the carcinoid tumor prevention measures to reduce those risks helps in the effective management of carcinoid tumors. […] Although 100% carcinoid tumor prevention is not possible, following certain measures can help one reduce their carcinoid tumor formation risk. Some of the carcinoid tumor prevention measures are: […] A protein diet not only helps reduce the risk of the disease but also helps manage carcinoid tumor symptoms. Protein strengthens the immune system and assists the body in fighting against abnormal cells. Further, a diet rich in protein helps maintain optimal health in patients with carcinoid tumors. […] Excessive consumption of alcohol for prolonged periods increases the risk of various cancers, including carcinoid cancer. Limiting alcohol consumption lowers the risk of carcinoid tumors. In patients with carcinoid tumors, certain foods trigger the symptoms. Patients with carcinoid tumors should avoid the consumption of alcohol, vinegar, yeast, soybean products, smoked and salted fish, and aged cheese.

• #2 Treatment Options – Carcinoid Cancer Foundation

  https://www.carcinoid.org/for-patients/treatment/treatment-options/

  It has been shown that giving niacin supplementation to neuroendocrine cancer patients not only resolves several common symptoms of carcinoid/neuroendocrine tumors(NETs) and pellagra, such as skin lesions and diarrhea/ steatorrhea, but also generally improves the health of the NET patients. Therefore, our results warrant that niacin status should be determined for all NET patients, so that active niacin replacement could be provided to biochemically niacin-deficient patients. In areas of the world where preformed niacin is not added to the food supply and screening of niacin status is not possible, all carcinoid patients should be supplemented with niacin as a preventative therapy. […] We suggest that hypertensive as well as hypotensive carcinoid crises respond to octreotide and that this agent should be considered for prophylactic and emergency use in all carcinoid syndrome patients prior to and during anesthesia and surgery.

• #2 Explore Carcinoid Tumor Prevention Risk factors and Prevention Measures at HCG Oncology

  https://www.hcgoncology.com/types-of-cancers/carcinoid-tumours-prevention/

  Smoking increases the risk of carcinoid tumors, as the smoke contains several harmful carcinogens that cause genetic mutations, which in turn can lead to tumor formation. Thus, quitting or not initiating smoking reduces the risk of carcinoid tumors. […] Stress may not increase the risk of carcinoid tumors. However, it may worsen the symptoms in patients with carcinoid tumors. The patients should manage their stress effectively through various techniques. […] Patients with carcinoid tumors should provide detailed information about their medical history and the medications they are taking. Certain medications may worsen the symptoms of carcinoid tumors. These include asthma inhalers, decongestants, and antidepressants. […] Certain mind-body exercises, such as meditation and yoga, help reduce stress and the severity of symptoms. Further, these techniques and other measures enhance immunity and reduce the risk of various cancers.

• #2 Explore Carcinoid Tumor Prevention Risk factors and Prevention Measures at HCG Oncology

  https://www.hcgoncology.com/types-of-cancers/carcinoid-tumours-prevention/

  Emotional stress worsens carcinoid tumor symptoms. Patients should consider managing their emotional stress through music therapy, guided imagery, and meditation. […] Effective carcinoid tumor prevention measures include a high-protein diet, limiting alcohol consumption, stress management, meditation, yoga, music therapy, and avoiding certain medications such as decongestants and antidepressants (as these medications worsen carcinoid tumor symptoms).

• #2 Carcinoid Tumor

  https://ketteringhealth.staywellsolutionsonline.com/Library/DiseasesConditions/Pediatric/ChildSurgery/134,38

  Experts don’t know how to prevent carcinoid tumors. None of the known risk factors can be controlled or changed. […] You can help manage a carcinoid tumor by learning as much as you can about it and taking an active role in your treatment. Be sure to follow all your healthcare providers’ directions, take your medicines, and keep all your appointments. Tell your healthcare team about any side effects or other problems you’re having. There are often ways to help. Here are some other tips: […] Don’t use alcohol or eat foods that trigger carcinoid symptoms.

