Carcinoid tumors, lung

Encyclopedia of Cancer, 20050229 by Maureen Haggerty

Brushing sample

A doctor who performs a bronchoscopic biopsy may also wipe a tiny brush over the surface of the tumor. Tumor cells extracted in this way (brushing sample) are examined under a microscope. A brushing sample can add useful information to the results of bronchoscopic biopsy.

Needle biopsy

Doctors often use needle biopsy to obtain samples of tumors that are not close to the large airways. Guided by a computed tomography scan (CT scan) image, a long needle is passed between the ribs and into the lung to remove a small piece of the tumor. Because carcinoid tumors are usually small, localization using a needle biopsy may be difficult or impossible.

Thoracotomy

If neither bronchoscopic biopsy nor needle biopsy yields enough tissue to identify the tumor type, the doctor may open the patient's chest (thoracotomy) to remove a tissue sample. A doctor who feels certain that a tumor is a carcinoid may perform a thoracotomy and remove the entire tumor without having taken a biopsy sample.

Treatment team

Lung carcinoids are treated by thoracic and cardiothoracic surgeons.

Clinical staging, treatments, and prognosis

Staging

Once lung carcinoids have been diagnosed, more tests are done to find out if the cancer has spread from the lung to other parts of the body (staging). A doctor needs to know the stage to plan treatment. Doctors stage lung carcinoids the same way they stage non-small cell lung cancers:

Stage 0: Cancer is only found in a local area and only in a few layers of cells. It has not grown through the top lining of the lung.

Stage I: The cancer is only in the lung, and normal tissue is around it.

Stage II: Cancer has spread to nearby lymph nodes.

Stage III: Cancer has spread to the chest wall or diaphragm near the lung; or the cancer has spread to the lymph nodes in the area that separates the two lungs (mediastinum); or to the lymph nodes on the other side of the chest or in the neck. Stage III is further divided into stage IIIA (usually can be operated on) and stage IIIB (usually cannot be operated on).

Stage IV: Cancer has spread to other parts of the body.

Treatment of lung carcinoids

Doctors consider tumor size and location, and whether the patient has additional lung problems or serious disease affecting any other organ, in order to determine the most appropriate treatment for lung carcinoids.

Surgery

Removing the tumor (surgical resection) is the treatment of choice for these cancers because most lung carcinoids:

can be cured by surgery alone

do not respond to chemotherapy or radiation

must be removed in order to prevent airway obstruction and other complications of tumor growth

If the tumor is located in a large airway, the surgeon may remove the tumor and normal tissue above and below it, then sew together the remaining lung tissue. This procedure is a sleeve resection.

If tumor size or location makes sleeve resection impossible, the surgeon removes the affected lobe of the lung (lobectomy). In rare cases, the surgeon removes the entire right or left lung (pneumonectomy).