Make your own free website on Tripod.com

Welcome to Dr. Hamid Sanatinia's Virtual Headquarters
Islet Cell Tumors

Home

Should we treat or not???
Performace Status
Antiemetics
Growth Factors
Calculations
Chemo Precautions
TOXICITY CRITERIA
Antidepressants
Chemoprotection
MESNA
Dexrazoxane
Radioprotectants
Hypercalcemia of malignancy
Mucositis
Neutropenic Fever
Palliative Care
Radiation Oncology
<<<<<<<<<>>>>>>>>>
ALL
AML
Anal
Bladder Cancer
Brain Cancer
Breast (risk category)
Breast (adjuvant)
Breast (metastatic)
Breast (Xeloda)
Breast (hormonal)
Breast Cancer Genetics
Carcinoid
CLL
CML
COLON CANCER
Endometrial
Esophagous
Gastric
Gestational Trophoblastic Disease
Germ Cell (Ovary)
Hairy Cell Leukemia
Head/Neck
Head/Neck: ChemoRT abstracts
Head/Neck: Larynx
Head/Neck:Nasopharyngeal
Hodgkins
Islet Cell Tumors
Kidney
Liver
LUNG, NSC
Stage III Unresectable NSC Lung Cancer
Lung, SC
Lymphoma, Aggressive
Lymphoma, AIDS
Lymphoma, Burkitts
Lymphoma, CNS
Lymphoma, Cutaneous
Lymphoma, Indolent
Lymphoma, MALT
Lymphoma, Mantle cell
Lymphoma, Mediastinal B-Cell
Lymphoma, Refractory NHL
Melanoma
Mesothelioma
Multiple Myeloma
MDS
NHL
Ovarian
Pancreas
Prostate
Prostate (Hormonal)
Rectal Cancer
Sarcoma
Sarcoma, Ewing's
Sarcoma, Osteogenic
Skeletal Metastasis
Testicular Cancer
Thymoma
Thyroid Cancer
Waldenstrom's
Unknown Primary
<<<<<<<<<>>>>>>>>>
Molecular Genetics
Oncogenes, the list!
Immunoperoxidase stains
Tumor Markers
Bleomycin
Cisplatin
Etoposide
Ifosfamide
Methotrexate
Temazolamide
Mechanism of Action
Dose Modifications (Renal)
Dose Modifications (hepatic)
MDR

1. Gastrinomas
2. Insulinomas
3. Glucagonomas
4. VIPomas
5. Somatostatinomas
6. Carcinoid
------------------
Chemotherapy Regimen

_____________________________________________________________
Gastrinomas



_____________________________________________________________

Insulinomas

DIAGNOSIS:
Fasting glucose
C-peptide
24 hour fasting and measurement of insulin/C-peptide
- if non-diagnostic, a 48-72 fasting may be attempted
Additional provocative tests:
-Stimulation with tolbutamide or calcium infusion resulting in rapid increase in circulating insulin levels
LOCATING THE TUMOR:
Abdominal CT, ultrasound of the pancreas, MRI, or nuclear medicine scanning with radiolabelled somatostatin analougue.
Note that among gut neuroendocrine tumors, somatostatin imaging is least successful in patients with insulinomas.
Angiography with the simultaneous infusion of calcium produces positive results in about 85% of patients.
Portal vanous sampling could locate these tumors (75-100%) but difficult to do!
Endoscopic or intraoperative ultrasound may have a higher sensitivity.
TREATMENT
1. Surgical resection of tumor (usually solitary). Presence of MEN-1 does not preclude surgical resection.
2. Octreotide - may reduce insulin release
3. Diazoxide - an antihypertensive agent that can suppress insulin release in 50% of patients
4. Chemotherapy -
_____________________________________________________________

Glucagonomas
Sx:
Mild diabetes or glucose intolerance
migratory necrolytic erythema (when metastasized)
Chronic dermatitis
Hypercoagulable state in up to 1/3rd of patients
Weight loss, mucositis, neuropsychiatric manifestations

DIAGNOSIS
1. CT/angio
2. Glucagon levels above 1000 pg/ml in conjunction with the syndrome. Lesser levels may be noted in other conditions such as renal failure, live disease, or stress.

TREATMENT:
1. Surgery (hope for cure)
2. Octreotide
3. IFN + 5FU (helpful for rash, glucagon levels, & tumor size)
_____________________________________________________________

VIPomas

Sx
Profuse watery diarrhea, hypokalemia, achlorhydra
Stool volumes can exceed 700 ml/d & 70% of patients excrete more than 3 liter/d!
Less Common- abdominal cramping, flushing, hypercalcemia, hypophosphatemia

DIAGNOSIS
Elevated circulating VIP> 60 pmole/liter
CT will localize up to 70% of them
Up to 75% are in the pancreas. Other areas include: the lung, colon, or liver.
Note that about 50% of these tumors have metastasized at the time of diagnosis

TREATMENT
1. Control the diarrhea!
- IVF
- Octreotide
2. Surgical resection of the tumor

_____________________________________________________________

Somatostatinomas

Sx
Diabetes (inhibiting insulin secretion)
Steatorrhea (inhibiting gallbladder contraction)
Gallstones


_____________________________________________________________


Carcinoid Tumors
Note that up to 50% of patients with carcinoid tumors are asymptomatic!

Foregut carcinoid
-respiratory tree, pancreas, stomach, proximal duodenum
-can produce a number of hormones: 5-HIAA, serotonin, histamine, adrenocorticotropic hormone
-can cause flushing (less common than midgut tumors)

Medigut carcinoid
-duodenum, jejunum, ilieum,appendix, R-colon
-can produce serotonin
-cause the most common symptoms of carcinoid (flushing, diarrhea, asthma, heart valve disease, facial telangiectasia)

Hindgut carcinoid
-L-colon & rectum
-produce serotonin & sometimes catecholamines & other neuropeptides.


DAIGNOSIS
1. Urinary 5-HIAA
-note that many foods are rich in serotonin such as nuts, bananas, walnuts, pineapples, pecans. Also, drugs such as tylenol can increase 5-HIAA.
2. Platelet Serotonin level
-measurement not affected by the ingestion of serotonin-rich food.
-useful for foregut tumors because U. or serum 5-HIAA not useful.
3. Provocative testing with pentagastrin infusion
-Releases serotonin in 75% & cause flushing in almost 100% of patients.


_____________________________________________________________


CHEMOTHERAPY REGIME
(for those who are candidates for chemotherapy)

5FU + Streptozocin

Doxorubicin + Sterptozocin
-studies have indicated that this is superior to 5FU+streptozocin. Dox containing regimen produce an almost 70% objective remission rate and a significantly increased median surival.

Cisplatin + Etoposide
-This is a choice in poorly differentiated neuroendcrine tumors of the gut. You can use any chemotherapy that works with small cell carcinoma of the lung.










Pathological diagnosis of endocrine tumors of the gut:
-These cells can reduce silver soutions (called argentaffinity). They can also take yp silver ions from the solution (called argyrophillia), or to form isoquinolones & fluoresce after treatment with hot formaldehyde.
-Specific cells also produce specific hormones that can likewise be detected using antisera