Carcinoid Tumors

Treatment

Treatments differ depending where the carcinoid tumor develops in the body. Whether physicians recommend surgical approaches or radiological intervention procedures (such as hepatic artery embolization, radiofrequency ablation and cryotherapy) is based on many factors. Some are:

• Location and size of the tumor(s)
• Symptoms and complications from the primary or metastatic carcinoid tumor and/or its hormone productions
• Whether and how far the cancer has spread
• Overall health of the patient

Surgery

A physician who finds a carcinoid tumor before it spreads to nearby organs will recommend surgery. The surgical approach used will depend upon the tumor site. During surgery, physicians may also remove nearby lymph nodes. Lymph node dissection can help determine if the disease has spread.

Whenever possible, surgeons remove the entire tumor. In some advanced cases (particularly those involving the liver) removing only a portion of the tumor may be possible. Removing about 90 percent of the tumor can benefit a patient by relieving carcinoid syndrome symptoms and is likely to prolong survival. Removal of the primary tumor from the intestine, even with advanced disease, can improve quality of life in patients with obstructive symptoms.

Heart Valve Replacement
Scarred heart valves can be a complication of carcinoid tumors. Cardiologists and cardiac surgeons are part of the team approach to treating carcinoid tumors at Mayo Clinic, which is a leading center for the replacement of damaged valves.

Stereotactic Radiosurgery
Patients who have carcinoid tumors that have metastasized (spread) to the brain may benefit from stereotactic radiosurgery.

Liver Transplant
Some patients whose tumors have metastasized only to the liver have received liver transplants. Experienced Mayo Clinic physicians conduct an extensive evaluation to determine if a patient is an appropriate candidate for this treatment.

Radiation Therapy

In radiation therapy, high-dose X-rays destroy cancer cells and shrink tumors. External beam radiation may be used when the carcinoid tumor has metastasized to bone or when the local tumor cannot be removed surgically. Although radiation does not typically cause a significant change in the size of carcinoid tumors, it may decrease the pain associated with tumors and may prevent them from growing in the future.

Interventional Radiology

When the spread of a carcinoid tumor has minimal effect on the liver, physicians may consider radiofrequency ablation. In this nonsurgical treatment, ultrasound guides specialists as they insert a needle through the skin and into the liver tumor. The physician then heats the tip of the needle to destroy the cancer nodule.

For some patients with extensive liver involvement, surgery is not an option. Then the treatment team may consider hepatic artery embolization. This procedure is performed by expert interventional radiologists, who may use it when surgical debulking is not recommended. To perform hepatic artery embolization, specialists inject chemotherapy into the diseased region of the liver, and then block the hepatic artery (the major artery to the liver) to ensure that the drugs stay in the tissue surrounding the tumor.

In some cases, physicians may use cryotherapy; liquid nitrogen is applied to kill carcinoid tumors cells by freezing them.

Medical Therapy

Specialists consider standard chemotherapy when needed. They also may use octreotides to relieve symptoms and, perhaps, also stabilize tumor growth. Patients who are not candidates for other treatment can get information about innovative clinical trials conducted by Mayo Clinic physicians and researchers.

Other Drugs

Physicians also consider using interferon, which stimulates the body's immune system to fight tumor cells. Interferon can be injected under the skin. Patients who are eligible to enroll in a clinical trial may benefit from new approaches to treating carcinoid tumors. These may help control the cancer or related symptoms.