Carcinoid treatment in Israel

Carcinoid is a rare type of tumor that develops from neuroendocrine cells and can produce certain hormones and biologically active substances. Most often, carcinoid affects the mucous membrane of the small intestine, bronchial tree, and in some cases can be localized in the pancreas and genitourinary system.

As a rule, carcinoid tumors are benign in nature (they do not metastasize), although they are prone to locally destructive growth. Some carcinoid tumors have the ability to metastasize and are malignant.

Since carcinoid neoplasms are often hormonally active and release certain biologically active substances into the systemic bloodstream, patients with such tumors have carcinoid syndrome, which allows the disease to be diagnosed at fairly early stages.

Carcinoid syndrome is a group of specific symptoms that occur under the influence of those hormones that are produced in excess by carcinoid.

With timely treatment, 5-year survival rates approach 95%. It is important to find a clinic that specializes in managing such patients and has experience treating carcinoid. These are the doctors who work in the adult oncology department of Tel Aviv Medical Clinic.

We offer our patients:

• Individual approach to treatment. When drawing up an examination plan and treatment regimen, specialists do not use one template or protocol for everyone, but rather modify treatment and diagnostic procedures depending on the needs of each patient and the characteristics of their disease.
• All treatment measures comply with global clinical guidelines and standards for providing medical care in oncology.
• A multidisciplinary team of professionals provides assistance to one patient. All decisions are made on a consultative basis.
• All our specialists are highly qualified and have repeatedly completed internships at the best oncology centers in the world.
• The department is equipped with only modern expert-class treatment and diagnostic equipment. All diagnostics can be completed in one place within 3-4 working days.
• All our patients can participate in clinical trials of new drugs and treatment methods absolutely free of charge. Often, this is the only chance for a person to overcome a serious illness.
• The ability to perform innovative genetic diagnostics, which will allow us to create a more effective treatment protocol and select individual treatment protocols.
• Innovative treatment methods and drugs that are actively being introduced into practice.
• Treatment by the best Israeli specialists with a worldwide reputation.
• Minimally invasive surgical interventions (endoscopic and laparoscopic operations).
• Modern video capsule diagnostics of the small intestine.
• Modern drug therapy for carcinoid with Octreotide or Lanreotide, Netazepide.
• Radionuclide treatment of carcinoid using the radiopharmaceutical Lu-177-Dotatate.

Reasons for carcinoid

In most cases, carcinoid occurs sporadically, that is, a mutation occurs in initially healthy cells under the influence of negative external or internal factors, which leads to the development of atypical cells and tumor growth.

However, there are hereditary diseases and genetic syndromes that can cause the development of various tumors, including carcinoid. For example, MEN-1 syndrome (multiple endocrine neoplasia type 1 or Wermer syndrome) occurs with mutations in the MEN1 gene, RET oncogene, which can be determined by genetic testing.

Risk factors for developing carcinoid:

• chronic gastrointestinal diseases, such as atrophic gastritis;
• alcohol abuse, smoking;
• genetic predisposition (some types of neurofibromatosis, multiple endocrine neoplasia syndromes);
• infection with certain types of viruses;
• dietary features.

Symptoms of carcinoid

Patients with carcinoid tumors may experience symptoms associated with the growth of the tumor, and symptoms associated with the production of certain hormones and substances by the carcinoid.

In the first case, the signs depend on the location of the tumor. If the small intestine is affected, patients may complain of cramping abdominal pain, changes in stool. If the bronchopulmonary system is affected – cough, shortness of breath, attacks of airway obstruction.

Classical carcinoid syndrome develops in less than 10% of patients with carcinoid tumors. It is characterized by: hot flashes to the head and neck (feeling of heat, reddening of the skin), intestinal colic and diarrhea, difficulty breathing and wheezing in the chest (broncho-obstructive syndrome).

Other paraneoplastic syndromes caused by the production of hormones by carcinoid may include:

• Cushing’s syndrome with hyperproduction of the hormone ACTH;
• acromegaly with hyperproduction of the releasing factor of somatotropic growth hormone;
• Zollinger-Ellison syndrome with hyperproduction of gastrin.

Important! About half of the patients have an asymptomatic course of carcinoid, since the tumor may not produce hormonally active substances.

Modern diagnostic methods

Diagnostics of carcinoid is often difficult, since the disease is rare and most often affects the upper sections of the small intestine, which are inaccessible to objective examination, for example, during colonoscopy.

The carcinoid diagnostic program at Tel Aviv Medical Clinic necessarily includes:

• Urine analysis for 5-hydroxyindoleacetic acid – this is a product of the body’s processing of serotonin, which is produced in excess by a carcinoid tumor. Therefore, the amount of this metabolite in the urine increases. Such a simple analysis (analysis of urine collected over 24 hours) allows you to confirm the diagnosis of carcinoid if the patient has characteristic complaints.

