Appendiceal Carcinoids
Rectal Carcinoids
Small Bowel Carcinoids
Gastric, Pancreatic, and Colon Carcinoids
Current Clinical Trials

Appendiceal Carcinoids

For patients with appendiceal carcinoid tumors less than 1.5 cm in greatest diameter, appendectomy is adequate treatment with cure rates of essentially 100%.[1] No follow-up management is required if the tumor is confined within the wall of the appendix. Tumors 1.5 to 2 cm in diameter can be treated by simple appendectomy or more aggressive surgical treatment. Tumors 2 cm or greater in diameter are less common, but must be considered malignant. Invasion of the mesoappendix does not alter prognosis, but invasion of the cecum mandates more extensive resection. When right hemicolectomy is performed, a lymphadenectomy, as performed for colon cancer, is appropriate.

For patients with rectal carcinoid tumors 1 cm or less in diameter, simple fulguration or local excision is adequate treatment. Cure rates of essentially 100% may be anticipated, and no follow-up management is required.[2]

Tumors 2 cm or larger should be considered malignant and should be treated by an appropriate cancer operation, but sphincter-preserving procedures are preferred when possible. Otherwise, standard therapy includes abdominoperineal resection.

Tumors 1 to 2 cm in diameter can be treated either by local excision or by more radical resection. The decision should be based on actual size of the tumor, extent of invasion, and necessity for abdominal perineal resection versus a sphincter-preserving resection, and estimated operative risk. If local excision is elected, the patient should be carefully followed.

For patients with small bowel carcinoid tumors less than 1 cm in diameter, conservative local resection is sufficient. For tumors greater than 1 cm in diameter, excision of a wedge of mesentery containing regional nodes is indicated.[3] Patients with tumors 1.5 to 2 cm or larger are at risk for recurrence; however, a standard surveillance program has not been established. A search for multiple primary lesions should be made in all patients with small bowel carcinoids.

Carcinoids of other sites in the gastrointestinal tract are rare. Optimal management of localized disease is aggressive surgical resection, although carcinoid tumors of the stomach and colon are typically less often localized than those in other gastrointestinal sites.[4,5]

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with localized gastrointestinal carcinoid tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References

1. Roggo A, Wood WC, Ottinger LW: Carcinoid tumors of the appendix. Ann Surg 217 (4): 385-90, 1993.  [PUBMED Abstract]
   
   
2. Mani S, Modlin IM, Ballantyne G, et al.: Carcinoids of the rectum. J Am Coll Surg 179 (2): 231-48, 1994.  [PUBMED Abstract]
   
   
3. Moertel CG: Karnofsky memorial lecture. An odyssey in the land of small tumors. J Clin Oncol 5 (10): 1502-22, 1987.  [PUBMED Abstract]
   
   
4. Spread C, Berkel H, Jewell L, et al.: Colon carcinoid tumors. A population-based study. Dis Colon Rectum 37 (5): 482-91, 1994.  [PUBMED Abstract]
   
   
5. Maurer CA, Baer HU, Dyong TH, et al.: Carcinoid of the pancreas: clinical characteristics and morphological features. Eur J Cancer 32A (7): 1109-16, 1996.  [PUBMED Abstract]
   
   

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