“There are number of different treatment options for patients with neuroendocrine tumours or NETs”.
“First of all, we make a decision on the basis of the growth rate of the tumours”
“We have a range of anti-tumour agents that we can offer to patients.”
“Treatment depends on the type of NETs. In general, in localised disease, surgery is a curative treatment.”
The table below shows the various treatments for NETs that are available. Always consult your doctor to discuss and determine the most appropriate treatment options for you.
“If your specialist tells you that he or she will not be prescribing anything and that they are keeping you under observation it does not mean that you are not receiving any treatment. Most NETs are very slow growing.”
Surgery is usually the first choice for treatment if imaging scans show that the primary tumour is contained in one area (localised) or there has been only limited spread within an organ of the body. If it is possible to remove the tumour completely with surgery then no other treatment may be necessary.
Even if the primary tumour has spread (metastasised), surgery may still be possible to remove part of the tumour and any other secondary tumours.
This is often referred to as tumour debulking.
If GEP-NETs or other NETs are blocking an organ, such as the bowel, then surgery may be helpful to relieve the blockage. If the tumour has spread to the liver, surgery can be used to remove the parts of the liver containing the tumour. Very occasionally, a liver transplant may be considered.
“My cancer was caught at an early stage and removed surgically. At first I was monitored every six months, and now it’s annually, with various tests and scans.”
*Quote from a patient who completed an anonymous survey conducted in five countries in 2015
Radiation therapy is one of the most common treatments for NETs. It uses high-energy particles or waves, such as X-rays, gamma rays, electron beams, or protons, to destroy or damage cancer cells.
Before radiotherapy can be given, imaging scans will be performed to determine the precise location of the tumours.
Radiation therapy aims to give the highest chance of curing or shrinking the cancer, and the lowest doses to surrounding healthy cells to avoid treatment side effects. Other names for radiation therapy are radiotherapy, irradiation, or X-ray therapy.
External beam radiotherapy is given to cancer patients as a series of short, daily external treatments, typically for several weeks.
It uses equipment similar to a large X-ray machine called a linear accelerator. Each of these short treatments is called a fraction. Giving external beam therapy in fractions means that less damage is done to normal cells than to cancer cells.
Intra-operative radiation therapy (IORT) is a relatively new and very precise way to deliver radiation therapy during surgery. During surgery, radiation is applied directly to the area where the tumour has been removed. This may help to remove any microscopic tumour cells and potentially reduce the chance that a tumour could grow back. A single treatment may be enough in some cases, although some patients may still need additional external beam radiotherapy for a short while after surgery.
Chemotherapy involves the use of anti-cancer (cytotoxic) drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach neuroendocrine cancer cells within the body.
Common ways to give chemotherapy include the use of a thin tube (catheter) placed into a vein using a needle (intravenous delivery) or via an oral pill or capsule.
The type of chemotherapy that you are given will depend on where in the body the NETs started.
For example, some people may receive chemotherapy to treat NETs in the pancreas (pancreatic NETs) or lungs (bronchial NETs). Chemotherapy can be used alone to treat NETs, or together with other treatments and procedures overviewed in this section.
Targeted cancer therapies are drugs or other substances that block the growth, development and spread of cancer by interfering with specific molecules involved in carcinogenesis (the process by which normal cells become cancer cells), tumour vasculature and tumour growth.
These treatments are also known as molecularly targeted therapies. They are used to treat specific types of neuroendocrine cancer by targeting the biological differences between cancer cells and normal cells.
Some molecularly targeted therapies can fight the tumour cells without harming the healthy cells.
Targeted cancer therapies may be prescribed to some people with NETs, most of them having first received somatostatin analogue medications.
Somatostatin analogues are medications that copy the action of somatostatin.
Somatostatin is a hormone – a chemical messenger that is naturally produced in the body. It can stop the over-production of other hormones that cause neuroendocrine cancer symptoms, such as diarrhoea, flushing and wheezing.
Somatostatin analogues may reduce symptoms of NETs by stopping the body from making too many hormones. They may also control the growth of certain types of NETs.
When you start using a somatostatin analogue, you may be given an injection of the product up to three times a day or you may receive a longer-acting injection that can last for a month or so.
Interferon is a naturally occurring substance that is produced by the body’s immune system during an illness such as a viral infection, such as influenza.
Interferon is sometimes called biologic therapy or immunotherapy and is used to treat some people with NETs.
Sometimes interferon is taken on its own as a medication for NETs.
However, it is often taken as part of a combination therapy with somatostatin analogues. Interferon may not be a suitable therapy for everyone with NETs.
Other treatment options are currently under clinical development, and may become available in the future. Please note such treatments are not yet approved, and there is a possibility they may never be approved and available in your country.
Targeted radionuclide therapy is also called peptide receptor radionuclide therapy (PRRT) or hormone-delivered radiotherapy. PRRT is based on using radioactive substances (radionuclides) to target receptors on the tumour cells’ surface.
In this type of treatment for NETs, radionuclides are chemically combined with hormones (somatostatin analogues). When this combination treatment is injected into the body, it will fix on the surface of the neuroendocrine cancer cells and deliver a targeted radiation dose to prevent further tumour growth or even destroy the tumour.
Besides interferon there are other drugs and approaches being developed to specifically use the body’s immune system to attack cancer cells:
One approach is the use of laboratory-made antibodies that can recognise that a cell is cancerous and destroy it without harming the body’s normal cells.
Another approach is to take some of a person’s blood, separate out a specific white blood cell type called a T-cell, adapt it in the laboratory and then put it back into the same patient.
The adapted T-cells then attack the cancer cells more specifically while leaving normal cells alone.
Have a question about NETs? See if it has been answered by one of our experts
Patient support groups for NETs can often provide social and emotional support
View a list of specialist NETs clinics and NETs hospital units in Europe