Which surgery for carcinoid
This page tells you about the different operations you might have for carcinoid (neuroendocrine tumours).
Which surgery for carcinoid?
If your tumour is just in one area and has not spread your surgeon will try to remove it completely. If this isn’t possible, your surgeon may still do surgery to remove most of it. This is called debulking.
Your doctor will speak to you about the best type of surgery for you. The type of operation you have will depend on
- Where the carcinoid is
- Its size
- Whether it is causing a blockage
- Whether it has spread
You can view and print the quick guides for all the pages in the treating carcinoid section.
If your tumour is just in one area and has not spread (early stage or localised) your surgeon will try to remove it completely. If this isn’t possible, your surgeon may still do surgery to remove most of it. This is called debulking.
If the tumour is causing a blockage in your gut, your surgeon may do an operation to bypass the blockage. This can help to relieve your symptoms. Before your operation, your doctor will speak to you about the best type of surgery for you. The type of operation you have will depend on
- Where the carcinoid is
- Its size
- Whether it is causing a blockage
- Whether it has spread
Remember – you have to give your consent before having any operation. Your surgeon will answer any questions you have about the operation before you sign the consent form. Here are some questions to ask your doctor about surgery for carcinoid.
It is possible to get carcinoid in the small bowel (small intestine), large bowel (colon), appendix, or back passage (rectum).
The surgery you have will depend on the size of the tumour and where exactly it is. The types of surgery used for carcinoid include
If the tumour is smaller than 1cm and low down enough in the bowel, your doctor may be able to remove it via your back passage, during a colonoscopy. This operation is called an endoluminal resection. You won’t have an external wound with this type of procedure. You will need regular follow up colonoscopies afterwards. Your doctor will tell you how often you should have them.
You may just have the bowel carcinoid tumour removed, together with a border of healthy tissue round it and nearby lymph nodes. This operation is called a local excision. Most people will have a cut (incision) through the skin of the tummy (abdomen). Generally, surgeons can do this for tumours in the small bowel that are less than 1cm across or tumours in the large bowel that are smaller than 2cm. Removing the border of healthy tissue and the lymph nodes reduces the risk of the cancer coming back.
Sometimes, doctors find carcinoid in the appendix when removing the appendix for some other 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.
If your tumour is too big for a local excision, your surgeon will remove the area of bowel containing the carcinoid. This operation is called a bowel resection. The surgeon then joins the ends of bowel back together inside your body. They call the join an anastomosis. How much bowel your surgeon takes away depends on the size of the cancer and where it is. You will also have lymph glands removed from around the bowel, in case any cancer cells have spread there.
Over the past few years surgeons have been developing keyhole surgery to remove early stage bowel tumours including carcinoid tumours. 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 may recover more quickly and have less pain afterwards.
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 will need a permanent colostomy or ileostomy because it may not be possible to join the ends of the bowel back together. Or because the carcinoid 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 will 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 nurses, called stoma nurses, can help you learn to manage practically and come to terms with the stoma emotionally. The stoma nurse will continue to visit you at home after you have left the hospital.
Remember – most people who have surgery for carcinoid in the bowel don't need to have a permanent colostomy. Read about having a colostomy in our bowel cancer section. If you have any questions about colostomy, the Colostomy Association will be happy to help and support you.
Sometimes carcinoid completely blocks the bowel (known as a 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
- 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.
Carcinoid of the pancreas is called a pancreatic neuroendocrine tumour (PNET).
You will see a surgeon who specialises in surgery of the pancreas and liver. Your surgeon will remove as much of the tumour as possible and the lymph nodes from around the pancreas. You may need the whole pancreas removed or part of it.
You can find more information about pancreatic surgery in our section about cancer of the pancreas. Do remember that the rest of the pancreatic cancer section is about a different type of pancreatic cancer and the treatments mentioned there will not apply to you. You will need to use your back button to come back to the carcinoid section.
If you have a carcinoid of the stomach, your treatment will depend on the type of tumour you have. Doctors group these tumours as type 1, 2 or 3, depending on the risk of them spreading to other parts of the body.
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, you may be able to have it removed during an endoscopy. But if it is more than 1cm you will need an operation to remove it, together with a border of healthy tissue around it and the nearby lymph nodes.
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.
We have detailed information about surgery for stomach cancer in our stomach cancer section. This may be helpful if you are going to have this type of surgery. But do remember that the rest of the information in the stomach cancer treatment section will not apply to you. You will need to use your back button to come back to the carcinoid section.
If you have 1 or 2 tumours within a single 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 development 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 radiofrequency ablation.
A doctor specialising in lung surgery (known as a thoracic or cardiothoracic surgeon) will do your operation. The surgery you have will depend 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 your carcinoid was diagnosed with tests or a small biopsy and it is localised, you may need to have the tumour removed, together with a border of healthy tissue around it. Your surgeon will also remove the lymph nodes closest to the lung to lower the risk of the carcinoid coming back.
The exact operation you have will depend on the size and position of the carcinoid tumour. You may just have a small section of one part of the lung removed (a wedge resection or segmentectomy) for small, early stage tumours. Or you may have a lobe of a lung removed (lobectomy), or even a whole lung removed (pneumonectomy). But lobectomy and pneumonectomy are not often used for lung carcinoid tumours.
We have detailed information about lung surgery in our lung cancer section. But do remember that the rest of the information in the lung cancer treatment section will not apply to you and you’ll need to use your back button to come back to the carcinoid section.
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