Carcinoid Tumors constitute 1-2% of lung carcinomas. 75-90% of lung carcinoids are central, and 10-25% are peripheric. Pulmonary carcinoids are the most common primary lung tumors in children and adolescents.

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Carcinoid Tumors

  • Typical carcinoid tumor:
    • It constitutes 90% of lung carcinoid tumors.
    • Low-grade malignant tumor
    • 5-15% regional lymph node metastasis at the time of diagnosis
    • Distant organ metastases around 3%
  • Atypical carcinoid tumor:
    • Atypical carcinoid is rare.
    • Moderately malignant tumor
    • There may be 40-50% regional lymph node metastases at the time of diagnosis.
    • Distant organ metastases in 20%

Note:   Carcinoid tumors are among the neuroendocrine tumors of the lung. Therefore, the differential diagnosis should be made pathologically for other neuroendocrine tumors (large cell neuroendocrine carcinoma and small cell carcinoma). Histological appearance, presence of necrosis, and mitosis affect this classification.

Carcinoid Tumors Symptoms

Up to 40% of carcinoid tumors are detected randomly in radiological findings without any prominent clinical symptoms. Because they give late signs, the diagnosis is usually made late. Some of these patients are treated for asthma and pneumonia.Signs of Carcinoid Tumors are as follows:

  • Cough
  • Hemoptysis/Bleeding from the mouth
  • Recurrent pneumonia
  • Stridor/ wheezing sound when breathing

Note: For this reason, it is necessary to investigate underlying tumors in young asthma and pneumonia patients resistant to treatment.

Diagnosis of Carcinoid Tumors

Carcinoid Tumors Treatment

  • PA chest X-ray
  • Thorax CT
  • Bronchoscopy
    • It is principally diagnosed by biopsy guided by bronchoscopy.
    • Since carcinoid tumors are hemorrhagic lesions, they may bleed during the biopsy.
    • If it bleeds, we prefer rigid bronchoscopy, which is rare.
  • PET-CT

Staging:

  • The TNM classification is used for the staging of carcinoid tumors.

Treatment of Carcinoid Tumors

  • Since typical carcinoid tumors are low-grade malignant than other lung tumors, surgery is complete resection of the tumor with as much lung tissue as possible.
  • Broncho-plastic procedures
    • If the central side of the tumor is within the main bronchi, we resect the tumor, and the two healthy bronchi are sutured as an end-to-end anastomosis.
    • It may be more beneficial to perform these broncho-plastic procedures with open surgery.
  • Segmentectomy
    • Segmentectomy is performed if the tumor is in a segment and the surgical margins are negative. If possible, it is the best choice.
    • Segmentectomy should be the first choice to use minimally invasive surgical methods.
    • Robotic Surgery or Thoracoscopic/ VATS
  • Lobectomy
    • Lung resection may be inevitable in cases where irreversible changes affect the distal part of the tumor.
      • Robotic Surgery or Thoracoscopic/ VATS
    • A sleeve lobectomy should be preferred if the tumor is in the lobe of the bronchus.
  • In these patients, complete lymphadenectomy should be performed surgically.
  • The surgical method is preferred in atypical carcinoid tumors, like other lung cancers, and carcinoid tumors are treated.

After the operation, the patient discharges within 3-5 days.

Oncology

Typical carcinoids do not require additional chemotherapy and radiotherapy after surgery. If there is metastasis to the lymph node in atypical carcinoid tumors, patients may need additional chemotherapy/radiotherapy.

Survival

Since these typical carcinoids show good differentiation, the survival of these patients is excellent if surgery is successful with negative surgical margins and metastasis-free lymph nodes.

 

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