Diagnosing carcinoid tumours involves a multi-step approach, combining clinical evaluation with specialised tests to confirm the presence of these tumours and assess their extent.

1. Clinical Evaluation: The diagnostic process often begins with a thorough patient history and physical examination. The doctor will ask about symptoms such as flushing, diarrhoea, or abdominal pain, and review any relevant medical history, including potential risk factors or family history of neuroendocrine tumours. A physical exam may reveal signs suggestive of carcinoid syndrome or other related symptoms.

2. Imaging Studies: To visualise the tumours and determine their location, doctors often use imaging techniques. Common methods include:

• CT Scans: Abdominal or chest CT scans can help identify the presence of carcinoid tumours and assess their size and spread.
• MRI: Magnetic resonance imaging may be used for a more detailed view, particularly for tumours in the liver or brain.
• Somatostatin Receptor Scintigraphy: This imaging technique uses radiotracers that bind to somatostatin receptors, which are commonly present on carcinoid tumours, allowing for their detection.

3. Laboratory Tests: Blood and urine tests are crucial in diagnosing carcinoid tumours. Elevated levels of certain biomarkers, such as serotonin, 5-HIAA (a serotonin metabolite), or chromogranin A, can indicate the presence of a carcinoid tumour. These tests help in confirming the diagnosis and monitoring tumour activity.

4. Biopsy A definitive diagnosis often requires a biopsy, where a sample of tissue from the suspected tumour is examined microscopically. This can be performed via endoscopy if the tumour is accessible or through a needle biopsy guided by imaging techniques.

5. Endoscopy: For tumours in the gastrointestinal tract, endoscopic procedures may be used to directly visualise the tumour and obtain tissue samples for biopsy. This method can provide valuable information about the tumour’s location and characteristics.

By combining these diagnostic tools, medical professionals can accurately diagnose carcinoid tumours, determine their stage, and plan appropriate treatment strategies.

Treatment of carcinoid tumours involves a multidisciplinary approach tailored to the tumour’s location, size, and stage. The primary treatment modalities include surgical intervention, medication, and sometimes radiation therapy.

1. Surgical Intervention: Surgical removal of the tumour is often the first-line treatment for carcinoid tumours, especially if the tumour is localised. The specific type of surgery depends on the tumour’s location. For carcinoid tumours in the gastrointestinal tract, particularly in the pancreas or duodenum, two significant surgical procedures are commonly used:

• Pancreaticoduodenectomy: Also known as Whipple’s surgery, this complex procedure involves the removal of the head of the pancreas, the duodenum (the first part of the small intestine), a portion of the bile duct, and sometimes part of the stomach and lymph nodes. It is typically performed for carcinoid tumours located in the pancreatic head or duodenum. The goal is to excise the tumour and any affected surrounding tissues while preserving as much of the digestive function as possible.
• Whipple’s Surgery: This procedure is often used interchangeably with pancreaticoduodenectomy and involves similar steps. It is a major surgery aimed at removing tumours from the pancreatic head, duodenum, and other adjacent structures. Post-operative management includes monitoring for complications and ensuring proper digestive function.

2. Medical Therapy: For cases where surgery is not feasible or the tumour is metastatic, medical therapies are crucial. Treatments may include somatostatin analogs, such as octreotide or lanreotide, which help control symptoms by inhibiting hormone secretion from the tumour. These medications can also slow tumour growth.

3. Targeted Therapy and Chemotherapy: For advanced carcinoid tumours or those that do not respond to initial treatments, targeted therapies and chemotherapy may be used. Targeted therapies aim at specific pathways involved in tumour growth, while chemotherapy can help reduce the size of tumours and manage symptoms.

4. Radiation Therapy: Although less common, radiation therapy may be employed in certain cases, particularly for tumours that are not surgically resectable or have spread to other parts of the body.

5. Supportive Care: Managing symptoms and maintaining quality of life are essential aspects of treatment. Supportive care may include nutritional support, pain management, and monitoring for potential side effects of treatment.

By combining these approaches, healthcare professionals aim to manage carcinoid tumours effectively, improve patient outcomes, and enhance quality of life.