Treatment

The treatment of a carcinoid tumor depends on the size and location of the tumor, whether the tumor has spread, and the patient’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials as a treatment option when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.

Descriptions of the most common treatment options for a carcinoid tumor are listed below.

Surgery

Many carcinoid tumors are treated with surgery alone. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Complete removal of the entire tumor is the standard treatment when possible. Often, the surgeon will remove some normal tissue around the tumor in hopes of leaving negative margins (no trace of cancer in the healthy tissue). When a complete removal of the tumor is not possible, debulking surgery is often used. Debulking surgery removes as much of the tumor as possible and may provide some relief of symptoms. Learn more about cancer surgery.

Surgery for a gastrointestinal carcinoid tumor

Local excision. During this operation, the surgeon removes the primary tumor and a margin of tissue around the primary location. Most localized tumors can be surgically removed through a skin incision, but a rectal carcinoid tumor may be removed through the anus. Other gastrointestinal carcinoid tumors can sometimes be removed using an endoscope (see Diagnosis).

Electro-fulguration (radiofrequency ablation, RFA). Sometimes used for rectal carcinoid tumors, this treatment destroys the tumor by heating it with an electric current.

Segmental colon resection or hemicolectomy. During this surgery, one-third to one-half of the colon, as well as nearby blood vessels and lymph nodes, are removed.

Low anterior resection. During this surgery, a portion of the upper part of the rectum is removed.

Abdominoperineal resection. This surgery is used for larger tumors in the lower part of the rectum. After surgery, a colostomy (an opening from the colon to the outside of the body) may be used to carry urine and other waste outside of the body.

Liver resection. This surgery removes areas of metastases from the liver. It is not expected to cure cancer, but it is often helpful in relieving or reducing the symptoms of carcinoid syndrome.

Liver transplantation. Liver transplantation is rarely used in the treatment of carcinoid tumors, but it may help younger patients with carcinoid tumors that begin in the liver.

Procedures to treat liver metastases

Intratumoral ethanol injection. A CT scan is used to guide a needle into the areas of tumor spread, which are then destroyed by injecting concentrated alcohol through the needle. Liquid nitrogen can also be used to cool the needle and kill the cells by freezing. These methods are particularly useful if traditional surgical procedures are difficult or impossible to perform.

Hepatic artery occlusion or embolization. Generally used for patients with liver metastases, these procedures block the tumor’s blood supply by sealing off the blood vessels leading to the tumor. The effectiveness of chemotherapy combined with hepatic artery embolization is not yet clear and continues to be studied.

Surgery for a lung carcinoid tumor

Sleeve resection. The tumor is surgically removed along with parts of the airway above and below the tumor. The airway is then reconnected.

Wedge resection. During this surgery, a small, wedge-shaped piece of the lung is removed. This surgery is used if the tumor is very small.

Lobectomy. During this surgery, an entire lobe of a lung is removed. This surgery is often used if a sleeve resection is not possible due to the size and location of a tumor. A lobectomy is also used if a carcinoid tumor is found at the edge of the lungs away from large airways.

Pneumonectomy. During this surgery, an entire lung is removed.

Lymph node dissection. Removal of the lymph nodes near the lungs is also common during surgery for a lung carcinoid tumor. Removing the lymph nodes lowers the risk of the carcinoid tumor spreading to other organs.

For some people, such as those with lung diseases, heart disease, or other medical conditions, surgery cannot successfully treat the cancer. In these cases, palliative surgery to relieve symptoms can be helpful, such as removing most of the tumor through a bronchoscope or vaporizing most of it with a laser. Palliative surgery is often supplemented with radiation therapy. These treatments can help relieve symptoms caused by blocked airways.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. External-beam radiation therapy is the most common radiation treatment for carcinoid tumors, and is most often used to treat bone metastases in order to relieve symptoms. When radiation treatment is given using implants, it is called internal radiation or brachytherapy. Internal radiation therapy involves tiny pellets or rods containing radioactive materials that are surgically implanted in or near the site of the tumor. The implant is left in place for several days while the patient stays in the hospital.

Patients receiving radiation therapy may experience fatigue during the course of treatment, and the treated area may become red and dry. Radiation therapy to the chest and neck can cause a dry, sore throat, or a dry cough. Some patients experience shortness of breath during radiation therapy. Most side effects go away after the treatment is finished. Radiation therapy is not always effective in treating carcinoid tumors, but it may be useful for pain control. Learn more about radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor's office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time. The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Chemotherapy for a carcinoid tumor is most often used when the tumor has spread to other organs or is causing severe symptoms. This type of tumor rarely responds to chemotherapy alone, and other treatments may be necessary.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Immunotherapy

Immunotherapy (also called biologic therapy) is designed to boost the body's natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to bolster, target, or restore immune system function.Immunotherapies include alpha-interferon and octreotide, may shrink a carcinoid tumor or stop its growth. These therapies work by altering the surface proteins of cancer cells and by slowing their growth. Biologic therapies are also used to treat symptoms by controlling the production of hormones. Learn more about immunotherapy.

Targeted therapies

Targeted therapy is a treatment that targets faulty genes or proteins that contribute to cancer growth and development.Targeted therapies under investigation include drugs that interfere with new vessel formation or with specific survival pathways of cancer cells. Learn more about targeted treatments.

Treatment of a gastrointestinal carcinoid tumor by stage (localized, regional spread, or distant spread)

Localized

Stomach. A localized carcinoid tumor of the stomach can often be completely removed through an endoscope. A tumor larger than 2 centimeters (cm) is removed with a margin of surrounding stomach tissue through an incision in the abdomen. For patients whose carcinoid tumor is stimulated by gastrin, a hormone released by cells of the antrum of the stomach (the part next to the small intestine), the removal of the antrum may be recommended.

Small intestine. Surgery to remove the tumor and surrounding tissue is the most common treatment for carcinoid tumors (smaller than 1 cm) in the small intestine. Surgery for larger tumors involves removing more surrounding tissue, as well as some surrounding blood vessels and lymph nodes.

Large intestine. The most common treatment for tumors smaller than 2 cm is the surgical removal of the tumor and surrounding tissue, often done through a colonoscope (see Diagnosis). If the tumor is larger than 2 cm, surgery most often involves an incision through the skin.

Appendix. An appendectomy (removal of the appendix) is usually the only treatment needed for carcinoid tumors smaller than 1.5 cm. For tumors larger than 2 cm, the removal of about one-third of the colon next to the appendix, along with nearby blood vessels and lymph nodes, is often needed.

Rectum. A rectal carcinoid tumor smaller than 1 cm is treated with electro-fulguration (a procedure that destroys the tumor by heating it with an electric current). Tumors larger than 2 cm have a high risk of aggressive growth and spread, so they are removed using the same procedure as rectal cancer, where some of the healthy tissue of the colon or rectum and some of the nearby lymph nodes are removed.

Regional spread

When possible, the primary tumor and areas of spread to adjacent tissues and lymph nodes are removed during surgery. If this is not possible, surgery can help relieve symptoms, such as intestinal blockage.

Distant spread

Surgery is used to relieve symptoms, as it is not a curative therapy at this stage. If distant metastases are not causing symptoms, surgery may not be needed. If carcinoid syndrome is causing symptoms, surgery to remove as much cancer as possible is often recommended. Chemotherapy may also be offered to help relieve symptoms.

Find out more about common terms used during cancer treatment.