Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
There are no biochemical tests to determine the presence of a carcinoid lung
tumor or to diagnose a known lung tumor as a carcinoid lung tumor.
If your health care practitioner suspects that a patient has a
carcinoid lung tumor, he or she may be advised to undergo some blood and urine tests.
Sometimes the hormone-like substances can affect the chemistry of the blood by
and/or intestinal function and therefore alter the results of certain blood
tests. Some tests would detect some of the hormone-like substances or their
by-products produced by the carcinoid tumor.
An abnormal finding on chest X-ray is present in about 75% of patients with
a carcinoid lung tumor.
Findings on X-ray include either the presence of the tumor itself or
indirect evidence of its presence (for example,
obstruction caused by the
Some carcinoid lung tumors that are small or in
locations where they are covered by other organs in the chest may not be seen on
a chest X-ray. If a patient's health care practitioner is in doubt or there is a vague
abnormality on the chest X-ray, the patient may be advised to get a
CT scan done.
CT scna can demonstrate more details about the nodules, masses, or suspicious
changes found on chest X-ray.
A CT scan using intravenous contrast dye also can be useful. Because
carcinoid tumors are highly vascular, they may show greater enhancement on CT
It is useful for characterizing and
staging of the tumors.
Magnetic resonance imaging (MRI)
MRI generally provides information similar to that of CT scan.
MRI may be useful for differentiating small tumors from
Octreotide scintigraphy or OctreoScan:
A small amount of octreotide (a
radioactive hormone-like drug) is injected into a
vein. The drug is taken up by
the cells of the carcinoid tumor. The health care practitioner uses a special
radioactivity-detecting camera to see where the drug accumulates. This exam
helps in the diagnosis of a carcinoid lung tumor and determining whether the
tumor has spread to other areas of the body.
Iodine-131 meta-iodo-benzyl guanidine (MIBG) scintigraphy: MIBG is a
chemical that is taken up by the cells of the carcinoid tumor. In this exam,
radioactive iodine attached to MIBG is injected into the bloodstream. If a
carcinoid tumor is present, the scanner will detect the radioactivity and thus
help in diagnosing the tumor.
Even if a chest X-ray and/or CT scan shows a tumor,
these exams cannot confirm whether the mass is a carcinoid lung tumor, a lung
carcinoma, or a localized infection. The only way to verify the diagnosis of a
carcinoid tumor is to remove cells from the tumor and examine them under a
procedure is called biopsy.
A lung biopsy can be done in several ways:
procedure involves inserting a fiber optic
viewing tube called a bronchoscope into the
windpipe and the
airways of your lungs through the
It allows the health care practitioner to visualize the airways of the
lungs, and in case a tumor is found, to do a biopsy.
In most cases, the physician makes the diagnosis of
carcinoid lung tumor based on the findings from
bronchoscopy and a combination
of radiologic (for example, X-ray,
CT scan) studies.
Transbronchial fine-needle biopsy: If the tumor is small, a fine-needle
biopsy of a carcinoid tumor may be performed through the bronchoscope. This
procedure is called transbronchial fine-needle biopsy
Transthoracic needle biopsy: Tumors that are not accessible through
bronchoscopy and are located in the
periphery of the lung are accessed using a
long needle inserted between the ribs. CT scan images are used to guide the
needle into the tumor for taking a biopsy. This procedure is called
transthoracic needle biopsy.
Thoracotomy (surgically opening the chest cavity): In some persons, neither
a bronchoscopic biopsy nor a transthoracic needle biopsy can provide enough
tissue to identify the type of tumor, and a
thoracotomy may be necessary to
obtain a biopsy. Usually, the tumor is completely removed during thoracotomy.
Staging is a process of finding out how localized or widespread a tumor is.
Typical carcinoid tumors, considered the least aggressive form, most
commonly are found to be stage I tumors (localized to one area) at the time of
More than 50% of the less common atypical carcinoid
tumors show evidence of further spread to adjacent areas or
lymph nodes at the time of diagnosis.
The outlook for a carcinoid lung tumor depends, to a large extent, on its