Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of an appendiceal carcinoid tumor identified incidentally during appendectomy. Review of systems is negative for carcinoid syndrome (flushing, diarrhea, wheezing). No history of weight loss, abdominal pain, or systemic symptoms. Pathology report reviewed for tumor size, location (base vs. tip), lymphovascular invasion, and mesoappendiceal extension.
Clinical Examination Findings
Abdomen is soft, non-tender, and non-distended. Surgical site from recent appendectomy is clean, dry, and intact with no signs of erythema, induration, or purulent discharge. Bowel sounds are present and normoactive. No palpable masses or organomegaly noted. Cardiovascular exam reveals regular rate and rhythm, no murmurs or peripheral edema.
Treatment Protocol
Management plan determined by tumor size and risk stratification: 1) Tumors <1 cm: Appendectomy is curative. 2) Tumors 1-2 cm: Consider right hemicolectomy if base is involved, lymphovascular invasion present, or mesoappendiceal extension >3mm. 3) Tumors >2 cm: Right hemicolectomy is indicated. Post-operative surveillance includes serial chromogranin A levels and cross-sectional imaging (CT/MRI) as per NCCN guidelines.