RECENT DEVELOPMENTS IN DIAGNOSIS AND TREATMENT OF METASTATIC CARCINOID-TUMORS

In carcinoid patients a tumour of enterochromaffin cell origin is pres ent, which dependent on the site of origin can result in increased ser otonin production. Metastasized carcinoids are often diagnosed by meas uring 5-hydroxyindoleacetic acid excretion in the urine. This excretio n, however, can be influenced by food intake. On the other hand, serot onin measured in blood platelets is unaffected by food intake and, in addition, is found to be more sensitive. Therapy of metastasized carci noids is directed at tumour reduction or only reduction of symptoms. T umour reduction can be achieved surgically or by embolization. Combina tion chemotherapy has a maximum response percentage of about 33%. Over the last few years, both octreotide and interferon alpha have been us ed in these patients. They rarely result in a reduction of the tumour size (10-20%). Symptom reduction is achievable in most patients with t hese agents, however. Recently, increasing knowledge obtained concerni ng the various serotonin receptors and their antagonists is now being used in the treatment of patients with a metastasized carcinoid. In th e future it is expected that the different modalities will be combined increasingly.