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Neuroendocrine tumors are rare and usually slow-growing tumors arising from neuroendocrine cells. Neuroendocrine cells produce hormones that control metabolism, digestion, and other bodily functions.
Neuroendocrine tumors can start growing in the digestive tract, lungs, appendix, thymus, and other organs, and may spread to other parts of the body.
Carcinoid syndrome is a group of symptoms that occur when some neuroendocrine tumors (also called carcinoid tumors) overproduce hormones such as serotonin.
Dietary modification is one aspect of treatment for carcinoid syndrome. Patients who have carcinoid syndrome should avoid foods and substances that can trigger the release of serotonin and other hormones from carcinoid tumors.
Foods that should be avoided with carcinoid syndrome include:
- Foods and substances with high levels of amines, nitrogen-containing organic compounds, or adrenaline-like substances
- Fatty meats
- Smoked, salted or pickled fish or meat (herring, salami, sausage, corned beef, bologna, pepperoni)
- Aged cheeses (cheddar, Camembert, Stilton)
- Red wine
- Alcoholic beverages
- Spoiled protein foods (chicken liver)
- Yeast extracts and Brewer’s yeast, hydrolyzed proteins
- Broad beans
- Sauerkraut
- Shrimp paste
- Some soybean products, miso soup, soy sauce, tofu
- Limit:
- Foods with high serotonin levels
- Eggs
- Cheese
- Pineapple
- Nuts such as walnuts and pecans
- Bananas and plantains
- Tomatoes
- Kiwi fruit
- Plums
- Limit:
- Avocados (Haas)
- Dates
- Grapefruit
- Cantaloupe
- Honeydew
- Olives
- Eggplant
- Certain nuts (Brazil nuts, filberts, almonds, cashews, macadamia nuts)
- Coconut
- Spicy foods
- Fructose
Smaller, more frequent meals are also easier for patients with carcinoid syndrome to digest.
Other treatments for carcinoid syndrome depend on the symptoms, where the tumor is located, and how much the cancer has spread.
Treatment aimed at controlling symptoms of carcinoid syndrome includes:
- Anti-diarrheal medications
- Medicines that block neuroendocrine tumors from producing the substances that cause symptoms
- Adjusting prescription medications
- Some drugs can affect amine or adrenaline levels
- Never stop taking a prescribed medication without first talking to your doctor
- Palliative therapy (supportive care) to help manage pain, maintain quality of life, and reduce stress that comes with a serious illness
- Treatment for carcinoid heart disease
- May involve surgery to replace a diseased heart valve with a healthy heart valve
Treatments for neuroendocrine tumors may help relieve symptoms of carcinoid syndrome and include:
- Surgery to remove all or part of a neuroendocrine tumor
- Embolization
- Ablation therapy
- Biologic therapy
- Chemotherapy
- Immunotherapy
- Radiation delivered directly to the tumor
- Somatostatin analogs (SSA)
- Telotristat ethyl (Xermelo)
- Targeted therapies
What Are Symptoms of Carcinoid Syndrome?
About 40% of people who have carcinoid cancer will experience carcinoid syndrome. Symptoms of carcinoid syndrome can include:
- Flushing
- Rapid heartbeat
- Abdominal cramps
- Watery diarrhea
- Skin rash
- Spider veins (telangiectasias), usually on the nose, cheek, or upper lip
- Wheezing
- Trouble breathing/shortness of breath
- Carcinoid heart disease, which affects the heart valves (does not always cause symptoms)
- Fluid in the abdomen (ascites) and fluid in the feet (swelling or edema)
- Trouble breathing/shortness of breath
- Tiredness/fatigue
- Low blood pressure
- Heart murmur
How Is Carcinoid Syndrome Diagnosed?
Carcinoid syndrome is diagnosed with a patient history and physical examination, and tests such as:
- Urine tests
- Blood tests
- 5-HIAA (5-hydroxyindoleacetic acid)
- Chromogranin A (CgA)
- Imaging tests
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI) scan
- Iodine-123-meta-iodobenzylguanidine scan (MIBG)
- Endoscopy
- Ultrasound
- Echocardiogram (“echo”)
- Pancreastatin Test, Substance P and Neurokinin A Tests
- Full body imaging tests: Somatostatin Receptor Scintigraphy (SRS) Test (Octreoscan)
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https://www.uptodate.com/contents/carcinoid-syndrome-the-basics?search=carcinoid%20syndrome&source=search_result&selectedTitle=1~78&usage_type=default&display_rank=1
https://www.carcinoidsyndrome.org/
https://www.carcinoid.org/for-patients/general-information/nutrition/nutritional-concerns-for-the-carcinoid-patient-developing-nutrition-guidelines-for-persons-with-carcinoid-disease/