Carcinoid tumors are rare and can be difficult to diagnose. Getting proper treatment for patients with these types of tumors can be even more challenging. The Nebraska Medical Center offers a Neuroendocrine Tumor Clinic to treat these difficult cases – one of a few in the country.
Luciano Vargas, MD , an abdominal transplant surgeon that specializes in the surgical management of neuroendocrine tumors at The Nebraska Medical Center, says the clinic sees patients from across the country for evaluation and treatment. “We have several types of surgical techniques that we use to remove the tumor: primary surgical resection, staged hepatectomy resection or liver transplantation.”
Dr. Vargas joined the staff at The Nebraska Medical Center in July 2012. He attended medical school at the University of Texas Health Sciences Center in San Antonio; completed two years of general surgery residency at the University of Nebraska Medical Center (UNMC) in Omaha; followed by two years of research in intestinal transplantation and a fellowship in liver transplantation. He is also an assistant professor of Surgery at UNMC.
The Neuroendocrine Tumor Clinic meets twice monthly and has a growing patient base. Dr. Vargas works in collaboration with a neuroendocrine oncologist, Jean Grem, MD and a dedicated nurse, Lucie Case.
Patients with carcinoid tumors typically present in the fifth and sixth decade of life and have various presentations, notes Dr. Vargas. Some are asymptomatic while others experience vague symptoms such as abdominal pain and bloating. If individuals have excess hormone production, they can experience diarrhea, flushing spells, heart palpitations and wheezing.
A physical examination may show heart valve lesions and signs of niacin-deficiency. “To confirm the presence of a carcinoid cancer will ultimately require a tissue diagnosis,” says Dr. Vargas. “Additional studies that are used to follow individuals with carcinoid cancer include 5-HIAA levels in the urine, CT and MRI scans, chromogranin A and an octreotide radiolabelled scan.”
Surgery to remove the tumor is the first line of treatment. The staged hepatectomy procedure involves removing a portion of the tumor from the liver. A port-vein embolism to block the blood supply to the affected part of the liver is then performed to stimulate growth to the unaffected portion. If the carcinoid tumor is unresectable and localized to the liver, the patient may be a possible liver transplant candidate. Liver transplant patients can expect one-, three- and five-year survival rates of 81 percent, 65 percent and 49 percent respectively.
The liver transplant program at The Nebraska Medical Center was formed in 1985. With more than 2,500 liver transplants and more than 500 pediatric liver transplants under its belt, it is now one of the most active and advanced centers in the world.
If the entire tumor is resected, the patient will continue to be monitored for the rest of his or her life. “These types of tumors tend to recur so we like to see them twice a year with repeat imaging to confirm tumor remission,” says Dr. Vargas.
He says his clinic works closely with the primary care doctor to follow up with these patients. “We believe that a good communicative relationship is vital to patient outcomes,” says Dr. Vargas. “Often our patients are not local or our interaction with them comes down to once or twice a year. So we rely on the primary care physician to be the first responders to any changes in the condition of our neuroendocrine patients. To foster this relationship, we make ourselves easily available by email and phone.”