Carcinoid tumors usually do not have symptoms in the early stages. If you have symptoms, they may include:

• Abdominal pain
• Intestinal blockage, which cause nausea/vomiting, abdominal pain and change in bowel habits
• Intestinal bleeding, which may cause blood in the stool or black, tarry stool
• Anemia and fatigue

Carcinoid Syndrome

In about 1% of cases, carcinoid tumors can spread to the liver. This may cause a group of symptoms called carcinoid syndrome.

Symptoms of carcinoid syndrome usually are vague. It may be diagnosed first as other similar and more common conditions. Symptoms may not be present all the time. They may be brought on or made worse by certain foods, activities or medical procedures. If you have signs of carcinoid syndrome may include:

• Flushing (redness or warm feeling) of the face and neck
• Diarrhea
• Shortness of breath, fast heartbeat, tiredness or swelling of the feet and ankles
• Pain or full feeling in the abdomen
• Difficulty breathing or wheezing

These symptoms do not always mean you have a carcinoid tumor. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.

Since carcinoid tumors grow slowly and often do not cause symptoms in the early stages, they can be challenging to diagnose. Many times, they are found during surgery or treatment for another condition, such as appendicitis. Even in advanced stages, this type of cancer often is misdiagnosed.

Carcinoid Tumor Diagnostic Tests

If your doctor suspects you have a carcinoid tumor or if one has been found during another procedure, the first step will be a thorough physical exam and medical history. Your doctor will ask questions about your general health, your medical history and your family history, and your smoking habits.

Tests to diagnose a carcinoid tumor or find out if it has spread may include one or more of the following. These tests also may be used to find out if treatment is working.

Blood and urine tests, which may include:

• Complete blood count (CBC)
• Blood chemistry studies to check certain substances in the blood
• 24-hour urine collection for 5-HIAA (metabolite of serotonin)
• Measurement of serotonin levels in blood

Imaging tests, which may include:

• Colonoscopy
• Esophagastrodoudenoscopy or upper endoscopy
• Endoscopic ultrasound (EUS)
• CT or CAT (computed axial tomography) scans, including high-resolution CT scans
• MRI (magnetic resonance imaging) scans
• Octreotide scan or somatostatin receptor scintigraphy (OctreoScan™): This is the most common imaging test to diagnose carcinoid tumors. Octreotide, a radioactive substance, is injected into a vein. As it travels through the body, it attaches to carcinoid tumor cells that have somatostatin receptors. A radiation-measuring instrument shows where the octreotide has collected.
• Angiogram: In this test to examine blood vessels and flow, a dye is injected into a blood vessel. X-rays are taken as the dye moves through the vessel.
• Barium swallow or upper gastrointestinal (GI) series: You swallow a radioactive substance. X-rays are taken as it moves through body.
• Barium enema or lower GI series: You are given an enema that contains barium. X-rays are taken as it spreads into the colon. After the enema, air may be sent into the colon to help spread the barium to get a more accurate image.
• Enteroclysis: A tiny tube is inserted through the mouth or nose into the small intestine. Barium contrast, as well as a substance that makes air in the intestines and causes them to expand, is put through the tube. X-rays are taken.
• I-131 MIBG scan: A chemical called MIBG with radioactive iodine is injected into a vein. As it moves through the body, images are taken with a special camera.
• Capsule endoscopy: You swallow a capsule with a light and tiny camera. As the capsule moves though the digestive system, it takes thousands of photographs. The doctor looks at the images on a computer.
• Double balloon enteroscopy: This test uses a special endoscope that is one tiny tube inside another. The doctor can biopsy any abnormal areas.
• Proctoscopy: A hollow tube (proctoscope) with a light on the end of it is inserted into the anus. The doctor can view the lining of the rectum and anus.

Biopsy: Methods to biopsy carcinoid tumors include:

• Needle biopsy: A needle is inserted into the tumor. Ultrasound or CT scan may be used to guide the needle.
• Surgery: A tissue sample is taken from the abdomen during surgery

Our Treatment Approach

At MD Anderson, your treatment for carcinoid tumor is personalized especially for you. A team of experts including oncologists, surgical oncologists, pathologists and others collaborate and communicate about your options before and during your therapy. Most carcinoid tumors grow slowly, and they often can be treated successfully.

As one of the nation’s most active cancer centers, we see a higher level of patients with carcinoid tumors than many oncologists or centers. This gives us extraordinary expertise and experience in treating this complex type of cancer. We use advanced approaches to ensure the most-advanced treatment with the least impact your body.

If surgery is required for a carcinoid tumor, it is important to choose a specialist with the highest possible level of skill and experience. This helps increase your odds for successful treatment. At MD Anderson, our surgeons are among the most experienced in the nation, with some of the best outcomes.

Carcinoid Tumor Treatments

If you are diagnosed with a carcinoid tumor, your doctor will discuss the best options to treat it. This depends on several factors, including:

• The tumor’s size and where it is located
• If the cancer has spread
• Your general health
• Your symptoms

Surgery is often the best option for small carcinoid tumors that have not spread. Chemotherapy and radiation therapy may be used to shrink tumors, although they often may not be successful. Other treatment methods, including internal radiation therapy and biologic therapy, are being tested. Your treatment for carcinoid tumor will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Carcinoid Tumor Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest. Unfortunately, no standardized screening tests have been shown to improve carcinoid tumor outcomes.

Carcinoid Tumor Risk Factors

Anything that increases your chance of getting a carcinoid tumor is a risk factor. These include:

• Conditions that affect how the stomach makes digestive juices, including atrophic gastritis, pernicious anemia or Zollinger-Ellison syndrome.
• Family history of a rare syndrome called multiple endocrine neoplasia 1 (MEN1)
• Race: African-Americans are more likely to develop carcinoid tumors in certain areas of the body than whites
• Gender: Carcinoid tumors are slightly more common in women
• Smoking tobacco: Read more about MD Anderson’s smoking cessation clinical trials

Not everyone with risk factors gets carcinoid tumors. However, if you have risk factors, you should discuss them with your doctor.