Neuroendocrine Tumor Treatment

Neuroendocrine tumors (NETs) are a diverse group of rare tumors that develop in neuroendocrine cells. Found throughout the body, these specialized cells have characteristics of both nerve cells and hormone-producing cells. NETs can form in the gastrointestinal tract, pancreas, lungs and, less commonly, the thyroid and adrenal glands. Some neuroendocrine tumors grow slowly and remain localized, while others are aggressive and spread to other parts of the body.

The exact cause of most neuroendocrine tumors is unknown, but certain genetic conditions, such as multiple endocrine neoplasia type 1 (MEN1), may increase the risk. NETs can occur at any age but are most often diagnosed in adults between the ages of 40 and 60.

Some neuroendocrine tumors produce excess hormones, which can lead to a range of symptoms, including skin flushing, diarrhea, wheezing and heart palpitations. However, many NETs do not produce hormones and may go undetected for years, often becoming apparent only after they have grown large or spread.

Typically, the diagnostic process begins with a review of the patient’s symptoms and medical history, followed by imaging studies, such as computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET) scans. Blood and urine tests may also be used to detect abnormal hormone levels. In most cases, a biopsy is required to confirm the diagnosis and determine the type and stage of the tumor.

After confirming the diagnosis, the physician will consider treatment options based on the location, size, spread and hormone activity of the neuroendocrine tumor. Treatment may involve surgery, radiation therapy, chemotherapy, targeted therapy and/or interventional radiology.

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• Surgery operating and recovery rooms
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• Pathology and laboratory
• Publix Pharmacy
• Ancillary clinical services
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• Gift shop

Surgery for neuroendocrine tumor treatment

Surgery is often a key component of NET treatment, particularly when the tumor is localized and can be removed safely and completely. In many cases, surgery offers the best chance for long-term cancer control or cure, especially if the tumor is well-differentiated. Even if the cancer has spread beyond its site of origin, surgery may still be considered to reduce the tumor burden and manage the related symptoms. The type and extent of the procedure can vary depending on the location and size of the neuroendocrine tumor and whether it has metastasized.

What does surgery for neuroendocrine tumor treatment involve?

The specifics of surgical NET treatment can vary widely based on the location of the cancer and other factors. In some cases, a traditional resection can be performed to remove part or all of the tumor and any affected nearby tissues. A gastrointestinal tumor may require removal of part of the stomach or intestine, while a pancreatic tumor may involve a distal pancreatectomy or Whipple procedure. If the cancer has spread to the liver, the surgeon may remove the liver lesions or perform a debulking procedure to reduce the tumor volume. NET surgery may be performed using open, laparoscopic or robotic techniques, depending on the complexity of the case. Alternatively, the surgeon might recommend an advanced procedure, such as microwave ablation, to destroy the cancerous tissues without physically removing the tumor from the body.

What are the potential benefits of surgery for neuroendocrine tumor treatment?

Surgery can provide several important benefits for a patient with a NET. For a localized tumor, it may offer the possibility of complete removal and long-term cancer remission. In a metastatic case, debulking surgery can reduce tumor-related symptoms, especially those caused by hormone secretion, and improve the patient’s quality of life. Surgical treatment can also help prevent future complications related to tumor growth, such as organ damage and obstruction.

What are the risks and possible complications of surgery for neuroendocrine tumor treatment?

As with any surgical procedure, NET surgery carries some risks, such as excessive bleeding, infection, blood clots and adverse reactions to the anesthesia. Depending on the location of the tumor, there may also be a risk of damage to the surrounding organs and tissues. If the surgery is complex, severe complications are possible, such as pancreatic leaks, delayed gastric emptying or bowel obstruction. When planning the procedure, the surgeon will take steps to minimize the risk of complications, which can vary depending on the extent of the surgery and the patient’s overall health.

What is the recovery process like?

