Oncology (General Cancer)/Carcinoid Tumor/Syndrome
My husband (38 years old) recently went to the dermatologist for facial flushing/redness/burning and some eye irritation (occasional burning, dryness, bloodshot). Last summer he had burning sensation on his face only during the warmer summer months but no redness or flushing. Then it went away until about 2 weeks ago (even when it is not warm) his face will feel sunburned and get really red, especially after physical exertion. And now he has kind of a permanent redness all over his face. It's not really red, just a little tan/pink. He has no other symptoms, no pastules or pimples. The warmth/burning comes and goes. Some days he doesn't burn at all. The dermatologist asked if he had chest/neck flushing, diarrhea or unexplained weight loss. All of which he does not have.
She prescribed an antibiotic and face cream and told him it sounds like he has Rosecea. But then she said she wants him to do a 24 hour urine test to rule out Carcinoid Syndrome. She said because it came on suddenly she wants to be sure its not that.
3 1/2 years ago (for another medical issue) he had a CT (abdomen and pelvis) and an MRI (soft tissue pelvis) and the results were normal on both of them.
I would appreciate your advice as to whether this facial flushing/redness could really be carcinoid syndrome. I have read these tumors are very slow growing. Wouldn't something have shown on his CT or MRI 3 yrs ago? (these scans were of the areas these tumors grow)
Can carcinoid syndrome only cause one symptom - flushing?
And another concern we have is that we read he can't have nicotine or caffeine when he does the urine test. Is it true that Nicotine and Caffeine will alter the results? Should he have the blood test (Chromogranin A test) done instead? (he can't quit smoking that quickly for the urine test)
I appreciate your help, we are very concerned about this.
First, carcinoid is slow-growing, but you don't need much tumor to cause the syndrome; and they can occur in the lungs as well as the abdomen, so if you had a negative MRI of the pelvis and neg. CT of abdomen that 3.5 years ago, that doesn't rule out carcinoid. Second, there ae other tumors (lung cancers) which are capable of mimicking carcinoid. Third, Hodgkin's disease can do this, especially if it is related to alcohol consumption. As for the urine test, the reason for a 24 hr urine to diagnose the disease is that carcinoid releases serotonin intermittently, and if you just get a blood test, it might not reflect what is going on. The Chromogranin A test does not prove carcinoid, but if you have a positive test, it can be useful in following it along. Carcinoid can cause only a single symptom in the beginning.
All that being said, I would think Rosacea is more probable, but your doctor is being prudent and I'd go along with those recommendations.
And your husband needs to stop smoking. In this day and age, you have to really hate your life to be a smoker.