At the second stage, doctors use visual diagnostic methods to find the tumor itself and plan a treatment regimen:

• ultrasound, MRI, CT, PET-CT. These studies allow in most cases to find the tumor, see it, establish the exact location, size, stage of spread of the tumor process, find metastases if any. To accurately examine the patient for metastatic lesions, scintigraphy with meta-131I-benzylguanidine or meta-123I-benzylguanidine is performed.
• Endoscopic diagnostic methods. To find a tumor, the patient may undergo gastroscopy, colonoscopy if gastrointestinal tract damage is suspected, or bronchoscopy if respiratory tract damage is suspected.
• Capsule endoscopy is a modern method of examining the small intestine, which is not available for visualization using standard diagnostic methods. The video capsule is a miniature high-tech device that the patient swallows. As it moves through the gastrointestinal tract, the capsule takes photos and videos of the mucous membrane. If there is a tumor in the intestine, the video capsule will record it.
• Biopsy. It is mandatory when a neoplasm is detected using endoscopic diagnostic methods. Only a pathohistological examination of a tissue sample after a biopsy makes it possible to 100% verify the diagnosis.

Important! All materials after biopsy of Tel Aviv Medical Clinic patients are sent to the best pathohistological laboratories of Israel, the USA, Europe, where they are reviewed by a specialist in such rare tumors as carcinoid. Thanks to such a thorough check, we are 100% sure of the correctness of the diagnosis, which allows us to accurately select the most effective treatment regimen.

Genetic diagnostics

Our patients also have access to innovative genetic diagnostics of biopsy material (molecular genetic studies). This is a mandatory part of modern diagnostics of oncological diseases.

Genetic testing of malignant cells allows us to obtain information that will be extremely useful for accurate diagnosis of the disease, choice of treatment method, and prediction of the effectiveness of therapy, thanks to obtaining a genomic profile of the neoplasm. With the help of this method, doctors are able to determine the most effective treatment for each individual patient.

In addition, testing allows us to determine the hereditary predisposition of each person who has already had cases of carcinoid tumors in the family, and to determine the need for preventive examinations for the early diagnosis of such a disease.

An example of such a modern diagnosis for carcinoid:

• ENDCP | Hereditary Endocrine Cancer Panel, Varies.
• NF1Z | Neurofibromatosis Type 1, NF1, Full Gene Analysis, Varie.
• PTNZ | PTEN Hamartoma Tumor Syndrome, PTEN Full Gene Analysis, Varies.
• RETZZ | Multiple Endocrine Neoplasia Type 2 Syndrome, RET, Full Gene Analysis, Varies.
• The full list of molecular genetic studies that TAMS offers to its patients can be viewed here. All genetic tests are unique tests that can be performed at TAMC.

Prognosis for carcinoid

As a rule, the prognosis for carcinoid tumors is favorable. Considering that carcinoid in most cases does not show signs of malignancy, 5-year survival with modern treatment approaches 100%.

Modern treatment of carcinoid

One of the main advantages of carcinoid treatment at Tel Aviv Medical Clinic is the use of a comprehensive approach to therapy. In the fight against the tumor, the specialist uses the entire available arsenal of treatment methods. Therapy always consists of a combination of 2, 3 or more methods. As a rule, the treatment regimen includes surgical removal of the tumor in combination with drug therapy, chemotherapy in the case of malignant neoplasms. In some cases, certain innovative treatment methods are added to the treatment program (targeted drugs, immunobiological drugs, experimental agents, etc.).

All Tel Aviv Medical Clinic patients can take part in clinical trials of new drugs or methods for treating carcinoid. Our medical center regularly conducts final phases of clinical trials, so if you meet the criteria, you can become a participant in such an experiment absolutely free of charge. For some patients, this is a real chance for a full recovery and prolongation of life.

The main method of treating carcinoid is surgery. Depending on the location of the tumor, its size and spread, surgeons can perform open or minimally invasive surgeries (endoscopic, laparoscopic, thoracoscopic, bronchoscopic). In case of widespread carcinoid lesions, surgeons perform a cytoreduction operation, when all visible tissue lesions caused by the carcinoid are carefully removed, while healthy tissues are preserved.

In case of liver metastases, minimally invasive methods of removing foci in the organ can be used – radiofrequency ablation (RFA) and embolization of the branches of the hepatic artery. Carcinoid tumors grow slowly, so such methods can prolong the patient’s life by 10-15 years.

If the tumor cannot be removed surgically, drugs are used to control symptoms (in particular, to control the symptoms of carcinoid syndrome and other paraneoplastic endocrine disorders). Octreotide and Lanreotide can be administered once a month to control hot flashes. These drugs can reduce the hormonal activity of the neoplasm and alleviate the symptoms of the pathology. Chemotherapy is usually ineffective, but some regimens (streptozocin with fluorouracil and cyclophosphamide) are often used in people whose disease has reached an advanced stage.

Radiation therapy is ineffective and is not used in the treatment of patients with carcinoid.

The drug Netazepide has an excellent effect in patients with gastrin-secreting tumors. It blocks this hormone and helps shrink such tumors in patients with gastrin-producing gastric carcinoid.

Radionuclide therapy. This therapy uses the radiopharmaceutical Lu-177-Dotatate. This is a radioactive substance that binds to the cells of carcinoid tumors that contain the protein somatostatin, and then helps shrink the tumor using small doses of ionizing radiation. For each patient, the decision on the combination of certain treatment methods (which methods to start with, what to add next, at what stage of treatment to perform surgery, when and according to what scheme to use chemotherapy or a targeted drug or other immunobiological drugs) is made jointly by a team of specialists. Each person and their disease are different, so our doctors, relying on their experience in treating oncological pathologies, often go beyond standard protocols, changing treatment schemes and doses of necessary drugs, radiation methods in order to obtain the best results for their patients.

Take Control of Your Health Today! Schedule a consultation with our top specialists and receive a personalized treatment plan. Contact us now!