Lung Carcinoids: A Comprehensive Review for Clinicians

SIMPLE SUMMARY: Lung carcinoids are divided into typical and atypical. Most tumors are slow-growing yet have malignant potential, which is more common in patients harboring atypical carcinoids. A large proportion of these patients are diagnosed incidentally on chest X-ray or CT scan. Cough, dyspnea, or recurrent pneumonia are common presenting symptoms. Endocrine symptoms, such as carcinoid syndrome or ectopic Cushing’s syndrome, are uncommon. Most individuals are cured by surgery, but some tumors metastasize. For patients with metastatic disease, chemotherapy, peptide receptor radionuclide therapy (PRRT), or targeted therapies are alternatives. In this article, we review the pathology, symptoms, diagnosis, and treatment of patients with lung carcinoids. ABSTRACT: Lung carcinoids are neuroendocrine tumors, categorized as typical or atypical carcinoids based on their histological appearance. While most of these tumors are slow-growing neoplasms, they still possess malignant potential. Many patients are diagnosed incidentally on chest X-rays or CT scans. Presenting symptoms include cough, hemoptysis, wheezing, dyspnea, and recurrent pneumonia. Endocrine symptoms, such as carcinoid syndrome or ectopic Cushing’s syndrome, are rare. Surgery is the primary treatment and should be considered in all patients with localized disease, even when thoracic lymph node metastases are present. Patients with distant metastases may be treated with somatostatin analogues, chemotherapy, preferably temozolomide-based, mTOR inhibitors, or peptide receptor radionuclide therapy (PRRT) with (177)Lu-DOTATATE. Most patients have an excellent prognosis. Poor prognostic factors include atypical histology and lymph node metastases at diagnosis. Long-term follow-up is mandatory since metastases may occur late.