Carcinoid Tumors, Lung Health Article

Treatment team

Lung carcinoids are treated by thoracic and cardiothoracic surgeons.

Clinical staging, treatments, and prognosis

Staging

Once lung carcinoids have been diagnosed, more tests are done to find out if the cancer has spread from the lung to other parts of the body (staging). A doctor needs to know the stage to plan treatment. Doctors stage lung carcinoids the same way they stage non-small cell lung cancers:

• Stage 0: Cancer is only found in a local area and only in a few layers of cells. It has not grown through the top lining of the lung.
• Stage I: The cancer is only in the lung, and normal tissue is around it.
• Stage II: Cancer has spread to nearby lymph nodes.
• Stage III: Cancer has spread to the chest wall or diaphragm near the lung; or the cancer has spread to the lymph nodes in the area that separates the two lungs (mediastinum); or to the lymph nodes on the other side of the chest or in the neck. Stage III is further divided into stage IIIA (usually can be operated on) and stage IIIB (usually cannot be operated on).
• Stage IV: Cancer has spread to other parts of the body.

Treatment of lung carcinoids

Doctors consider tumor size and location, and whether the patient has additional lung problems or serious disease affecting any other organ, in order to determine the most appropriate treatment for lung carcinoids.

SURGERY.

Removing the tumor (surgical resection) is the treatment of choice for these cancers because most lung carcinoids:

• can be cured by surgery alone
• do not respond to chemotherapy or radiation
• must be removed in order to prevent airway obstruction and other complications of tumor growth

If the tumor is located in a large airway, the surgeon may remove the tumor and normal tissue above and below it, then sew together the remaining lung tissue. This procedure is a sleeve resection.

If tumor size or location makes sleeve resection impossible, the surgeon removes the affected lobe of the lung (lobectomy). In rare cases, the surgeon removes the entire right or left lung (pneumonectomy).

Surgeons use lobectomy to remove peripheral carcinoids located at the edges of the lungs farthest from the large airways. If the tumor is very small, the surgeon may remove it and a wedge-shaped piece of lung tissue surrounding it (wedge resection).

Surgeons who remove lung carcinoids usually remove some of the lymph nodes near the lungs because:

• About 10% of typical carcinoids and 30% to 50% of atypical carcinoids have spread to lymph nodes by the time the disease is diagnosed.
• Not removing lymph nodes might increase the risk of cancer spreading to other organs.
• Surgery alone cannot cure lung carcinoids that have spread to other organs.
• Examining lymph nodes can indicate the likelihood that cancer will recur.

Surgeons who remove lung carcinoids try to preserve the patient's lung function by removing the smallest possible amount of normal lung tissue.

PALLIATIVE TREATMENT.

A patient who has severe emphysema, chronic bronchitis, heart disease, or other medical problems may not be able to withstand the stress of surgery to cure lung carcinoids or to cope with breathing difficulties resulting from removal of normal lung tissue.

Doctors use a bronchoscope and a laser to burn away (vaporize) most of the tumor in a patient who is too ill to withstand surgery. These palliative treatments can relieve most symptoms associated with lung carcinoids, but cannot cure the disease. They are often supplemented by radiation administered externally or directly into the air passages (intrabronchial radiation).

MEDICAL TREATMENTS.

Guidelines issued in 2001 by the National Comprehensive Cancer Network recommend the use of radiation following surgery to remove carcinoid lung tumors, and chemotherapy and radiation following surgery to remove atypical lung carcinoids.

Injected into a vein or taken by mouth, chemotherapy drugs are also used to treat lung carcinoids that have spread to other organs, are causing severe symptoms, or have not responded to other medications. Doctors may combine two or more chemotherapy drugs or add them to other medications to relieve symptoms of lung carcinoids that have spread to other organs.

Octreotide controls wheezing, flushing, and other symptoms of carcinoid syndrome. This medication may temporarily shrink lung carcinoids but does not cure them.

Alpha-interferon can shrink some lung carcinoids that have spread to other parts of the body and relieve symptoms of carcinoid syndrome. Doctors can prescribe other medications to relieve specific symptoms.

Radiation may be an option for patients who are too frail or ill to undergo surgery but is not a very effective treatment for lung carcinoids. High doses of radiation can damage lung tissue, create scar tissue, cause breathing problems, and make the patient more susceptible to infection.

PROGNOSIS.

Five-year survival rates for patients with lung carcinoids are 90% to 100% for typical tumors, and 40% to 76% for atypical tumors. Ten-year survival rates are about 10% lower than five-year rates for both types of tumors. The prognosis is worse for lung carcinoids that measure 1 1/4" (3.2 cm) or larger or have spread to lymph nodes.

Some patients who have had lung carcinoids must continue to have regular x rays and blood tests to help doctors detect recurrent disease in its earliest stages. Any patient who has had a lung carcinoid should notify the doctor whenever new symptoms develop. These symptoms could be side effects of treatment or signs that the disease has recurred. A patient who has recovered from surgery should ask the doctor about an exercise routine to restore energy and reduce shortness of breath.