Rectal Carcinoid

Objectives

 To identify the incidence and distribution, and risk factors of rectal

carcinoid
 To understand the role of various imaging studies/procedures in the
diagnosis and management of rectal carcinoid
 To classify the appropriate management for rectal carcinoid based
on the size
Wala, di ko na kaya ang antok Patrick. Ikaw na gumawa nito.
Mamatay na ako sa kaantukan. Senseless na nga tong mga
nakalagay e.
 S.E.
 50 years old
 Female
 Single
 Roman Catholic
 Makati City
Chief complaint

 Carcinoid Tumor
History of Present Illness
7 months prior to admission
 For executive check-up, incidental finding on sigmoidoscopy

 Screening colonoscopy with polypectomy was suggested

1 month prior to admission

 Screening colonoscopy was done and revealed

 Rectal endoscopic ultrasound with mucosal resection was suggested

History of Present Illness
3 weeks prior to admission
 Lower GI endoscopic ultrasound was done and revealed

 Colonoscopy with snare polypectomy was done and revealed

 Rectal polyp was then sent for histopathology

 Advised consult with a colorectal surgeon, was subsequently admitted.

Review of Systems

 General: No recent weight change, No body weakness

 Skin: No rashes or pruritus

 HEENT: No headache, No blurring of vision, No difficulty of swallowing

 Respiratory: No cough

 Cardiovascular: No palpitations

 GI: No bleeding

 Extremities: Unremarkable
Past Medical History

 Nonhypertensive (not sure if meron o wala e, check mo nalang sa

chart)
 Nondiabetic
 Rectal Polypectomy (July 25, 2015)
 (+) Allergies to contrast dye, (shrimp? may iba pa alam ko, can
hardly remember)
Family History

 (-)HPM
 (-) DM
 (-) Cancer
 (-) Bronchial asthma
 (-) Heart disease

I cannot recall if meron na kahit ano sa family nila. Ugh.

Personal and Social History

 Smoker (she stopped, di ko lang maalala syempre ilang weeks,

months or years ago. Hahaha!)
 Occasional Alcoholic Drinker
Physical Examination

 Conscious, Coherent, Ambulatory

 BP: PR: RR: Temp:
 Pink palpebral conjunctivae, anicteric sclerae
 Supple neck, no palpable cervical lymphadenopathy
 Symmetrical chest expansion, no retractions, clear breath sounds
 Adynamic Precordium , apex beat at 5th LICS MCL, no murmurs
 Flabby, soft, nontender, (+) incisional scar at the suprapubic area,
normoactive bowel sounds
 DRE: No skin tag, good sphincteric tone, (+) rectal scar from
polypectomy site, left posterior area (si doc monroy ang nag-DRE)
 Extremties: No gross deformities, no edema
Salient Features

 50 years old
 Rectal Polypectomy (July 25, 2015)
Admitting Diagnosis

 Carcinoid Tumor
Course in the Hospital

 Upon admission
 Low residue diet
 PET CT Scan requested
 Metronidazole 500mg/tab q8 & Ciprofloxacin 500mg/tab q12
 GI, Cardiology and Pulmonology referral
 For Right Hemicolectomy with Transanal Full-Thickness Completion of
Polypectomy Site
PET CT SCAN
1 st Hospital Day

 Stratified as low risk for perioperative CV complication, no absolute

contraindication for the planned procedure
 Clear liquids then NPO post-midnight
 Oral antibiotics shifted to IV
2 nd Hospital Day

 Underwent Right Hemicolectomy with Transanal Full-Thickness

Completion of Polypectomy Site
2 nd Hospital Day

 At syempre di ko naman na alam ang nangyari pagkabalik nya sa

kwarto. Ahahaha. Dahil from na kami nun, ang receiving si melle. So
sya ang nagpostop dyan. Ewan ko lang kung may makita sa chart
na postop notes nya. Check mo nalang.
3 rd Hospital Day (1st Postop Day)

