Types of treatment for carcinoid

As with other types of cancer, the earlier a carcinoid tumour is diagnosed the easier it is to control and, possibly, to cure. Your doctors will plan your treatment according to

• Where your carcinoid started (the primary tumour)
• Whether it has spread
• The symptoms you have
• How the cells look under a microscope (the grade)
• Your general health
• Whether you have carcinoid syndrome

Carcinoids grow at different rates but they often grow very slowly. Some may not grow at all for months or years. If your carcinoid is not growing or causing symptoms, your doctors may decide that you don’t need any treatment straight away. They may just keep an eye on you with scans at regular intervals.

If your carcinoid is causing symptoms or growing, you may have one or more of the treatments below. People often need a combination of treatments for carcinoid.

You may have surgery if

• You are generally well
• You have early stage or localised carcinoid in the digestive tract, or lung

The aim of this surgery is to completely remove the carcinoid. It is known as curative or radical surgery.

You may have surgery to relieve symptoms of carcinoid that has spread - especially within the abdomen or to the liver. For example, surgery could remove a tumour blocking your bowel, or a tumour causing carcinoid syndrome. This is called palliative surgery or ‘debulking’.

The type of surgery depends on where the tumour is in the body. You can find out more in our section about surgery for carcinoid.

Somatostatin analogues are a type of drug treatment you may have if you have carcinoid syndrome. There are different drugs of this type, including octreotide and lanreotide. They are proteins that treat the symptoms of carcinoid syndrome in 2 ways

• Stopping the cells in the gut from producing too many hormones
• Changing the way our bodies react to the overproduction of hormones

For many people, somatostatin type drugs work well to control carcinoid tumours and their symptoms. These drugs may also shrink the tumour in some people. There is more about these treatments in the page about somatostatin analogues for carcinoid.

Chemotherapy is mostly used to shrink carcinoid tumours and control symptoms, rather than try to cure the carcinoid. Doctors don’t yet know how well chemotherapy can control carcinoid. In some research studies, carcinoid tumours shrank in about 1 in 3 people who had chemotherapy (30%). We need more research to find out which types of carcinoid are most likely to respond to chemotherapy. In one trial, doctors found that tumours that took up somatostatin were less likely to respond to chemotherapy.

You can find out more about chemotherapy and carcinoid in this section of CancerHelp UK.

You can have radiotherapy in different ways for carcinoid

• Targeted radionucleotide therapy
• External beam radiotherapy

Targeted radionucleotide therapy

You may have targeted radionucleotide treatments if you

• Have carcinoid syndrome
• Cannot have surgery

This treatment is similar to the scans used to diagnose carcinoid. Doctors call it ‘targeted therapy’ because it goes directly to the carcinoid cells, wherever they are in the body. It has very little effect on other cells in the body.

The 2 different types of targeted treatments are called MIBG and octreotide. It is possible to attach radioactivity to either of these substances. Then, when the MIBG or octreotide finds the carcinoid cells, it carries the radiation to them and kills them. You can have this type of treatment if your scans show that your tumour takes up MIBG or octreotide.

You can find out more about targeted radionucleotide therapy in this section of CancerHelp UK.

External beam radiotherapy

If you have carcinoid tumours that have spread to your bone (metastatic bone tumours), you may have radiotherapy treatment. This is especially helpful if you have pain in your bones.

Hepatic artery embolisation treatment is for people with carcinoid that has spread to their liver and who can’t have surgery. It is useful for people who have several areas of cancer spread. It also helps if your secondary cancers are making hormones and causing carcinoid syndrome.

The hepatic artery is the main artery going to the liver. Researchers have found that deliberately blocking (embolising) the hepatic artery may shrink carcinoid tumours for some people and reduce the amount of hormones they make. Doctors can either

• Inject chemotherapy into the hepatic artery
• Use other substances to block the blood supply to the tumour

Without a blood supply, the tumour cells will die. As the tumour cells die, you may have some liver pain but this is usually well controlled with painkillers. There is more about hepatic artery embolisation in this section of CancerHelp UK.

Sometimes, doctors use radiofrequency ablation (RFA) to treat carcinoid in the liver. They can treat both primary and secondary tumours, but will only treat tumours that are less than 4cm across.

Your doctor guides a probe through your skin into the tumour. The probe is an electrode - it can pass a radiofrequency current into the tumour. This makes the tumour vibrate and creates heat. The heat kills the tissue around the probe. There is more about radiofrequency ablation therapy in this section of CancerHelp UK.

Interferon is a type of of biological therapy that stimulates the body’s own immune response to help treat cancer. Our bodies make interferon naturally. You may have interferon if you have carcinoid cells in your liver, but hepatic artery embolisation or ablation therapy are both used more often in this case.

You may have interferon on its own or with one of the somatostatin analogues. You have the interferon injections under the skin (subcutaneously) 3 to 5 times a week. If you also have a somatostatin analogue, you have that daily at first and then monthly. You can learn to inject yourself to cut down on trips to the hospital or doctor’s surgery.

We don’t know enough about how best to use interferon for carcinoid. Doctors need to do further research to find out when it’s best to give it, and whether to give it with other treatments.

There is detailed information about interferon for carcinoid in this section of CancerHelp UK.

Researchers and doctors continue to look for better treatments, as well as new treatments. They test these in clinical trials. Your doctor may suggest that you join a trial. CancerHelp UK’s clinical trial section has information about clinical trials, including what it is like to take part. You can find details of individual trials in the CancerHelp searchable clinical trials database. Choose ‘neuroendocrine (NET)’ from the dropdown menu of cancer types.