Amongst all of the GICTs, colonic carcinoids are associated with a worse prognosis (27), with most of the patients presenting with advanced disease with an average tumour size of 5 cms and over two thirds having nodal and/or distant metastases (25,26). Colonic carcinoids are usually non-functional with less than 5 per cent containing cells producing serotonin and these Inhibitors,research,lifescience,medical patients

can present with BAY 87-2243 Carcinoid syndrome (25,28,29). Clinically colonic carcinoids should be managed as colonic adenocarcinomas with radical colectomy and metastasectomy as appropriate (15,30). Also, if present, widespread metastatic disease should not preclude removal of the primary lesion (15). Rectal carcinoids account for 2 per cent of rectal tumours and differ from other GICTs in that the neuroendocrine cells contain mostly glucagons and glicentin related peptides Inhibitors,research,lifescience,medical rather than serotonin (31). They are most common in the sixth decade of life (11), with patients presenting with pain, constipation and rectal bleeding. However, nearly half of the patients are asymptomatic and the lesions are found incidentally at routine endoscopy (32). The majority

of these tumours are less than 1 cm in size and are best treated by local excision (32), whereas those lesions greater than 2 cm have traditionally Inhibitors,research,lifescience,medical been treated with anterior resection or abdomino-perineal Inhibitors,research,lifescience,medical resection. This practice has been recently questioned as there does not appear to be much survival advantage over and above that achieved by local excision (33,34). The clinical course of patients with metastatic

carcinoid tumour is highly variable, with some patients remaining symptom-free for years (19). Liver is the commonest site of distal Inhibitors,research,lifescience,medical spread from GICTs which also rarely metastasise to extra-abdominal organs including bone, lung, central nervous system, mediastinal and cervical lymph nodes. Carcinoid liver metastases tend to be hypervascular and thus appear isodense on conventional post-contrast CT scans (35,36). Resection of carcinoid Megestrol Acetate liver metastasis is indicated in fit patients who do not have extra-hepatic metastatic disease, no tricuspid valve deficiency and have a resectable primary disease (37). Selective hepatic trans-catheter arterial embolization and trans-catheter arterial chemoembolisation can be used to treat liver metastasis in patients where major resections are not feasible. Radiofrequency ablation of liver metastases has been attempted in patients where arterial embolisation fails. Response rate of 80-95% have been reported following this treatment (38,39). Carcinoid syndrome is typically seen in patients with liver/lung metastases with an overall incidence of 10% in GICTs but 20% in those with jejuno-ileal disease (2,4).