A carcinoid tumor is a slow-growing neuroendocrine tumor that most often arises in the bowel or the bronchi of the lung. Lung carcinoids often grow inside a large airway, causing cough, wheeze or repeated pneumonia, and are usually cured with surgery when found early.
Key symptoms
- Persistent cough or coughing blood
- Wheeze on one side, often mistaken for asthma
- Repeated pneumonia in the same part of the lung
- Rarely flushing, diarrhea and wheeze (carcinoid syndrome), mostly with liver spread
- Sometimes no symptoms; found on imaging
What you find on exam
- Localized wheeze or reduced breath sounds over one area
- Signs of lung collapse or pneumonia behind a blocked airway
- Facial flushing, liver enlargement or a heart murmur in carcinoid syndrome
- Usually a normal exam
Tests
- Chest CT: a well-defined central or peripheral nodule
- Bronchoscopy with biopsy; the tumor bleeds easily
- Somatostatin receptor PET scan (Ga-68 DOTATATE) for staging
- 24-hour urine 5-HIAA and chromogranin A if carcinoid syndrome is suspected
Treatment basics
- Surgical removal with lymph node sampling, often curative
- Lung-sparing surgery such as sleeve resection for central tumors
- Somatostatin analogs such as octreotide for syndrome or spread
- Long-term follow-up imaging because recurrence can be late
Red flags
- Coughing large amounts of blood
- Severe flushing, low blood pressure and wheeze (carcinoid crisis), especially around surgery
- Signs of spread: weight loss, liver mass
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.