What is the treatment of a pulmonary carcinoid tumor?
Figure 6a: Bronchoscopic appearance of snare on Bronchial carcinoid
Figure 6b: Bronchoscopic appearance after snare removal of Bronchial carcinoid
Surgery is the main treatment of hormonally active tumors. The treatment goal is to remove the tumor and stop the symptoms produced by the hormone excess. Sometimes small, non-invasive bronchial carcinoids can be removed with bronchoscopy. (Figure 6a. and 6b) The risks of this technique are for bleeding and incomplete removal or recurrence of the tumor. The next option is to surgically remove the tumor and the wall of the airway to which it is attached. Sometimes very little or no lung tissue may be removed and the bronchus is reattached. The risk of leak at this connection is low but a very serious complication when it occurs, particularly when associated with infection. This is usually performed as an open operation known as a sleeve resection. If the tumor is located in the lung tissue or further from the main airway a portion of lung may need to be removed. This may be done through a minimally invasive or thoracoscopic procedure usually involving stapling and removing a small segment of the lung or depending upon the extent of the tumor or damage from infection a larger segment or lobe of the lung may be removed. Removal of lymph nodes may improve the outcome in atypical carcinoids but nodes are usually not involved in typical carcinoids. Chest tubes are often placed to drain fluid or air from around the lung to prevent it from collapsing for a short time after surgery.