A 50-year-old woman presents with a 6 cm carcinoid tumour of the appendix found incidentally during right hemicolectomy for cecal carcinoma. What additional staging workup is specifically required for this tumour size?
- A Serum chromogranin A and 24-hour urine 5-HIAA, with CT scan for metastases ✓
- B No additional workup as the tumour was already resected
- C PET-CT with FDG is the gold standard for carcinoid staging
- D MRI of the liver only, as hepatic metastases are the only concern
Correct answer: A. Serum chromogranin A and 24-hour urine 5-HIAA, with CT scan for metastases
Explanation
Appendiceal carcinoid tumours >2 cm have a high risk (up to 30%) of nodal and distant metastasis, warranting full staging with serum chromogranin A (a neuroendocrine tumor marker), 24-hour urinary 5-HIAA, and CT abdomen/chest to look for hepatic and distant metastases. Somatostatin receptor scintigraphy (Octreotide scan) or Ga-68 DOTATATE PET is also indicated. FDG-PET is less sensitive for well-differentiated NETs.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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