A National Cancer Institute-designated Comprehensive Cancer Center

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Gastrointestinal Carcinoid Tumors

Gastrointestinal Carcinoid Tumors
From diagnosis and treatment to recovery, City of Hope stands at the forefront of caring for patients with gastrointestinal carcinoid tumors.
 
Our approach is comprehensive and aggressive. We combine highly advanced technologies, the most promising treatments and the collective skills of renowned specialists to provide our patients the best outcomes possible.
 
Patients here can also often access investigational therapies not available elsewhere through our extensive clinical trials program.
 
About Gastrointestinal Carcinoid Tumors
 
  • A gastrointestinal carcinoid tumor is cancer that forms in the lining of the gastrointestinal tract.
  • The gastrointestinal tract includes the stomach, small intestine, and large intestine. These organs are part of the digestive system, which processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) in foods that are eaten and helps pass waste material out of the body. Gastrointestinal carcinoid tumors develop from a certain type of hormone -making cell in the lining of the gastrointestinal tract. These cells produce hormones that help regulate digestive juices and the muscles used in moving food through the stomach and intestines. A gastrointestinal carcinoid tumor may also produce hormones. Carcinoid tumors that start in the rectum (the last several inches of the large intestine) usually do not produce hormones.
  • Gastrointestinal carcinoid tumors grow slowly. Most of them occur in the appendix (an organ attached to the large intestine), small intestine, and rectum. It is common for more than one tumor to develop in the small intestine.
  • Having a carcinoid tumor increases a person's chance of getting other cancers in the digestive system, either at the same time or later.

     
Recurrent Gastrointestinal Carcinoid Tumors
A recurrent gastrointestinal carcinoid tumor is a tumor that has recurred after it has been treated. The tumor may come back in the stomach or intestines or in other parts of the body.

Gastrointestinal Carcinoid Tumor Risk Factors

Certain factors can increase your risk of developing gastrointestinal carcinoid tumors:
 
  • A family history of multiple endocrine neoplasia type 1 syndrome
  • Having certain conditions that affect the stomach's ability to produce stomach acid, such as atrophic gastritis, pernicious anemia or Zollinger-Ellison syndrome
  • Smoking tobacco
 

Diagnosis

Several different tests are used to detect gastrointestinal carcinoid cancer:

Physical exam and history

Blood chemistry studies

Urine test

Gastrointestinal X-ray (also called an upper GI series) For this examination, the patient drinks a liquid containing barium, which makes the gastrointestinal tract easier to see in the X-ray.

CT or CAT (computerized axial tomography) scan This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.

PET (positron emission tomography) scan This scan is used to identify malignant cells even before an actual “lump or bump” can be detected in a physical exam, or on CAT or MRI scans. A small amount of radionuclide glucose (sugar) is injected into a vein. Because cancer cells divide more frequently than normal cells, they take up more glucose than normal cells and appear brighter in the scan.

Gastrointestinal endoscopy A thin, lighted tube called an endoscope is inserted into the body. The device emits ultrasound waves that create images of internal organs and structures.

Colonoscope A thin, lighted tube with a small camera is inserted through the rectum into the large intestine to provide physicians with a view of the gastrointestinal tract.

MRI (magnetic resonance imaging) MRI creates a series of detailed pictures of areas inside the body, using the combination of a powerful magnet, radio waves and computer imaging.

ERCP (endoscopic retrograde cholangiopancreatography) This procedure is an X-ray examination of the gastrointestinal tract which is aided by a video endoscope. Through the endoscope, the physician can see the inside of the affected area. Dye is injected so the gastrointestinal tract can be better visualized to determine if there is a blockage or other abnormality.

Biopsy Tissue samples are examined under the microscope to determine what types of cells are present.

Treatments

Different types of treatment are available for patients with gastrointestinal carcinoid tumors.

