Controlling the carcinoid syndrome.

blood pressure cause death from coronary heart disease? Journal of Human Hypertension 1988;2:7-10. 10 Fletcher AE, Beevers DG, Bulpitt CJ, et al. The relationship between a low treated blood pressure and IHD mortality: a report from the DHSS Hypertension Care Computing Group (DHCCP). 12 Hypertension Detection and Follow-up Program Collaborative Group. Hypertension Detection and Follow-up Program. I. Reduction in mortality of persons with high blood pressure including mild hypertension. Simple blocking drugs, somatostatin, and then perhaps embolisation Patients with the carcinoid syndrome experience flushing and diarrhoea and sometimes wheezing and progressive right heart failure. The symptoms are caused by the products of carcinoid tumours derived from the foregut or midgut reaching the general circulation. Rarely the syndrome occurs without secondary spread of the tumour (when the venous drainage from a primary carcinoid tumour directly enters the systemic circulation), but most patients have hepatic metastases. Patients with secondary carcinoid deposits survive, however, much longer than patients with secondary adenocarcinoma, and treating the distressing symptoms produced by circulating products from tumours is therefore well worth while. Survival for 15 to 20 years is well recognised, and in some series the mean survival has been as long as eight years from presentation, though three to five years is more usual.' Various approaches to palliating the carcinoid syndrome have been advocated, but there is little agreement on their comparative value. Conventional radiotherapy to reduce the mass of hepatic tumours is generally agreed to be ineffective at tolerable doses,2 though targeting radioactive isotopes with labelled precursors of tumour products is being explored.3 Surgical resection is rarely possible as deposits oftumours are generally multiple and in both hepatic lobes. Partial hepatectomy may be considered in roughly one in 10 patients who have the disease predominantly in one lobe.4 Alternatively, successful debulking may be achieved by "shelling out" a few large secondaries.5 Two problems are that the patients most capable of withstanding a major operation are likely to have a better prognosis than the average and that the release of tumour products during the operation makes it hazardous. The best results of conventional cytotoxic chemotherapy are currently achieved with combinations of agents, usually including streptozocin. Shrinkage of the tumour or a reduction in circulating tumour products occurs in about a quarter to two fifths ofpatients, but the price in toxicity deters even enthusiasts.6 Human leucocyte interferon given thrice weekly is reported to induce objective responses in about …