In 2007, Albert Garcia, now 59, went to his doctor for a screening colonoscopy. What he learned is that he had cancer in his large intestine. But lucky for him, it was determined to be a carcinoid, not a carcinoma.
A carcinoma starts in the cells that form a particular organ. For example, breast cancer grows in the breast ducts (or lobules) and colon cancer arises from the cells lining the colon wall.
“But carcinoids stem from very specialized cells,” says Dr. Seza Gulec, director of surgical oncology, Jackson North Medical Center/FIU.
Your body has a well-organized nervous system that includes the brain, cerebellum, spinal cord and nerve tissue. But it also has a more diffuse system made up of individual cells or clusters of cells found throughout the body.
“This is the neuroendocrine system and it’s unique,” says Gulec, who has seen Garcia since he moved to Wellington about a year ago.
Through the production of hormones, these cells fine-tune how organs function. And it’s these neuroendocrine cells that give rise to carcinoid tumors.
Today, these tumors are synonymous with a low-grade neuroendocrine tumor that can be found just about anywhere in the body, says Dr. Pasquale Benedetto, the Leonard M. Miller Professor of Medicine at Sylvester Cancer Center.
Carcinoid, which means “carcinoma-like,” was first characterized in 1907 by Siegfried Oberndorfer, a German pathologist.
“Under the microscope, carcinoids look like carcinomas but they behave better than most cancers,” Gulec says.
No one knows what causes these tumors, which can be either benign or malignant. They are relatively indolent, or slow growing. But over time, they, like any cancer, can squeeze out healthy cells and cause problems in the organs they occupy.
Carcinoids recently garnered attention when Apple co-founder Steve Jobs was diagnosed with a neuroendocrine tumor in the pancreas that metastasized to the liver. It proved fatal.
“You can’t ignore a carcinoid, absolutely not,” Gulec says.
According to the American Cancer Society, about 8,000 neuroendocrine tumors are diagnosed each year in the gastrointestinal tracts (the stomach, intestine, appendix, colon or rectum) of patients in the United States. These account for about 90 percent of all neuroendocrine tumors.
These tumors can also start in the lungs, pancreas and ovaries, although a small number develop in other organs. The incidence of carcinoid tumors has been increasing but doctors don’t know why, according to the ACA.
Often these tumors are hard to find and diagnosed only incidentally, says Christina Gomez, a medical oncologist at Holy Cross Hospital’s Michael and Dianne Bienes Comprehensive Cancer Center.
For example, you, like Garcia, may be having a routine colonoscopy or a chest CT scan when a carcinoid tumor in your intestine or lungs is identified. Or you might suffer appendicitis only to discover the blockage is caused by a carcinoid tumor. Many more are only found post mortem.
After a carcinoid tumor is noted by your pathologist, your doctor may run tests to determine the cancer’s rate of growth. As cells divide, they give off a protein that can be stained and seen under the microscope. The more of this protein that is present in the tissue sample, the more cell division and the faster the tumor growth.