Find out how your doctor decides which treatment you need. Includes information about the different types of treatment for carcinoid.
Deciding which treatment you need
A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).
The treatment you have depends on:
- where the carcinoid started (the primary tumour)
- whether it has spread
- how the cells look under a microscope (the grade)
- the symptoms you have
- your general health
- whether you have carcinoid syndrome
Your doctor will discuss your treatment, its benefits and the possible side effects with you.
You are likely to have a carcinoid (neuroendocrine tumour) specialist nurse. They go to the MDT meetings. They can help answer your questions and support you. They are often your main point of contact throughout your treatment.
The main treatments
Doctors use several different types of treatment for carcinoid tumours. But you might not have any treatment straight away if your tumour is not causing symptoms or growing.
Carcinoid tumours grow at different rates, but they often grow very slowly. Some might not grow at all for months or years. So your doctor might just keep an eye on it at first with regular scans. Or they may start you on a drug called a somatostatin analogue, such as octreotide.
For a growing carcinoid tumour or one that is causing symptoms, you have surgery to remove the tumour if possible. If you can't have surgery, various other treatments are used to control the tumour and your symptoms.
People often need a combination of treatments. These can include:
- somatostatin analogues
For carcinoid tumours in the liver, you might have radiofrequency ablation or hepatic artery embolisation.
You might have surgery if you:
- have a small carcinoid tumour (early stage disease)
- are generally well
When the surgery aims to completely remove the tumour, it is called curative or radical surgery.
Sometimes you might have surgery to relieve symptoms of a carcinoid tumour 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 you have depends on where the tumour is in the body.
The most common drug treatments for carcinoid tumours are somatostatin analogues, such as octreotide and lanreotide. They are proteins that can slow down the production of hormones by the tumour.
For many people, these drugs work well to control carcinoid tumours and their symptoms.
Radiotherapy uses high energy rays to kill cancer cells. You can have radiotherapy in different ways for carcinoid tumours.
Targeted radionuclide therapy
This is a type of internal radiotherapy. You might have targeted radionuclide treatment if you can't have surgery, or you have a carcinoid tumour that has spread and is causing symptoms.
Doctors call it targeted therapy because the radiation goes directly to the carcinoid cells, wherever they are in the body. It has very little effect on other cells.
For the main type of radionuclide therapy, doctors attach radioactive iodine to a substance called MIBG. The carcinoid cells take up (absorb) the MIBG, and then the radiation kills the cells.
To have this type of treatment your scans must show that your tumour absorbs MIBG.
Another type of targeted radionuclide treatment uses microscopic beads coated with a radioactive substance called yttrium-90. These beads are injected into blood vessels that feed carcinoid tumours in the liver. The beads block the blood vessels and the radiation kills the tumour cells. This treatment is called selective internal radiotherapy (SIRT).
External beam radiotherapy
External beam radiotherapy is when the radiotherapy beams are aimed at your tumour from a machine. You are most likely to have it for carcinoid that has spread to another part of the body, such as to the bones or brain. It can help to relieve symptoms such as pain.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
You are most likely to have chemotherapy for a fast growing tumour (high grade). Or for a tumour that has spread to other parts of the body and is causing symptoms, particularly tumours of the pancreas (pancreatic neuroendocrine tumours).
You usually have a combination of 2 or 3 chemotherapy drugs.
Radiofrequency ablation (RFA) uses heat made by radio waves to kill cancer cells. Doctors can use it to treat small carcinoid tumours in the liver.
Hepatic artery embolisation
Hepatic artery embolisation is used to treat carcinoid tumours in the liver that can't be removed with surgery.
The treatment blocks the blood supply to the tumour. This makes the cancer cells die. Doctors might give chemotherapy directly into the liver at the same time. This is called chemoembolisation.
Interferon is a drug that stimulates the body’s own immune response to help treat cancer. You might have it if your carcinoid tumour has spread to other parts of your body. It helps to control symptoms and can slow the growth of tumour cells.
You may have interferon on its own, or with one of the somatostatin analogue drugs.
You might just have simple treatments to control your symptoms. For example, you may just need to treat diarrhoea with loperamide (Immodium) or codeine phosphate. Or you might be able to limit the symptoms of carcinoid syndrome with changes to your diet.
Your doctor might ask you to take part in a clinical trial. Doctors and researchers do trials to improve treatment by:
- making existing treatments better
- reducing side effects of treatment
- developing new treatments