The female presented with right abdominal discomfort and found right ovarian mass. During the surgery, the appendix looked suspicious therefore it was resected by the surgeon. The histopathology reported as carcionoid tumour of the appendix, with otherwise bengn tumour of the ovary.
We learnt that the carcinoid tumour of appendix is considered the "least invasive" among all carcioid tumour. Besides blood chromogranin A level monitor, endoscopy studies, and Galium PET scan, any other point that we should look at during the follow up?
Dear Dr YU
If the base of appendix or the mesentery of it or tutor size is more than 2cm, it is advised to perform right semi colectomy.
beside if the tumor is not hi grade ,better to do octerotide scan
follow up:
surveillance with CT scans or MRI of the abdomen and pelvis; urine 5-hydroxyindoleacetic acid (5-HIAA); and chromogranin A (CgA) every six months for the first one to two years after surgery, annually for the next four years, and then every two years until approximately 10 years after surgery. For surveillance of NETs at other sites, we generally follow the same strategy but eliminate urinary 5-HIAA.
Not recommend posttreatment surveillance for appendiceal tumors
If it is suspected preoperatively usally not common proceed with Limited Right hemicolectomy.Post operatively diagnosed cases with appendicular base involvment again proceed with Right limited colectomy.Otherwise needs follow up,the problem in our part of the country is difficult to follow and in many will mistook carcinoid for carcinoma.Hence it is our practice to explain and advice limited R colectomy.
Dear Dr YU
I recommend to read this paper:
Send to
Endokrynol Pol. 2013;64(6):480-93. doi: 10.5603/EP.2013.0029.
Neuroendocrine neoplasms of the small intestine and the appendix - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours).
Bolanowski M, Bednarczuk T, Bobek-Billewicz B, Handkiewicz-Junak D, Jeziorski A, Nowakowska-Duława E, Steinhof-Radwańska K, Zajęcki W, Zemczak A, Kos-Kudła B1; Consensus Conference; Polish Network of Neuroendocrine Tumours.
Collaborators (36)
Author information
Abstract
We present revised Polish guidelines regarding the management of patients harbouring neuroendocrine neoplasms (NENs) of the small intestine and appendix. The small intestine, especially the ileum, is the most common origin of these neoplasms. Most of them are well differentiated with slow growth. Rarely, they are less differentiated, growing fast with a poor prognosis. Since symptoms can be atypical, the diagnosis is often accidental. Typical symptoms of carcinoid syndrome occur in less than 10% of patients. The most useful laboratory marker is chromogranin A; 5-hydroxyindoleacetic acid is helpful in the monitoring of carcinoid syndrome. Ultrasound, computed tomography, magnetic resonance imaging, colonoscopy, video capsule endoscopy, balloon enteroscopy and somatostatin receptors scintigraphy are used in the visualisation. A histological report is crucial for the proper diagnostics and therapy of NENs, and it has been extensively described. The treatment of choice is surgery, either radical or palliative. Somatostatin analogues are crucial in the pharmacological treatment of the hormonally active and non-active small intestine NENs and NENs of the appendix. Radioisotope therapy is possible in patients with a good expression of somatostatin receptors. Chemotherapy is not effective in general. Everolimus therapy can be applied in patients with generalised NENs of the small intestine in progression and where there has been a failure or an inability to use other treatment options. Finally, we make recommendations regarding the monitoring of patients with NENs of the small intestine and appendix.
PMID: 24431119 DOI: 10.5603/EP.2013.0029
Good Luck
I would recommend to follow ENETS Consensus Guidelines for Neuroendocrine Neoplasms of the Appendix (Excluding Goblet Cell Carcinomas): Pape UF, Neuroendocrinology 2016;103:144–152
Most often, an appendectomy (surgical removal of the appendix) is the only treatment needed for carcinoid tumors that are 2 cm (a little less than an inch) across or smaller. Still, other factors, such as the way the tumor cells look under the microscope, the patient's age, general health, and the patient's degree of worry about the possibility of the cancer coming back, might also be used to determine whether more treatment is needed.
Tumors larger than 2 cm are more likely to have already spread to nearby tissues and lymph nodes, so more extensive surgery is usually recommended for these tumors. This means removal of about a third of the colon next to the appendix (a hemicolectomy), along with nearby blood vessels and lymph nodes. This procedure might not be recommended for people who are older or have other serious health problems (especially if these problems make surgery more risky), because the benefit might not outweigh the risks.
http://www.cancer.org/acs/groups/cid/documents/webcontent/003102-pdf.pdf
In addition to Dr Krause; Goblet cell appendiceal carcinoids tend not to produce a grossly visible tumour mass but diffusely infiltrate the wall and have features of both carcinoid and adenocarcinoma. These patients should be offered hemicolectomy.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3397653/pdf/jgo-03-02-120.pdf
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