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Types of surgery

Find out about the different types of surgery for carcinoid.

The type of operation you have depends on:

  • where the carcinoid tumour is
  • how big it is
  • whether it is causing a blockage
  • whether it has spread

Your surgeon aims to completely remove a tumour that is only in one area and has not spread (an early stage or localised carcinoid).

If they can’t do this, they might still do surgery to remove most of it. This is called debulking.

If your carcinoid tumour is causing a blockage in your gut, you might have surgery to bypass the blockage. This can help to relieve your symptoms.

Carcinoid tumours can develop in the small bowel (small intestine), large bowel (colon), back passage (rectum) or appendix.

Removing the tumour during a colonoscopy

Your doctor might be able to remove your tumour during a colonoscopy. This is usually for tumours smaller than 1cm across and are low down in the bowel.

This operation is called an endoluminal resection. You don’t have an external wound with this surgery.

You have regular follow up colonoscopies afterwards. Your doctor tells you how often you should have them.

Local excision

A local excision means removing the tumour together with a border of healthy tissue around it. Your surgeon also removes some of the nearby lymph nodes.  Surgeons generally do this for tumours in the:

  • small bowel that are less than 1cm across
  • large bowel that are smaller than 2cm

Most people have a cut (incision) through the skin of their tummy (abdomen).

Removing the border of healthy tissue and the lymph nodes reduces the risk of the cancer coming back.

The lymph nodes form a network of glands throughout the body. They drain away fluid, waste products and damaged cells, and contain cells that fight infection. The lymph nodes are often the first place that cancer cells reach when they break away from a tumour.

In the appendix

Sometimes doctors find a carcinoid tumour in the appendix when they remove the appendix for another reason. The appendix is part of the large bowel. If the cancer is only inside the appendix, you probably won’t need any more surgery.

Removing part of the bowel

If the tumour is too big for a local excision, your surgeon removes the area of bowel containing the carcinoid tumour. This operation is called a bowel resection.

After removing the section of bowel, your surgeon joins the ends of bowel back together inside your body. They call this join an anastomosis.

How much bowel your surgeon takes away depends on where the tumour is in the bowel and its size. They also remove the lymph nodes from around the bowel, in case any cancer cells have spread there. 

Keyhole bowel surgery

Surgeons have been developing keyhole surgery to remove early stage carcinoids. This type of operation is called a laparoscopic resection. The surgeon makes several small cuts (up to 1.5cm) in your abdomen instead of making one large cut (an open laparotomy). 

The surgeon passes a long narrow tube called a laparoscope, and other instruments, through these cuts. The laparoscope has a light on the end so the surgeon can look into your abdomen and remove the tumour through as small a cut as possible.

This type of surgery usually takes about 40 minutes longer than a traditional open operation. But you might recover more quickly and have less pain afterwards.

A stoma after removing a bowel carcinoid

Sometimes surgeons have to form an opening of the bowel onto the surface of the abdomen (a stoma) after removing part of the bowel. This may be either a colostomy or ileostomy.

This is not common after carcinoid surgery. The stoma is usually temporary and is done to allow the bowel time to heal before it has to start working normally again. You have the temporary stoma reversed in another operation a few months later.

Very rarely, some people need a permanent colostomy or ileostomy because it’s not possible to join the ends of the bowel back together. Or because the tumour is too low down in the back passage, so your rectum and anus have to be removed. But your surgeon will avoid this if at all possible.

While you have your stoma, you have to wear a bag to collect your poo (stools or faeces). This is a big change and can take some time to get used to. Specialist stoma nurses help you to manage practically and come to terms with the stoma emotionally. They continue to visit you at home after you leave the hospital.

Remember to click on the back button to return to the section about carcinoid.

Removing or bypassing a blockage

Sometimes a carcinoid tumour completely blocks the bowel (bowel obstruction). The waste from digested food can’t get past the blockage. This causes symptoms such as:

  • feeling bloated and full
  • crampy abdominal pain
  • feeling sick
  • vomiting large amounts
  • constipation
  • not being able to pass wind

You may be able to have an operation to remove or go around the blockage, and so relieve symptoms. It may be possible to rejoin the bowel, or you may need a colostomy. 

A carcinoid tumour of the pancreas is called a pancreatic neuroendocrine tumour (PNET). 

You see a surgeon who specialises in surgery of the pancreas and liver. They remove as much of the tumour as possible, along with the lymph nodes from around the pancreas. You might need to have the whole pancreas removed or just part of it.

The lymph nodes form a network of glands throughout the body. They drain away fluid, waste products and damaged cells, and contain cells that fight infection. The lymph nodes are often the first place that cancer cells reach when they break away from a tumour.

Remember to click on the back button to come back to the carcinoid section. The rest of the pancreatic cancer section is about a different type of cancer. The treatments mentioned there will not apply to you.

If you have carcinoid of the stomach, your treatment depends on what type it is. Doctors group these tumours as type 1, 2 or 3, depending on the risk of them spreading to other parts of the body.

Type 1 carcinoid of the stomach is unlikely to spread. You may not need surgery at all and instead have regular checks. Or your doctor may be able to remove the tumour during an endoscopy.

An endoscopy looks at the inside of the food pipe (oesophagus) and stomach. Your doctor uses a long flexible tube that has a light and camera at the end.

Type 2 carcinoid of the stomach is more likely to spread to other parts of the body after a while. If your tumour is less than 1cm across, your doctor may remove it during an endoscopy.

But if it is more than 1cm you have an operation to remove it. Your surgeon also removes a border of healthy tissue around the tumour and the nearby lymph nodes. This is to reduce the chance of it coming back.

Type 3 tumours may already have spread when they are diagnosed. Even if the tumour is small, you may need surgery to remove part or all of your stomach, together with the surrounding lymph nodes.

Remember to click on the back button to come back to the carcinoid section. The rest of the information in the stomach cancer section will not apply to you.

If you have 1 or 2 tumours within the same part (lobe) of the liver, you may have surgery to remove them. For some people this will cure their carcinoid.

If the carcinoid affects more than one lobe of the liver, surgery to remove the tumours can help to relieve your symptoms. It may also slow down the growth of the carcinoid.

If the carcinoid has spread into the liver from another part of your body, you may have the tumours removed. If there are several tumours you may have an operation called a multiple wedge resection. You may also have a treatment called radiofrequency ablation. 

A doctor specialising in lung surgery (known as a thoracic or cardiothoracic surgeon) will do your operation. The surgery you have depends on the size and position of the carcinoid tumour.

Sometimes lung carcinoid is found by chance during surgery for other lung conditions. Often, these tumours are in the very early stages and may need no further treatment.

If you have an early (localised) carcinoid your surgeon may remove the tumour with a border of healthy tissue around it. They also remove the lymph nodes closest to the lung to lower the chance of the carcinoid coming back.

Your surgeon may remove a small section of one part of the lung (a wedge resection or segmentectomy) for small tumours. Or in some cases they may remove a lobe of a lung (lobectomy), or possibly even a whole lung (pneumonectomy).

Remember to click on the back button to return to the carcinoid section. The rest of the information in the lung cancer treatment section will not apply to you.

Last reviewed: 
10 Jun 2016
  • Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETs)
    JK Ramage and others
    Gut, 2012. Volume 61, Issue 1

  • Pulmonary neuroendocrine (carcinoid) tumors: European Neuroendocrine Tumor Society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids
    ME Caplin and others
    Annals of Oncology, 2015. Volume 26, Issue 8

  • Cancer: Principles and Practice of Oncology (10th edition)
    VT DeVita , TS Lawrence, SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

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