Treatment options for neuroendocrine cancer

A team of healthcare professionals decide what your treatment options are. Surgery is often the main treatment. Other treatments include:

• somatostatin analogues
• radiotherapy
• chemotherapy
• targeted cancer drugs

Your treatment depends on what type of neuroendocrine cancer you have. On this page we provide a general overview of treatments for all types of neuroendocrine cancer. 

For more detailed information about treatment for your neuroendocrine cancer, choose your type from the menu at the link below. Your type depends on several factors including where in your body the cancer starts growing. 

Deciding what 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). 

Your MDT usually includes:

• a specialist nurse - also called a clinical nurse specialist (CNS)
• a pathologist - a doctor who diagnoses diseases from examining biopsies
• a clinical oncologist - a doctor specialising in radiotherapy treatment
• a medical oncologist - a doctor specialising in drug treatment
• a surgeon
• a pharmacist
• a radiologist - a doctor specialising in reading x-rays and scans

You might meet a social worker, psychologist or counsellor.

You might not start treatment straight away if you are well. This depends on your symptoms, and the results of your blood tests and scans. And the type of neuroendocrine cancer you have.

If you need treatment, your team plans it depending on:

• your type of neuroendocrine
• how fast it is growing (the grade)
• how far the cancer has spread (the stage)
• your general health and fitness

Your doctor will talk to you about your treatment options. They will discuss the benefits and the possible side effects with you.

The main treatments

Some people only have one type of treatment. Other people need a combination of treatments.

The main treatment for neuroendocrine tumours (NETs) is surgery. You might also have surgery for neuroendocrine carcinoma (NEC) if your cancer hasn't spread.

Surgery

The type of operation you have will depend on where the neuroendocrine cancer is in your body. 

Surgery might be the only treatment you need. Or you might have it combined with other types of treatment. 

You might have an operation even if the surgeon can't completely remove the cancer. Removing part of the cancer can sometimes reduce your symptoms. They sometimes call this debulking surgery.

Your doctor might only suggest surgery if they think it’s possible to remove most of the tumour.

Urgent treatment to control symptoms caused by neuroendocrine tumours

You might have symptoms if you have a NET that is producing too many hormones . Surgery to remove the cancer can help with symptoms. But you might need other treatment straight away to help you feel better. And to make sure you are well enough for surgery. This might include:

• somatostatin inhibitors
• fluid through a drip if you have had a lot of diarrhoea
• vitamin or mineral supplements
• drip or tube feeding if you have lost lots of weight

Other treatment options for neuroendocrine tumours (NETs)

You might have one of the following treatments for a neuroendocrine tumour (NET). We have information about treating neuroendocrine carcinoma (NEC) further down this page.

You might have other treatments if:

• you can’t have surgery to remove the NET
• the NET has spread to another part of the body
• the NET comes back after initial treatment

These treatments can control your symptoms and help you feel better but won’t get rid of the NET. There are a number of different treatment options. The best treatment for you depends on your situation.

Somatostatin analogues

Somatostatin analogues are medicines that stop your body from making too many hormones.

Some NETs make large amounts of hormones that cause a group of symptoms. Somatostatin analogues are a possible treatment for people with these symptoms. They help to control symptoms such as diarrhoea and flushing of the skin. They may also shrink the NET. 

The most common somatostatin analogues are:

• octreotide (Sandostatin)
• lanreotide (Somatuline)

You might have somatostatin analogues if your NET picks up somatostatin . Doctors can check for this using special scans. Some NETs don't pick up somatostatin. So if the NET doesn’t pick it up it means this treatment won’t work.

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. You may have chemotherapy if cancer has spread to your liver or to other parts of your body. 

The most common chemotherapy drugs for NETs are:

• streptozotocin
• temozolomide
• fluorouracil
• capecitabine
• doxorubicin

Peptide receptor radionuclide therapy (PRRT)

You might have a type of radioisotope therapy. This is called peptide receptor radionuclide therapy (PRRT). This is a way of using radioactive medicines to treat cancer.

