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Bronchial Carcinoid

By Anne S. Tsao, MD, Associate Professor and Director, Mesothelioma Program; Director, Thoracic Chemo-Radiation Program, University of Texas M.D. Anderson Cancer Center

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Patient Education

Bronchial carcinoids are rare, slow-growing neuroendocrine tumors arising from bronchial mucosa; they affect patients in their 40s to 60s.

Half of patients are asymptomatic, and half present with symptoms of airway obstruction, including dyspnea, wheezing, and cough, which often leads to a misdiagnosis of asthma. Recurrent pneumonia, hemoptysis, and chest pain are also common.

Paraneoplastic syndromes, including Cushing syndrome due to ectopic ACTH, acromegaly due to ectopic growth hormone–releasing factor, and Zollinger-Ellison syndrome due to ectopic gastrin production, are more common than carcinoid syndrome, which occurs in < 3% of patients with the tumor.

A left-sided heart murmur (mitral stenosis or regurgitation) due to serotonin-induced valvular damage occurs rarely with bronchial carcinoids (as opposed to the right-sided valvular lesions of GI carcinoid).

Diagnosis

  • Bronchoscopic biopsy

Diagnosis is based on bronchoscopic biopsy, but evaluation often initially involves chest CT, which reveals tumor calcifications in up to one third of patients.

Indium-111–labeled octreotide scans are useful for determining regional and metastatic spread.

Increased urinary serotonin and 5-hydroxyindoleacetic acid levels support the diagnosis, but these substances are not commonly elevated.

Treatment

  • Surgery

Treatment is with surgical removal with or without adjuvant chemotherapy and/or radiation therapy. Prognosis depends on tumor type. Five-year survival for well-differentiated carcinoids is > 90%; for atypical tumors, it is 50 to 70%.

Drugs Mentioned In This Article

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  • SANDOSTATIN