Surgery
Surgery is the primary treatment used for localized tumors. When applicable, our specialists utilize minimally invasive surgery (MIS) with advanced technologies such as laparoscopy and the new da Vinci S Surgical System with robotic capabilities that allows for greater precision. These surgeries feature small incisions and potentially:
  • Less blood loss, pain and visible incisions
  • Shorter hospital stays and recovery time
  • Fewer complications and quicker return to normal activities

 

One of the following surgical procedures may be used:

  • Appendectomy: Removal of the appendix.
  • Fulguration: Use of an electric current to burn away the tumor using a special tool.
  • Cryosurgery: Also called cryotherapy, this is a treatment that uses an instrument to freeze and destroy abnormal tissue.
  • Resection: Surgery to remove part or all of the organ that contains cancer. Resection of the tumor and a small amount of normal tissue around it is called a local excision.
  • Bowel resection and anastomosis: Removal of the bowel tumor and a small section of healthy bowel on each side. The healthy parts of the bowel are then sewn together (anastomosis). Lymph nodes are removed and checked by a pathologist to see if they contain cancer.
  • Radiofrequency ablation: The use of a special probe with tiny electrodes that release high-energy radio waves (similar to microwaves) that kill cancer cells. The probe may be inserted through the skin or through an incision (cut) in the abdomen.
  • Hepatic resection: Surgery to remove part of the liver.
  • Hepatic artery ligation or embolization: A procedure to ligate (tie off) or embolize (block) the hepatic artery, the main blood vessel that brings blood into the liver. Blocking the flow of blood to the liver helps kills cancer cells growing there.

 

Radiation Therapy
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. Our Department of Radiation Oncology was the first in the western United States to offer the Helical TomoTherapy Hi-Art System, one of the first radiation therapy systems of its kind to incorporate not only radiation therapy, but also tumor imaging capabilities comparable to a diagnostic computed tomography (CT) scan.

Two types of technology are integrated – spiral CT scanning and intensity modulated radiation therapy, or IMRT – thus producing hundreds of pencil beams of radiation (each varying in intensity) that rotate spirally around a tumor. The high-dose region of radiation can be shaped or sculpted to fit the exact shape of each patient’s tumor, resulting in more effective and potentially curative doses to the cancer. This also reduces damage to normal tissues and results in fewer complications.

Chemotherapy
Chemotherapy – the use of anticancer medicines – includes a wide range of drugs and treatment strategies to treat gastrointestinal carcinoid tumors.

City of Hope provides both standard chemotherapies as well as access to newly developed drugs through an extensive program of clinical trials.

As part of the treatment team, a medical oncologist will evaluate the best options, so that a course of chemotherapy, if appropriate, can be tailored to the patient.

Research and Clinical Trials

City of Hope is a leader in cancer research, driven to bring the latest scientific findings into clinical practice as quickly as possible. With our extensive number of clinical trials, patients here have access to new treatments that are not yet available elsewhere.

Currently, treatments being tested in clinical trials include:

  • Biologic therapy: Biologic therapy uses the patient’s immune system to fight cancer. Substances made by the body or scientifically produced are used to boost, direct or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
     
  • Novel Drug Therapies: Chemotherapy can be of benefit if other treatment modalities are not applicable. Novel chemotherapeutic drugs such as streptozotocin, 5-fluorouracil and doxorubicin have activity against carcinoid tumors. Sandostatin, which may be given as a month intramuscular injection, is often helpful with controlling symptoms associated with the carcinoid syndrome such as diarrhea and flushing.
 
To learn more about our clinical trials program and specifically about trials for gastrointestinal carcinoid tumors, click here.
 

Resources

All of our patients have access to the Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
 
Additional Resources
 
American Cancer Society
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
 
National Comprehensive Cancer Network
888-909-NCCN (6226)
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.
 
National Cancer Institute
800-4-CANCER
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
 
U.S. Dept. of Health & Human Services National Institutes of Health
301-496-4000
301-402-9612 for TYY
The National Institutes of Health (NIH) is one of the world's foremost medical research centers, and the federal focal point for medical research in the United States. The NIH, comprising 27 separate institutes and centers, is one of eight health agencies of the Public Health Service, which, in turn, is part of the U.S. Department of Health & Human Services.
 

Gastrointestinal Carcinoid Tumors Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Joe Komsky
Senior Director
Phone: 213-241-7293
Email: jkomsky@coh.org

 
 
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