Treatment of an incidentally detected appendicular carcinoid measuring 2.5 cm is: March 2009
**Core Concept**
Incidentally detected appendicular carcinoid tumors are a type of neuroendocrine tumor that arises from the appendiceal wall. The management of these tumors depends on their size, location, and the presence of metastatic disease.
**Why the Correct Answer is Right**
A 2.5 cm appendicular carcinoid tumor is considered a high-risk tumor due to its size. The recommended treatment for high-risk appendicular carcinoids is a right hemicolectomy, which involves the surgical removal of the right colon and a portion of the small intestine. This approach helps to prevent local recurrence and metastasis. The primary goal of surgery is to remove the tumor completely and ensure that no microscopic disease is left behind.
**Why Each Wrong Option is Incorrect**
**Option A:** Observation or watchful waiting is not recommended for incidentally detected appendicular carcinoids larger than 2 cm, as they have a higher risk of metastasis.
**Option B:** Simple appendectomy may not be sufficient for tumors larger than 1 cm, as it may not adequately address the risk of local recurrence and metastasis.
**Option C:** Chemotherapy or radiation therapy may be considered in the management of advanced or metastatic neuroendocrine tumors, but they are not the primary treatment for incidentally detected appendicular carcinoids.
**Clinical Pearl / High-Yield Fact**
It's essential to remember that appendicular carcinoids larger than 1 cm have a higher risk of metastasis and should be treated aggressively with right hemicolectomy.
**Correct Answer:** D. Right hemicolectomy.