Treatments for neuroendocrine tumours (NETs)
If you have a neuroendocrine tumour (NET), your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for a NET, your healthcare team will consider:
- where the cancer started
- if the cancer has spread and where it has spread
- the grade
- the stage
- whether the tumour makes and releases hormones (is functional) or not (is non-functional)
- other health conditions you have
- your personal preferences (what you want)
You may be offered one or more of the following treatments for a NET.
Surgery is the main treatment for most NETs. Most people with NETs benefit from some type of surgery when it can be done. Depending on where the cancer is located, you may have one or more of the following types of surgery.
Resection completely removes the tumour along with some healthy tissue around the tumour. It is most often done for NETs that are only in the organ where the cancer started (local tumours). It can also be done to remove metastases, for instance, when NETs have spread to the liver. The type of resection done usually depends on where the tumour is located and the size of the tumour. Resections that may be done for NETs include:
- local excision or endoscopic resection removes early stage tumours
- bowel resection removes part of the small intestine, large intestine or both
- gastric resection or gastrectomy removes part or all of the stomach
- appendectomy removes the appendix
- Whipple procedure removes part or all of the pancreas along with part of the stomach, the duodenum, the gall bladder and part of the bile duct
- distal pancreatectomy removes the narrow part of the pancreas
- lung resection removes part or all of a lung
- total thyroidectomy removes the thyroid
- liver resection removes part of the liver
Lymph node dissection removes lymph nodes and is usually done at the same time as a resection. It is done when the doctor thinks there is cancer in nearby lymph nodes based on the results of imaging tests and the size of the primary tumour. Which lymph nodes are removed depends on where the NET started.
Cytoreductive surgery removes a large amount of the cancer or as much cancer as possible. It is done when a complete resection can’t be done, but doctors think the NET can be completely destroyed with treatments (called curative intent). It may be done to help other treatments, such as chemotherapy or radiation therapy, work better.
Palliative surgery is done to control and relieve symptoms of advanced NETs and improve quality of life. It may include:
- debulking removes as much cancer as possible
- bypass surgery goes around an area that is blocked by the cancer
- stent placement opens up an organ or duct so substances like stool or air can flow normally
Drug therapy is commonly used to treat and manage NETs. Drugs are given for different reasons.
Somatostatin analogues are drugs that lower the amount of hormones made and released by some NETs. They are mainly used to control symptoms of carcinoid syndrome. They are also used to help reduce the risk and control the progression of heart problems (carcinoid heart disease). Somatostatin analogues may be used to slow down and control the growth of advanced or metastatic NETs when surgery can’t be done. The somatostatin analogues used are octreotide (Sandostatin) and lanreotide (Somatuline Autogel).
Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. It is used for poorly differentiated neuroendocrine carcinomas when other treatments don’t work or can’t be used. The type of chemotherapy drug or combination depends mainly on where the cancer started.
Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells to stop the growth and spread of cancer cells. It may be used to treat advanced well-differentiated pancreatic NETs (pNETs) when surgery can’t be done and the cancer continues to grow and spread. The targeted therapy drugs used are sunitinib (Sutent) and everolimus (Afinitor).
Supportive drugs are used to manage or prevent problems caused by NETs, including diarrhea, high blood pressure, fast or irregular heart rate and high levels of certain hormones.
Radiation therapy may be used in rare cases to treat NETs that have spread to other parts of the body (metastasized). It is used if the cancer can’t be removed with surgery or is causing symptoms.
Radionuclide therapy combines a radioactive material with a substance to target cancer cells throughout the body. Peptide receptor radionuclide therapy (PRRT) is a type of radionuclide therapy that may be used to treat NETs.
External beam radiation therapy uses a machine to direct radiation through the skin to the cancer. It may be used to relieve pain and manage symptoms of bone or brain metastases.
Liver directed therapy
Liver directed therapy is often used to treat NETs that have spread to the liver. It directly targets the cancer in the liver. It is mainly used when surgery can’t be done to control symptoms and the growth of the cancer in the liver.
Hepatic arterial embolization blocks or slows down the flow of blood through the main blood vessel to the liver (hepatic artery) so liver tumours do not receive the oxygen and nutrients they need to grow. Sometimes chemotherapy drugs are used during the embolization procedure (called chemoembolization).
Radiofrequency ablation (RFA) uses heat to destroy cancer cells or tumours.
If you can’t have or don’t want cancer treatment
You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.
Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially in the first 5 years after treatment has finished. These visits allow your healthcare team to monitor your progress and recovery from treatment.
A few clinical trials in Canada are open to people with NETs. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.
Questions to ask about treatment
To make the decisions that are right for you, ask your healthcare team questions about treatment.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
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