Recovery from NET surgery can vary based on the specifics of the procedure performed. Many patients remain in the hospital for several days afterward and may require a few weeks to several months for full healing. During this time, activity levels can be gradually increased, and dietary changes may be recommended. Follow-up appointments and imaging studies will be scheduled to monitor healing and check for signs of recurrence. Some patients may also receive additional treatments, such as medications or targeted therapies, after surgery to reduce the risk of the cancer returning.

Radiation therapy for neuroendocrine tumor treatment

Radiation therapy may be considered for a NET that is inoperable, has spread beyond its site of origin or is causing disruptive symptoms due to its location or hormone secretion. While many neuroendocrine tumors are slow-growing and may not respond as readily to radiation therapy as other cancers, certain advanced radiation delivery techniques can be effective for controlling tumor growth, relieving pain or targeting specific lesions in the bones, liver and other organs.

External beam radiation therapy (EBRT) for neuroendocrine tumor treatment

Standard external beam radiation therapy is the most commonly used type of radiation treatment for NETs. EBRT involves the use of a computer-controlled machine (linear accelerator), which directs high-energy beams at the tumor from outside the body, precisely targeting cancerous tissues while minimizing exposure to the surrounding healthy structures.

What does external beam radiation therapy for neuroendocrine tumor treatment involve?

Before beginning treatment, the patient will undergo advanced imaging studies to help the physician map out the exact location, size and shape of the tumor and develop a highly targeted radiation therapy plan. EBRT is typically delivered in daily outpatient sessions over the course of several weeks. During each session, the patient will lie still on a special table while a linear accelerator rotates around their body, delivering precise doses of radiation from multiple angles. While the actual radiation treatment is very short (usually lasting only a few minutes), the entire session, including setup and positioning, can take up to 45 minutes.

What are the potential benefits of external beam therapy for neuroendocrine tumor treatment?

EBRT can help shrink a localized NET, alleviate the associated pain and control symptoms caused by tumor pressure or hormone secretion. It may be used alone or alongside other treatments, such as surgery or systemic therapies, for increased effectiveness. In some cases, external beam radiation therapy may be used to treat a metastatic lesion, particularly in the bones or brain.

What are the risks and possible complications of external beam radiation therapy for neuroendocrine tumor treatment?

Temporary side effects of EBRT can include fatigue, skin irritation and localized discomfort in the treated area. Depending on the tumor site and radiation dose, long-term complications are also possible, such as tissue scarring, inflammation and damage to nearby organs. The physician will carefully plan treatment to minimize these risks.

What is the recovery process like?

Most patients can maintain their daily routines during and after EBRT, although they may experience fatigue and other mild side effects that subside within a few weeks after treatment ends. Follow-up visits and imaging scans will be scheduled to monitor the treatment response and manage any delayed effects.

Stereotactic body radiotherapy (SBRT) for neuroendocrine tumor treatment

SBRT is an advanced form of radiation therapy that can target a small, well-defined tumor with exceptional accuracy. Using advanced imaging techniques and specialized equipment, the physician can focus an intensive dose of radiation on the tumor while minimizing any exposure to the surrounding healthy tissues. This concentrated approach can be especially beneficial for treating NETs in areas of the body where precision is critical, such as the head, neck, lungs and gastrointestinal tract.

What does stereotactic body radiotherapy for neuroendocrine tumor treatment involve?

To plan SBRT, the physician will use three– or four-dimensional imaging technology and innovative localization techniques to pinpoint the exact size, shape and coordinates of the targeted tumor and observe how it moves as the patient breathes. To assist with treatment alignment during repeated sessions, small permanent tattoos may be applied to the patient’s skin. In some cases, a tiny metal marker (fiducial marker) will be placed inside or near the tumor for heightened accuracy. Additionally, a customized device, such as a mold or frame, may be created to help the patient remain comfortable and properly positioned throughout each treatment session.