• #2 Carcinoid Syndrome – Causes, Symptoms, Treatment, Diagnosis – MedBroadcast.com

  https://medbroadcast.com/condition/getcondition/carcinoid-syndrome

  Surgical removal of carcinoid tumours can result in a complete and permanent cure of carcinoid syndrome. […] Injection of octreotide may reduce the symptoms of carcinoid syndrome and even inhibit or reverse tumour growth. […] It’s important to have a diet high in protein if you have carcinoid syndrome. Your diet should also be supplemented with certain vitamins, such as niacin, as well as minerals (potassium, magnesium, calcium, iron, and salt) when these are low due to diarrhea. […] People with carcinoid tumours should avoid alcohol as well as physical and emotional stress, since these can cause carcinoid crisis attacks. For the same reason, people should avoid adrenaline-like medications, including nasal decongestants and some asthma inhalers. Although some symptoms of carcinoid syndrome can be prevented with medication, the best way to manage carcinoid syndrome is to treat the carcinoid tumour.

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

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

  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. Regularly follow up with your healthcare team for ongoing monitoring, adjustments to your treatment plan, and to address any concerns or questions.

• #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 international guidelines recommend SSAs as first-line therapy in CS in stage IV NET patients. […] Initiation of randomized controlled trials with a primary outcome on carcinoid syndrome symptoms is strongly recommended. […] Treatment of individual patients should consider the patients performance status and severity of complaints as well as tumor grade, stage and primary location. […] 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.

• #2 Neuroendocrine Tumours – Carcinoid – Appendix – Management – TeachMeSurgery

  https://teachmesurgery.com/general/small-bowel/neuroendocrine-tumours/

  *Symptomatic control for those with carcinoid syndrome can be achieved with use of somatostatin analogues, mainly octreotide or lanreotide* […] *When major surgery or embolisation is planned for patients with carcinoid syndrome, prophylactic administration of somatostatin analogues should be considered to prevent a potential carcinoid crisis, both intra-operatively or post-operatively.* […] *Somatostatin analogues (such as ocreotide) may be used for the prophylaxis of carcinoid crisis, depending on the presence of carcinoid syndrome, how well it is controlled, and the type and degree of surgery planned. In the highest risk patients, octreotide can be started 24 hours prior to the operation and continued for 48 hours post-operatively.*

• #2 Neuroendocrine Tumors (NETs): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22006-neuroendocrine-tumors-net

  As researchers dont know what causes NETs, theres nothing you can do to prevent them. Still, you can understand potential risk factors, like having an inherited condition like multiple endocrine neoplasia (MEN). […] Ask your healthcare provider for help understanding whether your family health history puts you at risk of developing NETs.

• #2 Perioperative Carcinoid Crisis: A Systematic Review and Meta-Analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9221110/

  Intraoperative carcinoid crisis (CC) is thought to be a potentially lethal complication for patients with neuroendocrine tumors (NET). Though perioperative octreotide is often recommended for prevention, recent NET society guidelines raised concerns regarding limited data supporting the use of perioperative octreotide to prevent CC. […] Our findings did not show a decreased risk in CC with prophylactic octreotide and questioned the advantage of routine prophylactic octreotide. […] The predominant strategy for carcinoid crisis prevention has therefore been the use of perioperative octreotide, a somatostatin receptor analog used to treat carcinoid syndrome. […] However, there is no standard scheme for the dose, timing, or administration method of octreotide to prevent carcinoid crisis.

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

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

  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. […] Eating certain foods that contain high levels of amines can trigger the symptoms of carcinoid syndrome. […] 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. […] Talk to your doctor about what to avoid or limit to help control the symptoms of carcinoid syndrome.

• #3 Explore Carcinoid Tumor Prevention Risk factors and Prevention Measures at HCG Oncology

  https://www.hcgoncology.com/types-of-cancers/carcinoid-tumours-prevention/

  Smoking increases the risk of carcinoid tumors, as the smoke contains several harmful carcinogens that cause genetic mutations, which in turn can lead to tumor formation. Thus, quitting or not initiating smoking reduces the risk of carcinoid tumors. […] Stress may not increase the risk of carcinoid tumors. However, it may worsen the symptoms in patients with carcinoid tumors. The patients should manage their stress effectively through various techniques. […] Patients with carcinoid tumors should provide detailed information about their medical history and the medications they are taking. Certain medications may worsen the symptoms of carcinoid tumors. These include asthma inhalers, decongestants, and antidepressants. […] Certain mind-body exercises, such as meditation and yoga, help reduce stress and the severity of symptoms. Further, these techniques and other measures enhance immunity and reduce the risk of various cancers.

