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William Scott¹, N Ismiil², M Khalifa³, MA Cooper²

University of Glasgow, Scotland¹, University of Oklahoma, USA³, and University of Toronto, Toronto, Ontario²

BACKGROUND: Carcinoid tumours may produce substances which produce symptoms but only when secreted directly into the systemic circulation; hence, most are indolent and asymptomatic. The incidence of carcinoid tumours is 1-2/100,000 but due to the indolent nature it may be higher. The long-term outcome of carcinoid tumours found incidentally is unknown.

AIMS: The aim of this study was to identify patients with asymptomatic UGI tract carcinoid tumour and to determine the long-term clinical course.

METHODS: A search was performed using ICD-9 codes for carcinoid tumour, neuroendocrine tumour and carcinoid syndrome of patients at Sunnybrook and Women’s College Health Sciences Centre (SW) from 01/01/1980 to 31/12/2002. A similar search was performed using the Pathology database. Charts were reviewed to identify patients with an incidental UGI carcinoid tumour. UGI was defined as oesophagus, stomach and duodenum and incidental was defined as an asymptomatic tumour discovered investigating an unrelated complaint. These charts were then reviewed to extract patient data (age, date of diagnosis, reason for initial investigation, comorbidities), features of the tumour (location, size, other endoscopic, surgical, pathological findings), and follow-up after diagnosis (endoscopy/surgery, recurrent tumour or carcinoid). Patients were contacted by telephone to determine the clinical course followed after diagnosis of the tumour.

RESULTS: Seven patients were identified from the records of which two were male and five were female. The average age at diagnosis was 71 years with the youngest aged 56 yrs and the oldest 90 yrs. All patients were diagnosed with carcinoid tumour within the past 10 years with five in the past three. Initial investigations were for anemia in 2 patients, anemia with melena in two, chronic dyspepsia in one, dysphagia in one, and pernicious anaemia in one. Four patients had a duodenal tumour, two had gastric fundal carcinoids, and one patient had a gastric pyloric tumour. Five patients were followed up by repeat gastroscopy, three of whom also had CT of abdomen and pelvis, one a 24 hour octreotide scan, and one a surgical resection. One patient had no follow-up and one had only recurrent symptom review. None of the patients had any evidence of metastatic spread. Only two patients participated in the telephone survey and both were well with no recurrence of tumour. One patient had died.

CONCLUSION: The numbers involved in the study are very small and obtaining statistically significant data is difficult. Asymptomatic UGI carcinoid tumours are rare and this has been confirmed by this study in that only seven patients were identified in a period of 20 years. The fact that five patients were diagnosed in the past three years may indicate an improvement in the detection of such tumours or a problem with the search used to find relevant patients in the databases from the 1980’s and 1990’s.

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