Carcinoid Tumors Of The LungWhat Is It?
Carcinoid tumors have been called "cancers in slow motion" because they grow slowly and are less likely than other tumors to spread (metastasize) to other parts of the body.
Most carcinoid tumors start in the small intestine, but about 25 percent begin in the lungs. Carcinoid tumors tend to occur near the center of the lungs. They make up only 1 percent to 3 percent of all lung cancers. Some carcinoid tumors produce hormones that can cause a number of symptoms, but carcinoid tumors in the lung are much less likely to do so.
There are two types of carcinoid tumors of the lung: typical and atypical. Typical carcinoid tumors are about nine times more common than atypical carcinoid tumors, and are less likely to spread beyond the lungs.
Carcinoid tumors of the lung occur equally in women and men, and appear mostly in people ages 45 to 55.
Symptoms
Symptoms can include coughing up blood or pneumonia. Sometimes, carcinoid tumors of the lungs don't produce any symptoms, and are discovered on a routine chest X-ray. How many symptoms you have and how severe they are depend on the size of the tumor and whether it produces abnormal hormones. Potential symptoms include:
- A persistent cough
- Coughing up blood (hemoptysis)
- Shortness of breath or wheezing
- Pneumonia (a lung infection)
- Facial flushing
- Diarrhea
- Fast heartbeat
- Weight gain
- Increased facial and body hair
Diagnosis
Carcinoid tumors can be seen on chest X-rays and computed tomography (CT) scans. When a tumor is spotted on an X-ray or CT scan, your doctor will need to remove cells from the tumor so they can be examined under a microscope. This is called a biopsy. A lung biopsy can be taken in several ways:
- In bronchoscopy, a fiber-optic viewing tube is inserted into your throat and passed into the lungs. Your doctor examines the tumor and can remove cells for testing. This procedure is most effective when the tumor is located near the center of the lung.
- Needle biopsy removes cells from tumors located at the edges of the lungs, closer to your chest wall. Guided by a CT scan, the doctor inserts a long needle between the ribs and uses it to remove tissue from the tumor.
- Thoracotomy is the surgical opening of the chest cavity; it may be necessary for obtaining a biopsy in some cases. Sometimes, the chest cavity may be entered using a thoracoscope which can be a less traumatic method than an open thoracotomy to obtain a biopsy.
Your doctor may order blood and urine tests to look for any abnormal hormones the tumor might be producing.
A test called octreotide scintigraphy can help to determine if the carcinoid tumor has spread beyond the lungs. A small amount of a radioactive drug is injected into a vein. The drug is attracted to carcinoid tumors. Your doctor will use a camera that detects radioactivity to see where the drug accumulates. Another similar test uses radioactive meta-iodobenzylguanidine (MIBG) instead of octreotide. MIBG is a chemical that is taken up by carcinoid tumors. Radioactive iodine is combined with MIBG and injected a vein.
Expected Duration
As with any cancer, even if carcinoid tumors disappear (go into remission), there is a chance they can return.
Prevention
Unlike most lung tumors, carcinoid tumors have not been associated with smoking, air pollution or other chemical exposures. There are no known ways to prevent this type of cancer.
Treatment
Surgery is the most important treatment for carcinoid tumors. There are several options. When the tumor is located in a large airway, the surgeon may remove the section of the airway containing the tumor. If a tumor is located at the edges of a lung, the surgeon just removes a small wedge of lung. Larger tumors or multiple tumors may require removing a lobe of a lung (lobectomy) or an entire lung (pneumonectomy).
Chemotherapy does not work well on carcinoid tumors. Currently, it is only being used when carcinoid tumors have spread to other parts of the body and when the side effects can be tolerated.
A drug called octreotide (Sandostatin) can be used when carcinoid tumors and produce hormones that cause uncomfortable symptoms. The drug is chemically related to a natural hormone called somatostatin. It relieves flushing, diarrhea and other symptoms. There is some evidence that it also may help to inhibit or reverse the growth of the tumor as well. Octreotide isn't a cure, however, and is used only when the disease has spread. A long-acting version of octreotide called Sandostatin LAR is now available that can be given once a month. Lanreotide is another drug like octreotide that is longer-acting and can be given once every 10 days. Alpha-interferon may be used along with octreotide. It is a substance that stimulates the body's immune system, may help shrink tumors and improve symptoms.
MIBG is absorbed by carcinoid cells and damages them. Researchers are studying MIBG to see if it is effective.
When To Call A Professional
Most people diagnosed with lung carcinoid tumors do not have symptoms. Instead, the tumors are seen on chest X-rays taken for other reasons.
If you have symptoms of carcinoid tumors of the lung, contact your doctor for an evaluation as soon as possible.
Prognosis
Because carcinoid tumors grow and spread slowly, they often are discovered at an early stage. The prognosis for people with early-stage typical carcinoid tumors of the lung is usually very good. An atypical carcinoid tumor is more likely to spread to nearby tissues or lymph nodes. Survival rates are lower for people with atypical carcinoid tumors and carcinoid tumors that have spread to other parts of the body.
Additional Info
National Cancer Institute (NCI)
U.S. National Institutes of Health
Public Inquiries Office
Building 31, Room 10A03
31 Center Drive, MSC 8322
Bethesda, MD 20892-2580
Phone: (301) 435-3848
Toll-Free: (800) 422-6237
TTY: (800) 332-8615
E-Mail: cancergovstaff@mail.nih.gov
http://www.nci.nih.gov/
American Lung Association
61 Broadway, 6th Floor
New York, NY 10006br />Phone: (212) 315-8700
Toll-Free: (800) 548-8252E-Mail: info@lungusa.org
http://www.lungusa.org/
National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
TTY: (240) 629-3255
Fax: (301) 592-8563
E-Mail: nhlbiinfo@rover.nhlbi.nih.gov
http://www.nhlbi.nih.gov/
U.S. Environmental Protection Agency (EPA)
Ariel Rios Building
1200 Pennsylvania Ave., N.W.
Washington, DC 20460
Phone: (202) 272-0167
http://www.epa.gov/
National Institute for Occupational Safety and Health
4676 Columbia Parkway
Mail Stop C-18
Cincinnati, OH 45226
Toll-Free: (800) 356-4674
Fax: (513) 533-8573
http://www.cdc.gov/niosh/