During active treatment, the patient will lie on a special table while a linear accelerator rotates around their body to deliver targeted radiation beams from multiple angles. To minimize tumor movement, the physician may instruct the patient to hold their breath at intervals lasting 10 to 30 seconds.

Stereotactic body radiotherapy can deliver radiation to a neuroendocrine tumor site with sub-millimeter accuracy. The treatment is usually completed in one to five sessions scheduled within one to two weeks.

What are the potential benefits of stereotactic body radiotherapy for neuroendocrine tumor treatment?

SBRT can be effective for treating a small, localized NET or metastasis, particularly in the liver, lungs or bones. Compared to conventional radiation therapy, it offers faster treatment in fewer sessions with a lower risk of damage to surrounding healthy tissues. Stereotactic body radiotherapy can be especially beneficial for a patient who is not a candidate for surgery.

What are the risks and possible complications of stereotactic body radiotherapy for neuroendocrine tumor treatment?

Although SBRT is generally well tolerated, side effects are possible. These include fatigue, localized discomfort and organ-specific symptoms depending on the treatment area. Though rare, potential complications include bleeding, inflammation and damage to nearby tissues. The precision of stereotactic body radiotherapy helps limit these risks.

What is the recovery process like?

Recovery after SBRT is typically brief. Most patients experience minimal downtime and can return to their daily activities shortly after treatment. Any side effects are usually mild and temporary. Ongoing imaging will be used to evaluate treatment success and tumor control.

MRI-guided adaptive radiation therapy (MRI-linac) for neuroendocrine tumor treatment

MRI-guided adaptive radiation therapy, also known as MRI-linac therapy, is a highly advanced technique that integrates real-time MRI imaging with radiation delivery. This approach allows the physician to continuously monitor the tumor during treatment and make immediate adjustments to accommodate any changes in its position caused by breathing or other internal bodily movements.

What does MRI-guided adaptive radiation therapy for neuroendocrine tumor treatment involve?

MRI-linac therapy typically involves daily treatment sessions scheduled over several weeks. Each session begins with MRI imaging to help the physician assess:

• The patient’s anatomy
• The size, shape and location of the targeted tumor
• The size, shape and location of the surrounding organs and tissues

Using this information, the physician will adjust the treatment plan to accommodate any anatomical changes, such as weight gain or loss. These refinements can help maintain optimal accuracy and support safer, more precise radiation delivery.

What are the potential benefits of MRI-guided adaptive radiation therapy for neuroendocrine tumor treatment?

The primary advantage of MRI-linac therapy is its ability to adapt to changes in the patient’s anatomy and tumor position, improving the precision of treatment and minimizing any damage to healthy tissues. It can be especially useful for NETs located near sensitive structures or prone to movement, such as those in the abdomen or pelvis.

What are the risks and possible complications of MRI-guided adaptive radiation therapy for neuroendocrine tumor treatment?

MRI-linac therapy shares similar risks with other forms of external radiation therapy, including fatigue, skin changes and localized symptoms depending on the treatment site. However, its precision helps reduce the likelihood of complications, such as unintended radiation exposure and organ damage.

What is the recovery process like?

Recovery from MRI-linac therapy is typically mild, with most patients resuming their normal activities shortly afterward. Tiredness and temporary discomfort are possible, but due to the targeted nature of the treatment, these side effects are often less pronounced than those of conventional radiation therapy. Regular follow-up medical evaluations and imaging will be scheduled to assess the long-term response to treatment.

Chemotherapy for neuroendocrine tumor treatment

Chemotherapy can be used to treat certain types of NETs, particularly those that are aggressive, fast-growing or have spread to other parts of the body. While many neuroendocrine tumors are slow-growing and may respond better to other forms of treatment, chemo can play a key role in managing a high-grade tumor. Depending on the type and location of the tumor, chemotherapy may be used alone or in combination with surgery, radiation therapy or targeted therapy.

