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Neuroendocrine tumor treatments

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

Once you have been diagnosed with neuroendocrine tumors (NETs), your care team will work with you to develop a comprehensive treatment plan based on your unique diagnosis and needs. Since most NET patients are diagnosed at an advanced stage, an integrative approach is key to your well-being.

Treatment varies, depending on factors such as the type and stage of the NET. Your cancer care team also considers your overall health and preferences.

When discussing treatment possibilities, they may also offer information on side effects for each option and how these may affect your quality of life.

The tumor itself may greatly impact your treatment options as well, including factors such as:

  • Where it started
  • How fast it’s growing
  • Whether it’s producing hormones or not
  • Its stage and grade (how fast the cells are dividing)

For NETs especially, there may be several treatment options available to you. Be sure to ask your care team any questions you have along the way as you decide. Choosing a treatment option should be a shared decision between you and your care team based on your goals and what’s important to you.

Common treatment options for neuroendocrine tumors include:

Active surveillance

Active surveillance may be a treatment option for low-grade NETs. Because such NETs tend to grow slowly, chances are low that they’ll spread or cause symptoms without your care team first noticing a change. Thus, this approach may prevent unnecessary treatment.

Your care team may recommend regular testing, including physical examinations, blood tests and/or imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scans to monitor any changes in the tumor(s). If they do notice any changes that suggest the tumor may grow or spread, your care team can provide further treatment options.

Surgery

Surgically excising the primary tumor is often the first approach recommended for patients with localized NETs. The goal of surgery is to fully remove a neuroendocrine tumor or reduce the tumor burden. Surgery may also be an option for those with advanced disease, to help relieve symptoms. Some surgical procedures for NETs include debulking or cytoreductive surgery, minimally invasive laparoscopic resections and liver transplantation.

  • Enucleation: This surgery removes only the tumor. It may be an option for small and localized tumors.
  • Debulking surgery: If the entire tumor cannot be removed, debulking it—or removing some of it—may be an option. Debulking surgery may help relieve some symptoms caused by an NET.
  • Cytoreductive surgery: This type of surgery for gastrointestinal NETs removes as many cancerous cells as possible in order to reduce the number of hormones the tumor can produce. It may also reduce some symptoms caused by the tumor.
  • Laparoscopic surgery: This type of surgery uses one or several small incisions to remove cancerous cells in the abdomen. The benefit of laparoscopic surgery is a faster recovery, since it’s a less invasive technique than standard surgery.
  • Liver transplant: For NETs that have spread to the liver, a liver transplant may be a treatment option.
  • Palliative surgery: If a tumor cannot be fully removed, but reducing its size could decrease symptoms, palliative surgery may be an option. This type of surgery focuses on improving comfort and quality of life. It may be paired with radiation therapy.

Chemotherapy

Chemotherapy for NETs may be used alone or alongside other treatments. It’s typically used when the tumor begins causing symptoms or has spread. There are a number of chemotherapy drugs, all of which help prevent cancer cells from multiplying and growing. Chemoembolization, in which chemotherapy drugs are administered directly into the tumor, may be an option if the disease has metastasized to the liver. During the course of chemotherapy treatments, patients may experience side effects, including:

  • Hair loss
  • Reduced appetite
  • Fatigue
  • Nausea
  • Vomiting
  • Diarrhea

Targeted therapy

Targeted therapy drugs work by targeting specific genes, proteins or other factors of the tumor. The benefit of targeted therapy is that it may stop or slow the growth of cancer cells while sparing damage to healthy cells. Your care team may need to run additional tests to find out more about your tumor in order to identify the right targeted therapy for you.

Some targeted therapies for NETs include:

  • Afinitor® (everolimus)
  • Sutent® (sunitinib)

Hormone therapy

Hormone therapy for NETs typically doesn’t shrink a tumor, but it may slow its growth. It’s primarily used to control the substances released from an NET, which are similar to hormones. These substances often create symptoms, so hormone therapy may reduce some of these symptoms. Hormone therapy for NETs centers around somatostatin, a hormone that plays a part in controlling other hormones such as insulin. Somatostatin analogs are drugs that act like the hormone somatostatin to reduce the symptoms caused by an NET.

The two somatostatin analogs are:

  • Sandostatin® (octreotide)
  • Somatuline Depot® (lanreotide)

Both drugs are typically given as an injection and may cause side effects such as:

  • Elevated blood sugar
  • Gallstones
  • Nausea
  • Bloating

Your care team may be able to suggest ways to manage these side effects.

Radiation therapy

Radiation therapy is generally used when a neuroendocrine tumor has spread or is in a location that makes surgery difficult. CyberKnife® may be a non-invasive option for some patients and enables our radiation oncologists to deliver high, targeted doses of radiation to NETs. For metastatic disease to the liver, TheraSphere® and SIR-Spheres® offer innovative options that deliver radiation directly to tumors in the liver.

Interventional radiology

For NETs that have spread to the liver, embolization procedures may help reduce or cut off the supply of blood to the tumor. Though these treatments aren’t surgical, they may involve staying overnight in the hospital. Embolization procedures may have an effect on liver enzymes for a few days or weeks after the treatment, and they may cause fever or pain around the liver as well.

Gastroenterology

We provide a wide range of treatment options for gastrointestinal NETs. Our gastroenterology team uses various technologies to look at the GI tract in different and minimally invasive ways. We may recommend innovative techniques and ablative treatments to help remove obstructions in the GI tract and relieve pain or breathing problems.

Molecular targeted therapy

Peptide receptor radionuclide therapy (PRRT) is a molecular targeted therapy that may be used to treat certain NETs. Molecular targeted therapies use drugs or other substances to identify and attack cancer cells while reducing harm to healthy tissue.

Learn more about PPRT.

Clinical trials

Your cancer care team can also help you explore options for taking part in a clinical trial, which provides treatment as part of a research study. Clinical trials help determine whether a new treatment—including new drugs, different doses or a novel combination of treatments—may be better than the current standard approach for that type and stage of cancer.

Next topic: What are the symptoms of neuroendocrine tumors?

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