Single hospital experience of carcinoid tumours of colon and rectum
Rohith Gopala Rao, Melissa Banks, Graeme Poston & James Arthur
Background: Carcinoid tumours of colon and rectum (CTCR) are a rare entity. A review of a tertiary referral units experience is presented.
Aim: Reviewing our experience of CTCR with emphasis on tumour site, disease stage, treatment and long term outcome.
Method: Retrospective analysis of our endocrine tumour database was performed. All patients diagnosed with CTCR between 2000 and 2009 were included.
Findings: Twenty-two patients were identified with CTCR. Seventeen were tumours (15 right colon, 1 recto-sigmoid and 1 rectal), while 5 (23%) were incidental polyps (1 transverse colon and 4 rectum). At presentation some 9 (41%) patients had lymph node disease, 9 had liver metastases of which 3 had concurrent nodal disease and 1 had bone, liver and peritoneal disease. Two patients developed delayed metastases after undergoing colectomy (1 Liver and 1 Lung). Three patients (14%) were deemed to have inoperable disease at diagnosis. Surgical intervention consisted of 13 right colectomies (59%), 1 anterior resection, 2 Transanal Endoscopic resections and one hepatic resection for delayed metastasis. Four of the incidental polyps had clear resection margins. Systemic chemotherapy was given to the 3 patients (2 with inoperable disease), 2 patients received MIBG therapy and 4 patients were managed with sandostatin for symptom control. Majority of tumours were well differentiated (60%). Four people (18%) have since succumbed to the disease with remainder being alive at this point of time. Only 4 (22%) patients have had five year disease free survival.
Conclusion: CTCR is rare with predilection for right colon. Its infrequent in comparison with small bowel and appendiceal carcinoids (147 in our database). Nodal and/or liver involvement at presentation is frequent, but in those with operable disease, tumour resection prolongs survival (12 of 13 colectomies). Incidental finding in polyps need no further intervention if margins are negative.