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Another Look At Carcinoid Tumor

Dr. Roach Writes: I certainly have gotten an education in carcinoid tumors, a type of neuroendocrine tumor found usually in the GI tract or the lungs. Like many physicians, I had learned in medical school that most carcinoid tumors were benign, and wrote that in a column. However, the reality is that while some carcinoid tumors will never spread, even well-differentiated tumors, which were formerly considered benign pathologically, have the potential to spread both locally and to distant organs. They often are referred to as “cancer in slow motion.” Poorly differentiated neuroendocrine tumors are hard-to-treat, aggressive cancers.

All neuroendocrine tumors should be followed by an expert. I am grateful to the passionate community of those living with neuroendocrine and carcinoid tumors for educating me and helping me get better information. I was struck by the number of people who had been misdiagnosed and misinformed, and I am glad to take the opportunity to shed more light on this difficult disease. It is clear that much has changed in the understanding of this cancer and that we all, patients and physicians, need to be more aware of this disease.

More information on neuroendocrine and carcinoid tumors can be found at Carcinoid.org and Carcinoid Neuroendocrine Tumor Society of Canada (cnetscanada.org).

Dear Dr. Roach: Two years ago, at age 90, my gynecologist told me that I did not need to see him anymore because of my age. When I mentioned this to my daughter, she became outraged, and said that I need to continue my mammograms and visits to the doctor. What is your opinion? — I.W.

Answer: This is actually three questions in one, and none of them is easy. How long do you “need” to continue Pap smears and mammograms, and do you need to keep seeing your gynecologist?

The Pap smear question actually is the easiest, since there is very good evidence that a woman who has had normal Pap smears regularly until age 65 is very unlikely to get cervical cancer. This does not apply to anyone with a history of cancer.

When to stop mammograms is controversial. I feel that they can continue in healthy women indefinitely, but especially in the presence of some other serious disease, a woman over 75 could choose to stop.

I still recommend a regular visit with the gynecologist. Even if a mammogram or Pap smear isn’t being done, the gynecologist can discuss other concerns and do an exam.

Dear Dr. Roach: I have read several articles regarding the use of medicines to treat erectile dysfunction, but no information about the effectiveness of vacuum devices. Please comment. — D.G.

Answer: You are right; physicians tend to be very knowledgeable about medications like Viagra or Levitra but not so much when it comes to non-pharmacologic treatments. However, medicines don’t work for everybody, and they aren’t safe for some people, like men on nitroglycerine or who have had adverse reactions. There are several options in that case, including a vacuum pump.

I have had several patients use these very successfully. There are both prescription (expensive) and over-the-counter options. The vacuum device creates the erection, and a rubber ring maintains the blood in the penis. About 75 percent of men have success with this method, but only half continue with the treatment. Other options include self-injection and penile implants.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or mail them to P.O. Box 536475, Orlando, FL 32853-6475.