What does chemotherapy for neuroendocrine tumor treatment involve?

Chemotherapy for a NET typically involves the intravenous (IV) infusion of one or more powerful anti-cancer drugs. After entering the bloodstream, the medications can circulate throughout the body to reach and destroy widespread cancer cells. Commonly used chemotherapy agents for neuroendocrine tumor treatment include:

• Capecitabine
• Cisplatin
• Doxorubicin
• Streptozocin
• Temozolomide

Treatment is usually administered in cycles, with each period of active treatment followed by a period of rest to allow the body time to recover. The specific drugs and schedule can vary depending on the grade and origin of the NET and the patient’s overall health.

What are the potential benefits of chemotherapy for neuroendocrine tumor treatment?

Chemotherapy can help shrink a NET, slow its growth, relieve the associated symptoms and improve the patient’s quality of life, particularly in cases of high-grade or metastatic cancer. Chemo can also make a neuroendocrine tumor more manageable for surgery or other localized therapies. This treatment approach may be considered if rapid tumor control is needed or other therapies prove ineffective.

What are the risks and possible complications of chemotherapy for neuroendocrine tumor treatment?

As with most cancer treatments, chemotherapy carries a risk of side effects, such as nausea, fatigue, hair loss, reduced appetite and increased susceptibility to infections due to low blood cell counts. More serious complications can include damage to organs, such as the kidneys or liver, neuropathy or long-term suppression of bone marrow function. These risks can vary depending on the specific drugs used and the patient’s tolerance.

What is the recovery process like?

Recovery from chemotherapy can vary from person to person. Many side effects are temporary and resolve shortly after treatment ends. However, the associated fatigue and reduced blood cell counts can take up to several weeks to improve. The patient will be monitored closely through blood testing and follow-up appointments to assess the treatment response and manage any lingering side effects. Supportive care, such as medications to relieve nausea and therapies to boost blood cell counts, may be provided to help improve the patient’s tolerance and recovery.

Targeted therapy for neuroendocrine tumor treatment

Targeted therapies use specialized drugs that home in on specific receptors or enzymes in cancer cells. The goal is to interfere with the molecular pathways contributing to tumor proliferation. For NETs, targeted therapies may be designed to slow tumor growth, inhibit blood vessel formation or block signals that allow cancer cells to divide and thrive. This treatment approach may be particularly beneficial for a patient with an advanced or metastatic NET that cannot be treated with surgery or other localized techniques.

What does targeted therapy for neuroendocrine tumor treatment involve?

Targeted therapies for NETs are usually taken orally in pill form, although some may be administered intravenously. Two commonly used targeted drugs are everolimus, which blocks a protein that promotes cancer cell growth, and sunitinib, which inhibits the formation of new blood vessels that tumors need to survive. Typically, treatment is continual and may be delivered over an extended period, depending on the patient’s tolerance and response. Regular monitoring through imaging scans and lab tests will be essential to assess the effectiveness of treatment and manage any side effects.

What are the potential benefits of targeted therapy for neuroendocrine tumor treatment?

Targeted therapy offers the distinct advantage of acting on specific molecular pathways involved in cancer growth. Unlike traditional treatments, such as chemotherapy, it limits any harm to healthy cells while effectively slowing tumor progression, controlling symptoms and improving the overall outcome. For a patient with a progressive or inoperable neuroendocrine tumor, targeted therapy can offer meaningful clinical benefits with relatively manageable side effects, helping to preserve quality of life.

What are the risks and possible complications of targeted therapy for neuroendocrine tumor treatment?

Although targeted therapy tends to cause fewer side effects than chemotherapy, this type of treatment is not completely without risks. Common side effects include fatigue, mouth sores, skin rashes, diarrhea, hypertension and elevated blood sugar levels. More serious but less common complications include lung inflammation, heart-related issues and impaired liver function. The likelihood and severity of these side effects can vary depending on the specific drug used and the patient's overall health.

