A couple more now with non-small cells and
these really are not your bronchogenic at all.
Carcinoid, well, let's take a look. Location -
well, as far as the lung is concerned,
no. Okay. Carcinoid will always begin in intestine.
Really? Alright, are you picturing that? So,
our discussion is long, it begins in intestine.
Correct. And you can produce a lot of serotonin
and a bunch of other, 40 other different metabolites.
Histamine and catecholamines, I mean, the
list goes on and on and on. But, of
all of them, the one that you’re paying
attention to by far is going to be the serotonin.
Now, bronchial carcinoid, let's take a look
at the characteristics. Excellent prognosis,
rarely metastasises. Symptoms due to mass
effect, which we’ll come to in a little
bit, that’s big for us. Number 1, flushing,
you must find. Now, we said that serotonin
that causes vasodilation, but there’s something
with carcinoid that you have to find. Majority
of your patient with carcinoid will have flushing.
What’s that mean? Increased redness, that
means vasodilation. Also, up in the lungs
look for the patient that has bronchospasms.
Okay? Number 2, and then, because this
is in intestines, you’re going to have diarrhoea.
What are you going to check for in your stool?
Do you see that stuff coming out of your butt
in the toilet, check it out. What do you find?
You find 5-HIAA. 5-hydroxyindoleacetic acid.
We had that discussion during diarrhoea, secretory.
And you have right sided valvular disease.
Now, as a whole with carcinoid syndrome, these
are things that you’re paying attention
to. And do this for me.
I want you to now talk about carcinoid syndrome,
which means that you began in the intestine.
In the intestine also secreting serotonin
metabolite 5-HIAA, diarrhoea, number 1.
Number 2, syndrome, not tumour. This
means that it metastasised to the liver. The
liver can’t handle all of the metabolites.
Out comes serotonin and company. Once you
leave the liver, because you can’t properly
detoxify because the tumour, that had the
serotonin, maybe diarrhoea, but the liver
is able to handle everything else, coming
from the portal vein. But if you metastasised
to liver, then you grow a colony, you secrete
these substances into the inferior vena cava.
Up it comes. All through the inferior vena
cava, what do you enter? Right atrium. What’s
your next structure? Take a look. Right sided-valvular
disease. You might have tricuspid regurgitation, stenosis.
You might have pulmonic regurgitation, pulmonic stenosis.
So for a diarrhoea, right sided-valvular.
Next, you’re going to lung. Now I want you
to think of this behaving like histamine.
ReLLY? With histamine, what does it do
to your bronchi? Oh yes, bronchospasm. You
have bronchospasm here. Tell me what kind
of effect does histamine have on your blood vessels?
You remember that movie Hitch with
Will Smith? What happened to him? He had an
anaphylactic reaction. Why I am
talking like that? Angioedema. What
caused that increased vascular permeability
and dilation? Oh, that was also histamine.
But this is carcinoid. Now, what he did? He
took a bunch of antihistamine, remember that
Benadryl and, anyhow. So, he took antihistamine,
that’s gonna combat that, that’s acquired
angioedema. My point is, you’re going to have
vasodilation and flushing. So, have a little
bit of fun with this and this is bronchial carcinoid.
Prognosis, excellent. Syndrome, I just
walked you through. The most
important feature is the flushing.