Goblet cell carcinoid (GCC) is a rare tumor normally occurring in the appendix which displays features of both a neuroendocrine tumor and a more aggressive form of cancer known as an adenocarcinoma. It is usually diagnosed in people over the age of 50. People with this tumor may develop acute appendicitis, abdominal pain, and diarrhea. Prognosis largely depends on the size of the tumor and whether it has spread to other parts of the body. Treatment involves surgery to remove the tumor. Depending on how much the tumor has spread, surgeons may remove the appendix, part of the colon, or the ovaries (in women). Some people will have chemotherapy after surgery.

Columnar epithelial cells are taller than they are wide: they resemble a stack of columns in an epithelial layer, and are most commonly found in a single-layer arrangement. The nuclei of columnar epithelial cells in the digestive tract appear to be lined up at the base of the cells, as illustrated in Figure 33.9. These cells absorb material from the lumen of the digestive tract and prepare it for entry into the body through the circulatory and lymphatic systems.

Figure 33.9 Simple columnar epithelial cells absorb material from the digestive tract. Goblet cells secrete mucus into the digestive tract lumen.

Columnar epithelial cells lining the respiratory tract appear to be stratified. However, each cell is attached to the base membrane of the tissue and, therefore, they are simple tissues. The nuclei are arranged at different levels in the layer of cells, making it appear as though there is more than one layer, as seen in Figure 33.10. This is called pseudostratified, columnar epithelia. This cellular covering has cilia at the apical, or free, surface of the cells. The cilia enhance the movement of mucus and trapped particles out of the respiratory tract, helping to protect the system from invasive microorganisms and harmful material that has been breathed into the body. Goblet cells are interspersed in some tissues (such as the lining of the trachea). The goblet cells contain mucus that traps irritants, which in the case of the trachea keep these irritants from getting into the lungs.

Figure 33.10 Pseudostratified columnar epithelia line the respiratory tract. They exist in one layer, but the arrangement of nuclei at different levels makes it appear that there is more than one layer. Goblet cells interspersed between the columnar epithelial cells secrete mucus into the respiratory tract.

The most common first signs in individuals with goblet cell carcinoid are acute appendicitis, abdominal pain and/or a lower abdominal palpable mass. Symptoms of appendicitis may include pain and/or swelling in the abdomen; loss of appetite; nausea and vomiting; constipation or diarrhea; inability to pass gas; and/or a low fever.

Other signs and symptoms may include bowel obstruction, intussusception, gastrointestinal bleeding, and chronic intermittent lower abdominal pain. Rare presentations have reportedly included mesenteric adenitis, and iron deficiency anemia due to cecal ulceration.

Surgical resection (removing the abnormal tissue) is the primary treatment for goblet cell carcinoid (GCC). However, due to the condition's rarity, there is a lack of ample evidence or general consensus regarding the extent to which resection should be performed for different stages of this condition.

Because of the typical course of the condition and the malignant nature of the tumors, treatment recommendations are more similar to that of adenocarcinomas rather than most carcinoids. Stage I tumors may be treated with appendectomy alone. However, in higher stages, a right hemicolectomy (RH) is the most commonly recommended surgical option despite controversy in the medical community. The justification for RH is to do adequate nodal sampling (when samples are taken to check for more cancer) because metastasis is common. Some researches have reported a lack of benefit from extensive surgery provided there is no nodal involvement. It has also been reported by some researchers that in patients studied, the 5-year survival rates were not significantly different between those treated with appendectomy and those who underwent RH. Careful follow-up after surgery is highly recommended and may include periodic physical examinations, blood testing, and imaging studies. In some cases, adjuvant chemotherapy is also recommended.

We are unable to give advice to individuals regarding the best course of treatment. We recommend speaking with your health care provider to discuss treatment options.

In general, 76% of individuals who are diagnosed with goblet cell carcinoid live at least five years after being diagnosed. Important factors to consider when determining prognosis include the size and location of the tumor, and whether or not the cancer has spread to other parts of the body. If cancer cells have spread to distant parts of the body, the chances of survival are decreased.