What is the recovery process like?

Because targeted therapy is often given over a long period, recovery is less about returning to baseline after a set number of treatment sessions and more about managing ongoing side effects and maintaining optimal health. The patient may have regular blood tests, imaging scans and follow-up visits to monitor their response and adjust the treatment plan as needed. Supportive care may be provided to manage any side effects and help the patient maintain their daily activities throughout the course of treatment.

Somatostatin analog therapy for neuroendocrine tumor treatment

Somatostatin analog therapy is a standard treatment for many NETs, particularly those that are well-differentiated and produce excess hormones. This unique therapy uses synthetic versions of somatostatin—a naturally occurring hormone that helps regulate the endocrine system—to slow tumor growth and reduce hormone-related symptoms. It is commonly used to manage carcinoid syndrome and help control tumor progression in patients with advanced cancer.

What does somatostatin analog therapy for neuroendocrine tumor treatment involve?

Somatostatin analogs, such as octreotide and lanreotide, are typically administered as long-acting injections, usually given every two to four weeks. The medication works by binding to somatostatin receptors on cancer cells, which helps reduce hormone secretion and may slow tumor growth. Treatment is often ongoing and may be continued for many months or years, depending on the patient’s response and overall health condition.

What are the potential benefits of somatostatin analog therapy for neuroendocrine tumor treatment?

Somatostatin analogs can be effective at controlling symptoms caused by hormone-secreting NETs, including flushing, diarrhea and abdominal pain. In addition to symptom relief, these innovative therapies can help stabilize tumor growth and delay cancer progression. For a patient with a slow-growing neuroendocrine tumor, somatostatin analogs may provide a long-term treatment option that preserves quality of life.

What are the possible side effects of somatostatin analog therapy for neuroendocrine tumor treatment?

Somatostatin analog therapy is generally well tolerated, but side effects can still occur. These may include pain at the injection site, gastrointestinal upset, gallstones and minor blood sugar fluctuations. Though less common, some patients experience fatigue, dizziness or thyroid function changes. Most side effects are manageable and tend to improve over time or with supportive care.

What is the recovery process like?

Because somatostatin analog therapy is generally used as a long-term cancer management strategy, there is no specific recovery period. Instead, the patient will be monitored through periodic blood testing and imaging to assess their hormone levels, tumor growth and treatment tolerance. Medication or dosage adjustments may be made to help alleviate any side effects. Most patients continue with their daily activities while receiving treatment and often experience symptom improvement and tumor stabilization over time.

Peptide receptor radionuclide therapy (PRRT) for neuroendocrine tumor treatment

Lutathera® (lutetium Lu 177 dotatate) is a form of targeted radiation therapy known as peptide receptor radionuclide therapy. This breakthrough treatment is approved by the U.S. Food and Drug Administration (FDA) for somatostatin receptor–positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs) in adults. Lutathera works by binding to the somatostatin receptors in a tumor and then emitting a radioactive isotope that damages and destroys the cancer cells while sparing most surrounding healthy tissues.

What does Lutathera for neuroendocrine tumor treatment involve?

Lutathera is administered via intravenous injection in a specialized nuclear medicine facility. Typically, the patient will receive one injection every eight weeks for a total of four treatments. Before each infusion, the patient will receive premedication and amino acids to help reduce nausea and protect their kidneys. After entering the bloodstream, the radioactive agent will travel throughout the body and selectively bind to tumor cells that express somatostatin receptors. Once bound, the drug will deliver targeted radiation to disrupt cancer cell function and replication. The patient will be monitored closely for a few hours afterward.

What are the potential benefits of Lutathera for neuroendocrine tumor treatment?

Lutathera has been shown to significantly slow cancer progression in patients with advanced, somatostatin receptor–positive NETs. It can reduce tumor size, relieve the related symptoms, such as flushing and diarrhea, and enhance the patient’s overall quality of life. For a patient with a GEP-NET that is not responsive to other therapies, Lutathera may offer a highly targeted and potentially effective treatment option.