• #3 Somatostatin Analogues Do Not Prevent Carcinoid Crisis

  https://journal.waocp.org/article_29664.html

  Somatostatin analogues (SSTA) have been recommended for prophylactic administration before intervention procedures for functioning NETs. […] The overall pooled risk of perioperative carcinoid crisis was similar despite the prophylactic administration of SSTA (OR 0.44, 95% CI: 0.14 to 1.35, p=0.15). […] SSTA was not helpful for preventing carcinoid crisis based on a meta-analysis of retrospective studies.

• #3 ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Pre- and Perioperative Therapy in Patients with Neuroendocrine Tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5637287/

  Patients with carcinoid syndrome should receive octreotide prophylaxis to prevent the development of carcinoid crisis during surgery. […] If patients already receive octreotide or other somatostatin analogs, this medication should be continued while awaiting surgery. […] Patients who have not received octreotide can be given 100-200 g 3 times/day subcutaneously for 2 weeks prior to surgery. […] If more acute operation is needed, octreotide is given as an intravenous infusion for 1-2 days before surgery. […] Perioperative treatment is recommended with intravenous octreotide; infusion is started 12 h before anesthesia at a dose of 50-100 g/h using dose titration until resolution of the symptoms (mean dose 100-200 g/h). […] In case of a carcinoid crisis reaction with hypotension during anesthesia, adrenergic drugs should be used cautiously and further octreotide infusion should be given even at doses as high as 500 g/h. […] Patients previously treated with somatostatin analogs may require even higher doses.

• #3 Neuroendocrine tumours, carcinoid syndrome & diet – Sunnybrook Hospital

  https://sunnybrook.ca/content/?page=neuroendocrine-tumour-carcinoid-syndrome-diet

  To prevent niacin deficiency, include in your diet: Protein-rich foods at every meal and snack: meat, poultry, fish, eggs, milk, peanut butter, beans, lentils, tofu; Grain products: breads and cereals. […] Your doctor may also prescribe a niacin supplement. […] Eat smaller, more frequent meals and snacks throughout the day. […] Limit greasy, fried, spicy, or very sweet foods. […] Avoid simple sugars such as sweets/desserts, fruit juices and sodas: add water to juice to make less sweet. […] Limit or avoid stimulants such as alcohol and caffeine. […] Include binding foods: applesauce, bananas, tapioca, barley, oats, white rice, noodles, peanut butter, baked potato without the skin. […] Avoid foods that are natural laxatives, such as prunes, prune juice, rhubarb, and papaya. […] Rehydration solutions can be used to keep you hydrated.

• #3 Carcinoid Crisis – NETRF

  https://netrf.org/old-for-patients/living-with-nets/carcinoid-syndrome/carcinoid-crisis/

  To protect against a carcinoid crisis during surgery, a patient should be treated with a somatostatin analog, such as Octreotide, either before and/or during the procedure. […] Some health care providers may not be aware of the threat of a carcinoid crisis and how to protect against it. Therefore, it is important to talk to all health care providers about a carcinoid syndrome diagnosis to educate them about the risk of carcinoid crisis.

• #3 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

  Despite the impressive response rates, the retrospective nature of 21 out of 22 studies renders a serious risk for reporting bias of successful cases. […] 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. […] 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 at 0.40.6 less stools per day on average. […] Consequently, a 3-month trial of telotristat ethyl could be considered in CS patients with frequent diarrhea despite SSA. […] 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.

• #4 FloridaHealthFinder | Carcinoid syndrome | Health Encyclopedia | FloridaHealthFinder

  https://quality.healthfinder.fl.gov/health-encyclopedia/HIE/1/000347

  Treating the tumor reduces the risk of carcinoid syndrome.

• #5 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 heart disease (CHD) is a major cause of morbidity and mortality in patients with carcinoid syndrome (CS). […] However, as the understanding of this rare syndrome improves, there is growing evidence that highlights ways that CHD can be prevented, one of which is to identify and treat CS in a timely manner. […] Our patients case highlights the importance of improved access to healthcare and timely diagnosis and treatment of CS as ways to prevent development of CHD. […] Once the diagnosis of CS is made, prompt treatment with somatostatin analogues, most commonly octreotide, should be initiated. […] While expert consensus opinion recommends octreotide therapy in patients with metastatic carcinoid tumors for prevention of CHD, data is lacking to support this notion. […] Regular screening for CHD should also be performed in all patients with CS.

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