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PARTICIPANTS Lowell B. Anthony, MD Louisiana State University Health Science Center Eugene A. Woltering, MD Professor of Surgery and Neuroscience EDITORIAL CONSULTANT Shlomo Melmed, MD Cedars-Sinai Health System

LOWELL ANTHONY, MD: Common areas that these tumors might start would be the small intestines, the large intestines, the pancreas, the stomach, and the lungs.

ANNOUNCER: But most people with carcinoid disease don't know they have it. Many fewer go to the doctor with symptoms.

LOWELL ANTHONY, MD: In terms of the number of cases that come to clinical attention, we're looking at about one case per three hundred thousand, or about three cases per million. And with the population of the United States approaching three hundred million, we're looking at new cases of carcinoid between seven hundred and maybe nine hundred new cases a year.

EUGENE A. WOLTERING, MD: The average carcinoid tumor is asymptomatic and is found by accident. It is found either at the time of an appendectomy, it's found incidentally at the time that someone has surgery that opens the abdomen, and the physician is looking around and finds it accidentally. So most of these are silent.

ANNOUNCER: There's no proven cause for carcinoid tumors. And any demonstrated link to genetics is weak, at best. In most cases, carcinoid disease behaves very differently from more common types of cancer. One reason is that carcinoid tumors are, in most instances, very slow-growing.

EUGENE A. WOLTERING, MD: Patients with carcinoid, even though they can be widely metastatic in the liver and the bones, may live decades, rather than months, days, or years.

ANNOUNCER: The second difference is that carcinoid tumors release an excess of a variety of hormones into the body.

If the tumors are large enough, or if they have spread to the liver, these hormones can lead to symptoms know as carcinoid syndrome.

EUGENE A. WOLTERING, MD: The carcinoid syndrome classically has three main components. The first is flushing, the second is diarrhea, and the third may be wheezing.

ANNOUNCER: In a minority of cases, carcinoid tumors behave like other forms of cancer.

EUGENE A. WOLTERING, MD: In general, carcinoids come in two varieties. One is a very slow-growing variety which is interestingly enough, called typical. There are another group of patients who have carcinoids that are atypical. Those patients have a much bigger problem. They have a very rapid turnover rate of their cells. They behave much more like classic cancers, like lung cancers, and their survival is much, much shorter.

The percent of patients that have atypical carcinoids is relatively low. Probably in, in my practice, five to ten percent of patients have atypical tumors.

ANNOUNCER: Even when a person has the slow-growing, typical, form of carcinoid disease, they still face danger.

EUGENE A. WOLTERING, MD: Carcinoids are tumors in slow motion. However, motion is motion. And one of the critical concepts in carcinoid is that these tumors divide and, and spread slowly. But it's sort of like the invading Mongol horde. It can be slow, but as long as they're invading and spreading, they're still a major life-threatening problem.

ANNOUNCER: Surgery is often the first step for treating carcinoid disease. Sometimes, when the tumors can't be removed, doctors kill the cancer cells using powerful radio waves. For the fast-growing variety of the disease, standard chemotherapy can be effective. For the more common, slow-growing, carcinoid disease, doctors use other types of medication. Interferon is sometimes used. But more commonly, doctors use an artificial version, called an analogue, of a naturally-occurring hormone called somatostain.

LOWELL ANTHONY, MD: Somatostatin analogues are administered either underneath the skin or in the muscle, either in an immediate form or a slow form, and they're transported to the actual tumor cell through the blood, where they bind to a very special substance that we call the somatostatin receptor.

EUGENE A.WOLTERING, MD: Somatostatin analogs like Sandostatin have been shown to be very effective; about eighty percent of patients' symptoms will improve. And it has also been shown to significantly lengthen the survival of patients with carcinoid.

ANNOUNCER: Carcinoid disease is sometimes called "cancer in slow motion" because is usually takes so long to progress. But carcinoid tumors can cause significant symptoms and, in some cases, can be a very serious. But with surgery and good medical treatments, patients with carcinoid disease can usually maintain a good quality of life.