Gastrointestinal carcinoid tumours are cancers in which malignant cells are found in certain hormone-making cells of the digestive, or gastrointestinal, system. The digestive system absorbs vitamins, minerals, carbohydrates, fats, proteins, and water from the food that is eaten and stores waste until the body eliminates it. The digestive system is made up of the stomach and the small and large intestines. The last 6 feet of intestine is called the colon. The last 10 inches of the colon is the rectum. The appendix is an organ attached to the large intestine.

Carcinoid syndrome is the pattern of symptoms that typically are exhibited by people with carcinoid tumours. The symptoms include bright red facial flushing, diarrhoea, and occasionally wheezing. A specific type of heart valve damage can occur, as well as other cardiac problems. Carcinoid tumours secrete excessive amounts of the hormone serotonin. Surgery with complete removal of the tumour tissue is the ideal treatment. It can result in a permanent cure if it is possible to remove the tumour entirely.

There are often no signs of a gastrointestinal carcinoid tumour in its early stages. Often the cancer will make too much of some of the hormones, which can cause symptoms. A doctor should be seen if the following symptoms persist:

• Pain in the abdomen.
• Flushing and swelling of the skin of the face and neck.
• Wheezing.
• Diarrhoea.
• Symptoms of heart failure, including breathlessness.

If there are symptoms, a doctor may order blood and urine tests to look for signs of cancer. Other tests may also be done. If there is a carcinoid tumour, the patient has a greater chance of getting other cancers in the digestive system, either at the same time or at a later time.

The chance of recovery (prognosis) and choice of treatment depend on whether the cancer is just in the gastrointestinal system or has spread to other places, and on the patient's general state of health.

There are treatments for all patients with gastrointestinal carcinoid tumours. Four kinds of treatment are used:

• Surgery (taking out the cancer).
• Radiation therapy (using high-dose x-rays to kill cancer cells).
• Biological therapy (using the body's natural immune system to fight cancer).
• Chemotherapy (using drugs to kill cancer cells).

Depending on where the cancer started, the doctor may take out the cancer using one of the following operations:

1. A simple appendectomy removes the appendix. If part of the colon is also taken out, the operation is called a hemicolectomy. The doctor may also remove lymph nodes and look at them under a microscope to see if they contain cancer.
2. Local excision uses a special instrument inserted into the colon or rectum through the anus to cut the tumour out. This operation can be used for very small tumours.
3. Fulguration uses a special tool inserted into the colon or rectum through the anus. An electric current is then used to burn the tumour away.
4. Bowel resection takes out the cancer and a small amount of healthy tissue on either side. The healthy parts of the bowel are then sewn together. The doctor will also remove lymph nodes and have them looked at under a microscope to see if they contain cancer.
5. Cryosurgery kills the cancer by freezing it.
6. Hepatic artery ligation cuts and ties off the main blood vessel that brings blood into the liver (the hepatic artery).
7. Hepatic artery embolization uses drugs or other agents to reduce or block the flow of blood to the liver in order to kill cancer cells growing in the liver.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the digestive system.

Biological therapy tries to get the patient's body to fight the cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defences against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

Treatment by type

Treatment of gastrointestinal carcinoid tumour depends on the type of tumour, the stage, and the patient's overall health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information.

Localized Gastrointestinal Carcinoid tumours

If the cancer started in the appendix, the treatment will probably be surgery to remove the appendix (appendectomy) with or without removal of part of the colon (hemicolectomy) and lymph nodes.

If the cancer started in the rectum, treatment will probably be simple surgery to remove the cancer, surgery using electric current to burn the cancer away, surgery to remove part of the rectum, or surgery to remove the anus and part of the rectum. An opening will be made for waste to pass out of the body (colostomy) into a disposable bag attached near the colostomy (colostomy bag).

If the cancer started in the small intestine, the treatment will probably be surgery to remove part of the bowel (bowel resection). Lymph nodes may also be taken out and looked at under the microscope to see if they contain cancer.

If the cancer started in the stomach, pancreas, or colon, the treatment will probably be surgery to remove the organ affected by the cancer and possibly other nearby organs.

Regional Gastrointestinal Carcinoid tumours

The treatment will probably be surgery to remove the organ affected by the cancer and possibly other nearby organs.

Metastatic Gastrointestinal Carcinoid tumours

Treatment may be one of the following:

1. Surgery to relieve symptoms caused by the cancer. Surgery to freeze and kill the cancer may also be performed.
2. Chemotherapy to relieve symptoms caused by the cancer.
3. Chemotherapy injected directly into the hepatic artery to block the artery and kill cancer cells growing in the liver.
4. Radiation therapy to relieve symptoms caused by the cancer.
5. Radioactive substances injected into the cancer to relieve the symptoms caused by the cancer.
6. Biological or immunological therapy.

Carcinoid syndrome

Treatment options for metastatic carcinoid tumour may be one of the following:

1. Surgery to remove the cancer.
2. Surgery to cut and tie the main artery that goes to the liver (hepatic artery ligation) or injecting chemotherapy into the liver through the hepatic artery to block the artery and kill cancer cells growing in the liver.
3. Drugs designed to relieve symptoms caused by the cancer.
4. Biological therapy to relieve symptoms caused by the cancer.
5. A clinical trial of new combinations of chemotherapy drugs.

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