Claudia asks:
Is it possible to have carcinoid tumors that do not show up on a CT scan of the abdomen? I have had bad flushing, wheezing and diarrhea for one and a half years. A CT scan showed multiple non-specific lymph nodes in mesentery, a possible hematoma on left side of the liver and a sub-centimeter hyper vascular lesion on the posterior right side of the liver. My GI doctor said he can't think of anything that would be causing my symptoms.

Anil Rustgi, MD responds:
Carcinoid tumors are very small, slow growing tumors of neuroendocrine origin, most commonly found in the gastrointestinal system. Due to their slow-growing nature, it often takes many years before symptoms present in a patient. These tumors can excrete an overload of hormone like substances that cause a wide variety of symptoms resulting in carcinoid syndrome. This syndrome manifests itself by causing flushing of the face and upper chest, diarrhea, and difficulty breathing (wheezing).

Urine and blood tests, as a first step, are beneficial in identifying specific excretions of tumors. In addition, a CT scan may be used to determine whether or not a tumor is present. Occasionally, a diagnostic procedure called an OctreoScan® picks up a missed tumor. This test involves injecting a nuclear tag, which attaches to tissue usually found in carcinoid cancers.

David Metz, MD and Gregory G. Ginsberg, MD are Penn gastroenterologists who specialize in neuroendocrine tumors. They can evaluate your condition and recommend the best course of treatment. To schedule an appointment, please call 800-789-PENN (7366) or request an appointment online.

Algia asks:
My son is being treated at Penn for cancer of the esophagus, which has spread to his stomach. He is on radiation and chemotherapy (pill form).

I am concerned over the lack of appetite he is now experiencing. I keep impressing upon him the need for essential vitamins to fight the cancer. Are patients educated about the importance of good nutrition?

Anil Rustgi, MD responds:
Esophageal cancer is a malignant (cancerous) tumor of the esophagus, the muscular tube that moves food from the mouth to the stomach. If the patient cannot tolerate surgery or the cancer has spread to other organs, chemotherapy or radiation may be used to help reduce symptoms.

If your son is having difficulty swallowing or has a decreased appetite, the following measures may help:

• Avoiding acidic, salty, spicy and rough foods.
• Drinking liquid nutrition supplements such as Ensure®, Boost®, or Carnation Instant Breakfast® to increase protein and calorie intake.
• Mixing food with butter, thin gravies and sauces to make it easier to swallow.
• Trying soft, blended foods such as casseroles, ice cream, yogurt, cheesecake, mashed potatoes, spaghetti with cream sauce, soups and eggs.
• Trying foods with a variety of tastes and textures. Tolerance for foods constantly changes during treatment.
• Using a blender or trying baby foods.

Dana asks:
I have recently been diagnosed with a gastric MALT lyphoma (4cm mass). I have recently finished a three-week course of antibiotics and will soon go for my next endoscopy. I am interested in getting a second opinion on my treatment, depending on the results of the scope.

I still have symptoms — upset stomach and pressure in my throat. Can the mass be treated with lasers? Are there any other treatment options? Also, have you seen many MALT patients with a history of celiac? My mother has celiac, but so far I have tested negative.

Anil Rustgi, MD responds:
Cancer affecting the mucosa-associated lymphoid tissue (MALT) in the stomach, or “gastric MALT lymphoma,” is a rare type of non-Hodgkin lymphoma characterized by B lymphocytes, a type of immune cell, that slowly multiply in the stomach lining. MALT lymphomas account for approximately 4 percent of all cases of lymphoma. It is caused by a Helicobacter pylori bacteria infection.

Even when fully developed, treating the infection with antibiotics can cause the lymphoma to shrink or even completely disappear. Often, however, these lymphomas recur after apparently successful antibiotic treatment, and chemotherapy or radiation therapy is then needed. The antibiotic Rituxin is another option.

Beginning in 2009, the Roberts Proton Therapy Center at the Perelman Center for Advanced Medicine will provide state-of-the-art proton radiation therapy for gastrointestinal cancer patients. Proton therapy is more accurate and the side effects are less severe than conventional radiation therapy.

To schedule a second opinion consultation with a Penn gastroenterologist, please call 800.789.PENN (7366) or request an appointment online.

Cyndy asks:
Are any of the gastroenterologists on staff at any of the three hospitals that make up the University of Pennsylvania Health system familiar with gastrointestinal stromal tumors, otherwise known as GIST? My family is one of only 2 that are included in a genetic study being conducted at Sloan Kettering in New York.

Anil Rustgi, MD responds:
Gastrointestinal stromal tumor (GIST) is a very rare cancer affecting the digestive tract or nearby structures within the abdomen. Known as a sarcoma, GIST is a cancer that grows from cells of the body's connective or supportive tissues such as bone, cartilage, tendons, nerves, fat, muscle, synovial tissue or blood vessels. Random genetic mutations are the apparent cause of GISTs, as there are no known environmental or behavioral risk factors contributing to the cancer.

Nuzhat Ahmad, MD specializes in gastrointestinal cancers, including GIST, using endoscopic ultrasound. She sees patients at the Hospital of the University of Pennsylvania.

You can make an appointment with Dr. Ahmad by calling 800-789-PENN (7366) or you can also request an appointment online.