Rectal Carcinoid Tumors: Differences, Treatment, and Prognosis

Carcinoid tumor~~~

Hello Doctor, I recently underwent a comprehensive health check-up at Cheng Kung University Hospital, and during an endoscopic rectal examination, a tumor was discovered.
After two outpatient surgeries for biopsy, I was diagnosed with a rectal carcinoid tumor, and I was hospitalized for surgical removal not long ago (which is why I received a major illness card).
I would like to ask about the differences between carcinoid tumors and other cancers, such as colorectal cancer.
What stage does my carcinoid tumor fall under in general cancer classification (is it considered in situ cancer)? What is the probability of successful treatment and the recurrence rate after surgery? Is there any immediate risk of mortality? What specific areas should I pay attention to? (Because my attending physician did not provide clear answers to my questions and was quite vague).

Below is my pathology report after the surgery:
PATHOLOGICAL DIAGNOSIS: Rectum, 2 cm above anal verge, excision: Carcinoid tumor.

GROSS FINDING: The specimen consists of a piece of tan soft tissue fragment measuring 1.4 x 0.8 x 0.6 cm.
There is a suture knot labeling the outer direction.
On cut, there is a small nodular lesion (0.5 cm) in the mucosal and submucosal area.
Representative sections are embedded in one cassette.

MICROSCOPIC FINDING: Section shows small uniform tumor cells arranged in trabecular and cord-like patterns separated by thin fibrovascular septa.
The tumor cells contain a moderate amount of eosinophilic cytoplasm.
Mitosis is rarely seen.
The tumor invades the submucosal layer (3.5 mm in depth).
Peripheral rectal mucosa shows ulcerative change.
Section margin is free.

jiern, 20~29 year old female. Ask Date: 2004/02/18

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello! I apologize for the delayed response to your question.
As an internist, I need to consult some resources to address surgical issues.
Rectal carcinoids differ histologically from the more commonly referred rectal adenocarcinomas, and they also have different degrees of malignancy.
The stage of the cancer is determined by how deeply it invades the layers of the bowel, the presence of cancer cells in the lymph nodes, and whether there is metastasis to other organs.
The success rate of treatment depends on the stage of the cancer; generally, a higher five-year survival rate correlates with a lower recurrence rate.
In the short term, if there is a threat to life, it is crucial to recover strength after surgery.
A normal, balanced diet and exercise, along with reducing smoking and alcohol consumption, can enhance your immune system.
If my response does not fully satisfy your inquiry, you may wish to consult a colorectal surgeon.
Sincerely, Dr.
Yang Pei-Chen, Chief of Gastroenterology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2004/02/18

More Info

Understanding rectal carcinoid tumors is crucial for patients diagnosed with this condition, especially when they have undergone surgery and are looking for clarity on their prognosis and treatment options. Rectal carcinoid tumors, also known as neuroendocrine tumors, differ significantly from more common colorectal cancers, such as rectal adenocarcinoma.

Differences Between Rectal Carcinoid Tumors and Rectal Adenocarcinoma
1. Histological Characteristics: Rectal carcinoid tumors are derived from neuroendocrine cells and typically exhibit a distinct histological pattern characterized by small, uniform cells arranged in trabecular or cord-like formations. In contrast, rectal adenocarcinomas arise from glandular epithelial cells and have a more complex structure with varying degrees of differentiation.

2. Aggressiveness: Carcinoid tumors are generally considered to be less aggressive than adenocarcinomas. They often have a slower growth rate and a lower tendency to metastasize. However, the behavior can vary based on tumor size and depth of invasion.

3. Staging: The staging of carcinoid tumors is different from that of adenocarcinomas. For carcinoid tumors, factors such as tumor size, depth of invasion, and presence of metastasis are critical. Your pathology report indicates that the tumor invaded the submucosal layer by 3.5 mm, which is an important factor in determining the stage.

Staging and Classification
Based on the information provided, your rectal carcinoid tumor is likely classified as a localized tumor, potentially falling under Stage I or II, depending on the specific criteria used by your healthcare provider. It is not classified as in situ (Stage 0) since it has invaded the submucosal layer. The absence of lymph node involvement or distant metastasis would further influence the staging.

Treatment Success Rates and Recurrence
The treatment for rectal carcinoid tumors typically involves surgical resection, which you have already undergone. The prognosis for carcinoid tumors is generally favorable, especially when they are localized and completely resected. The five-year survival rate for localized carcinoid tumors can be quite high, often exceeding 90%. However, recurrence rates can vary; while many patients do well post-surgery, some may experience recurrence, particularly if the tumor was larger or had deeper invasion.

Short-term Risks and Considerations
In the short term, the risk of life-threatening complications is relatively low, especially if the surgery was successful and there are no signs of metastasis. However, it is essential to monitor for any signs of complications such as infections or issues related to bowel function post-surgery.

Follow-up Care
Post-operative follow-up is crucial. Regular monitoring through imaging and blood tests (such as chromogranin A levels, which can indicate neuroendocrine tumor activity) is recommended. You should also maintain a balanced diet and engage in regular physical activity to support your recovery and overall health.

Conclusion
In summary, rectal carcinoid tumors are distinct from rectal adenocarcinomas in terms of histology, aggressiveness, and treatment outcomes. Your prognosis appears favorable given the details of your pathology report, but ongoing follow-up and monitoring are essential to ensure any potential recurrence is caught early. If you have further questions or concerns, consider discussing them with your healthcare provider, who can provide personalized insights based on your specific case.

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