 Clear liquids
 IV antibiotics continued
 PE of the Abdomen: Flabby, soft, tender at the postop site (VAS
8/10)
 Flatus and bowel movement? (di ko matandaan kelan sya
nagpoop e, pero hirap yan lumakad papuntang CR nun kaya may
commode sya, ano namang connection nun? Wahahaha)
 Bleeding per rectum? I dunnoh na.
 Pain management referral
 PCA fentanyl started
 Advised ambulation
4 th Hospital Day (2nd Postop Day)

 Histopathology
5 th Hospital Day (3rd Postop Day)

 General liquids
 IV antibiotics and pain medications continued
 PE of the abdomen: Flabby, soft, tender at the postop site (VAS
5/10), with complaint of dizziness
 No bleeding per rectum
6 th Hospital Day (4th Postop Day)

 Soft diet
 IV medications discontinued
 PE of the abdomen: Flabby, soft, nontender, notmoactive bowel
sounds
 With flatus and bowel movement
 Advised possible discharge
7 th Hospital Day (5th Postop Day)

 No subjective complaints

Discharged
Overview

 Carcinoid tumors occur most commonly in the gastrointestinal tract,

and up to 25% of these tumors are found in the rectum

 Most small rectal carcinoids are benign and overall survival is

greater than 80%

 Risk of malignancy increases with size, and more than 60% of tumors
greater than 2 cm in diameter are associated with distant
metastases

Ito sa Schwartz’s
Overview

 Small carcinoids can be locally resected transanally. Larger tumors

or tumors with obvious invasion into the muscularis require more
radical surgery

Pati ito sa Schwartz’s, ganyan lang kaiksi. Boohoo. Walang laman.

Overview
 The rectum is the most common site of gastrointestinal carcinoid tumors, and
occurs most commonly in individuals of their 5th-6th decades of life (Maeda,
2005)
 Rectal carcinoid tumors are usually found incidentally during endoscopic
examination. The typical endoscopic examination of rectal carcinoid tumors
reveals smooth, round, sessile elevations covered with normal-appearing or
yellow-discolored mucosa (Huang et al., 2011)
 Other characteristics of rectal carcinoid tumors include a preponderance in
males (1.6:1), small-sized tumors of 10 mm or less at detection (66.0%), a high
incidence of submucosal invasion (76.3%) and hematogenous spread (58.2%
of 287 metastases), an infrequent association with carcinoid syndrome (0.7%),
and a relatively high 5-year survival rate after lesion removal (81.5%)
Ito from journals. Pero di ko na talaga kaya ang antok. Ikaw na bahala talaga sa
discussion mister. Past 4 na e. pwede naman siguro ako matulog noh? Hahaha!
Effort tengene leng.
Walang kwentang reference. Click mo nalang
yung url. If okay sayo, isama mo, kung hindi, wag.
Easy. Tae. Zzzzzzzzzzzzzzzzzzzzzzzzzzzzzz.
 http://www.medscape.com/viewarticle/776029
Treatment Strategy for Rectal Carcinoids

 http://www.wjso.com/content/13/1/31
Surgical management and outcome of rectal carcinoids in a university
hospital

 http://theoncologist.alphamedpress.org/content/13/12/1255.full
Carcinoid Tumors

 http://www.sages.org/meetings/annual-meeting/abstracts-
archive/surgical-treatment-options-for-rectal-carcinoid-cancer-trans-
anal-excision-versus-low-anterior-total-mesorectal-excision/
Surgical Treatment Options for Rectal Carcinoid Cancer: Trans-Anal
Excision Versus Low Anterior Total Mesorectal Excision
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443297/
Surveillance of Small Rectal Carcinoid Tumors in the Absence of Metastatic
Disease
 http://archsurg.jamanetwork.com/article.aspx?articleid=600433
Rectal Carcinoid TumorsReview of Results After Endoscopic and Surgical
Therapy
 http://www.crs.org.tw/upload_newsletter/10010/139_03-100-08.pdf
Rectal Carcinoid Tumor: Treatment and Long-Term Outcome in 30 Cases
 file:///C:/Users/user%20pc/Downloads/ML_Maeda.pdf
Carcinoid tumor in the rectum