Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
16 Cards in this Set
- Front
- Back
|
How is it diagnosed?
|
At appendectomy
|
|
|
How common?
|
2 to 5/1000 operations
|
|
|
Of all intestinal malignancies it is the _____ most common?
|
Second
|
|
|
Secrete what?
|
Serotonin, chromogranin A, other vasoactive substances
|
|
|
Most common age?
|
40s
|
|
|
Carcinoid syndrome
|
Episodic flushing, wheezing, diarrhea, right-sided heart disease
|
|
|
Location of most appendiceal carcinoids
|
Distal one-third
|
|
|
Staging includes
|
Unnecessary unless there is evidence of intraabdominal spread, tumor >2 cm, incomplete resection, or symptoms. CT or MRI. Octreotide scan is the most sensitive. If suspicion for carcinoid syndrome, then obtain assays for 5-HIAA (urine) and serum chromogranin A.
|
|
|
Which serum/urine marker is most sensitive?
|
Chromogranin A
|
|
|
Outcome data
|
<2 cm - no recurrences noted with 26 years of follow up, 2-3 cm - 3 of 14, and 4 of 9 >3cm.
|
|
|
Survival
|
SEER database - <3 cm without regional nodal or distant metastases - 100%, 2-3 cm with regional node involvement or >3cm no nodes - 78%, Distant disease - 32%
|
|
|
Risk of lymph node involvement
|
<1.0 cm - 0%, 1-2 cm - 7.5%, >2 cm - 33%
|
|
|
Another paper on risk of LN involvement (from MGH)
|
<1 cm - 15%, 1-2 cm - 47%, >2 cm - 86%.
|
|
|
Survival in second paper Mullen MGH
|
100% - <1 cm, 92% 1-2 cm, 91% >2 cm @ 10 years, despite the fact that 86% had LN mets
|
|
|
Indications for right colectomy
|
>2 cm, 1-2 cm with mesoappendiceal invasion, positive or unclear margins, higher proliferative rate, angioinvasion, and mixed histology (goblet cell, adenocarcinoid).
|
|
|
Pediatric literature
|
Longitudinal follow up for children with tumors less than 2 cm indicates that appendectomy is curative.
|
