Clinical presentation, diagnosis, and management of typical and atypical bronchopulmonary carcinoid
Carcinoid tumors account for about 1% of all lung tumors. Most patients remain asymptomatic, but if symptoms present they will depend on the tumor location, size, and pattern of growth. The distinction between typical and atypical carcinoid is based on histology. Atypical carcinoid tumors tend to have higher potential for local recurrence as well as distant metastasis. Surgery is the treatment of choice for locoregional disease, but there is no recognized standard of care for advanced lung carcinoids and successful management requires a multidisciplinary approach. The aim of this article is to provide an updated review of the most recent literature for the diagnosis and clinical management of lung carcinoids.
Accepted for publication July 14, 2017
Correspondence
Hamza Hashmi, MD; H0hash03@exchange.louisville.edu
Disclosures The authors report no disclosures/conflicts of interest.
Citation JCSO 2017;15(6):e303-e308
©2017 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0365
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Posttreatment surveillance
Posttreatment surveillance after resection of node-positive typical bronchial NETs and for all atypical tumors.26 Patients with lymph-node–negative typical bronchial NETs are very unlikely to benefit from postoperative surveillance because of the very low risk of recurrence. CT imaging (including the thorax and abdomen) every 6 months for 2 years, followed by annual scans for a total of 5-10 years are a reasonable surveillance schedule.
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Prognosis 18,27
Typical bronchial NETs have an excellent prognosis after surgical resection. Reported 5-year survival rates are 87%-100%; the corresponding rates at 10 years are 82%-87%. Features associated with negative prognostic significance include lymph-node involvement and incomplete resection.
Atypical bronchial NETs have a worse prognosis than do typical tumors. Five-year survival rates range widely, from 30%-95%; the corresponding rates at 10 years are 35%-56%. Atypical tumors have a greater tendency to metastasize (16%-23%) and recur locally (3%-25%). Distant metastases to the liver or bone are more common than local recurrence. Adverse influence of nodal metastases on prognosis is more profound than for typical tumors. Survival rates by stage for patients who underwent surgical resection (including typical and atypical carcinoid27) are: stage I, 93%; stage II, 85%; stage III, 75%; and stage IV, 57%.