PRRT uses a radioactive substance called lutetium-177 or yttrium-90. Neuroendocrine cells have proteins on the outside of them called somatostatin receptor proteins. The hormone somatostatin attaches itself to this receptor protein. This would normally slow down the production of hormones by the cell. 

This treatment uses a man made form of the hormone somatostatin. This medicine is called a somatostatin analogue. The treatment attaches a radioactive substance to the somatostatin analogue drug. The drug can deliver the radiotherapy directly inside the neuroendocrine cell. This destroys it. 

You have special scans such as PET scans or octreotide scans . These can check whether your NET has these somatostatin receptors. If it does, your doctors might offer you this treatment for a NET that:

• started in your digestive system  or pancreas  
• has spread or cannot be removed with surgery
• is grade 1 or grade 2 - this means the NET is slow or moderately fast growing

Targeted cancer drugs

Cancer cells have changes in their genes (DNA) that make them different from normal cells. These changes mean that they behave differently. Targeted drugs work by ‘targeting’ the differences that a cancer cell has and destroying them. 

Common targeted cancer drugs for NETs include:

• everolimus
• sunitinib

Treatment options for neuroendocrine tumour (NET) that has spread to your liver

Neuroendocrine tumours (NETs) can spread to other parts of the body, including the liver. The following treatments might be options if your NET has spread to your liver:

Surgery to remove cancer from the liver

The surgeon might be able to remove cancer in your liver. But this isn’t always possible. The surgeon might remove the liver cancer at the same time you have the main surgery. Or you may have a second operation to remove it.

Your surgeon might remove just the cancer, or the part of the liver where the tumour is.

Radiofrequency ablation (RFA)

Radiofrequency ablation (RFA) uses heat made by radio waves to kill cancer cells. It is a treatment for cancer that has spread to the liver. You might have this if your cancer is in your liver and you can’t have surgery to remove it.

You might have RFA alone or together with other treatments.

Trans arterial embolisation (TAE)

Trans arterial embolisation aims to block the blood supply to cancer in the liver. The tumour can’t survive without a blood supply. Blocking the blood supply also stops the tumour releasing hormones into your blood. It’s also called hepatic artery embolisation.

Doctors might give a chemotherapy drug directly into the liver. You have this at the same time as blocking the blood vessel. This is called chemoembolisation or trans arterial chemoembolisation (TACE). This is a less common treatment for people with a neuroendocrine cancer.

Liver transplant

A liver transplant is an operation to remove your liver and replace it with a healthy one from a donor. It is a big operation and is only suitable for a very small number of people. You doctor will let you know if this kind of operation is possible for you. 

Internal radiotherapy (SIRT)

Selective internal radiation therapy (SIRT) is a way of giving radiotherapy treatment for cancer in the liver. 

It's a type of internal radiotherapy . Your doctor puts tiny radioactive beads into a blood vessel . This takes blood into your liver. The beads get stuck in the small blood vessels in and around the NET. Then the radiation destroys the cancer cells.

The aim of treatment is to slow the growth of your cancer. It might also help control hormone related symptoms, if you have them.

Treatment for neuroendocrine carcinomas (NECs)

Neuroendocrine Carcinomas (NECs) are different to neuroendocrine tumours (NETs). NEC cells look very abnormal and aren’t like normal neuroendocrine cells at all. Doctors call them poorly differentiated cancers. 

NECs are all high grade. This means they grow rapidly and are likely to spread. Unfortunately this means NECs are more difficult to treat than NETs. The treatment you need is different.

Treatment depends on your individual situation. For example where in your body the NEC has started, and whether it has spread. 

You might have surgery if your cancer hasn’t spread.

You usually also have chemotherapy treatment as well as surgery. You might have this:

• before surgery (neoadjuvant chemotherapy)
• after surgery (adjuvant chemotherapy)

You have chemotherapy on its own. For some NEC's, you might have it with radiotherapy. This is called chemoradiotherapy.

Chemotherapy drugs for NEC include:

• carboplatin or cisplatin
• etoposide
• irinotecan

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.