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Surgery for neuroendocrine cancer
Surgery is the primary treatment for neuroendocrine cancer. Surgery is used to:
- completely remove a localized neuroendocrine tumour or carcinoma
- remove as much of the tumour as possible (debulk)
- manage complications, such as intestinal obstruction or heart valve damage
The type of surgery done depends mainly on the size of the tumour or stage of the cancer. It may also depend on other factors, such as the type of tumour. Side effects of surgery depend on the type of surgical procedure.
Evaluation and treatment before surgery
Before surgery can be done, the person with neuroendocrine cancer will have a complete medical history and physical examination.
Supportive therapy may be started to relieve the signs and symptoms caused by the overproduction of hormones by functional neuroendocrine tumours or carcinomas. Serious, life-threatening problems can occur if the hormone levels are not controlled. A neuroendocrine tumour or carcinoma can release large amounts of hormones when it is touched during surgery, so the surgical team will take precautions to prevent and treat this complication.
Biological therapy with somatostatin congeners like octreotide (Sandostatin) stops neuroendocrine tumours and carcinomas from producing hormones.
Surgical removal of neuroendocrine tumours
A localized neuroendocrine tumour may be completely removed along with a margin of healthy tissue. Complete surgical removal of the tumour mass is usually possible in the early stages of the disease.
- In advanced neuroendocrine cancer, surgery is used to reduce the tumour mass as much as possible (debulking or cytoreduction). Debulking surgery may be repeated frequently to effectively reduce tumours, control symptoms, improve quality of life and prolong survival.
- Surgical resectionresectionA surgical procedure to remove tissue or part of an organ or structure., cryosurgerycryosurgeryA procedure that uses extreme cold (liquid nitrogen or liquid carbon dioxide) to freeze and destroy abnormal tissue. and radio-frequency ablation are different surgical methods used to remove or reduce tumours. In advanced stages where the cancer has spread to the liver, partial hepatectomy (surgical removal of a part of the liver) or a liver transplant can reduce tumour bulk and symptoms.
Doctors may use image guidance such as x-rays, CT, ultrasound or MRI to help them insert gelfoam, cellulose or other expandable substances into the artery leading to the tumour. These substances clog the artery and cut off the main blood supply to the tumour, eventually starving the tumour.
For people with liver metastases, using embolizationembolizationA procedure that blocks or slows down the blood supply to tissues or an organ. to block the blood flow to the tumour can reduce tumour mass and improve quality of life and survival. Embolization combined with cytotoxic drugs (chemoembolization) to treat liver metastasis is a treatment option for some people.