What are the possible side effects of Lutathera for neuroendocrine tumor treatment?

While Lutathera is generally well tolerated, side effects can occur, such as nausea, vomiting, fatigue and mild to moderate decreases in blood cell counts. Some patients also experience abdominal pain or temporary changes in liver function. Less common but more serious complications include kidney damage and long-term bone marrow suppression. Throughout treatment, the patient will be monitored closely to detect and manage any adverse effects.

What is the recovery process like?

Recovery between Lutathera treatments typically involves rest and supportive care to manage any temporary side effects. Periodic blood tests will be performed to check kidney function, liver enzymes and blood cell counts. Most side effects are mild and resolve within a few days to weeks. Follow-up imaging will be used to evaluate the tumor’s response to treatment. The patient will also be advised to follow radiation-specific safety guidelines for a short period after each infusion, such as limiting close contact with others, especially young children and pregnant women.

Interventional radiology for neuroendocrine tumor treatment

Interventional radiology (IR) for NET treatment involves minimally invasive, image-guided procedures that can be used to manage the tumor, particularly when it has spread to the liver. IR may be considered if surgery is not possible and other therapies have proven ineffective. Interventional radiology procedures for NETs include:

• Transarterial embolization (TAE) – TAE can block the blood vessels feeding a liver tumor, depriving it of the oxygen and nutrients it needs to grow and survive.
• Transarterial chemoembolization (TACE) – TACE can deliver chemotherapy drugs directly into a tumor’s blood supply before blocking it (similar to TAE), combining targeted drug delivery with reduced blood flow.
• Radioembolization (Y-90) – A form of internal radiation therapy, Y-90 can deliver tiny beads coated with the radioactive isotope Yttrium-90 to a liver tumor via the bloodstream, providing focused radiation therapy while sparing healthy tissues.

Each IR approach targets liver metastases by disrupting the blood supply to the tumor or delivering localized therapy directly to the cancerous tissues.

What does interventional radiology for neuroendocrine tumor treatment involve?

IR procedures are typically performed in a hospital or outpatient interventional suite. Using advanced imaging techniques, such as ultrasound, CT or fluoroscopy, the physician will carefully guide small surgical instruments through blood vessels. For example, during embolization, the physician will thread a catheter through the femoral artery and guide it into the hepatic artery, which supplies blood to liver tumors. Next, the physician will deliver particles (with or without chemotherapy or radiation therapy) to block blood flow to the tumor, causing it to shrink. Usually, IR procedures are performed under sedation or light anesthesia and do not require a large incision.

What are the potential benefits of interventional radiology for neuroendocrine tumor treatment?

Interventional radiology can effectively reduce the tumor burden in the liver, relieve hormone-related symptoms and improve the patient’s quality of life. It offers a localized treatment option that limits the exposure of healthy tissues to systemic therapy. For a patient who is not a candidate for surgery or who has a NET confined primarily to the liver, IR may offer durable tumor control and can be repeated over time as needed.

What are the possible side effects of interventional radiology for neuroendocrine tumor treatment?

The side effects of IR can vary depending on the type of procedure performed. For a few days afterward, the patient may experience post-embolization syndrome, which is characterized by pain, fatigue, low-grade fever and nausea. More serious but less common side effects include liver damage, infection, blood vessel injury and allergic reaction to the contrast dye used during the procedure. These risks will be carefully monitored and minimized by the healthcare team.

What is the recovery process like?

Recovery from interventional radiology procedures is typically shorter and less intensive than recovery from surgery. Most patients remain in the hospital for observation for one to two days, then gradually return to their normal activities within one to two weeks. Follow-up imaging will be performed to assess the effectiveness of treatment, and additional sessions may be recommended if necessary. Supportive medications may also be prescribed to manage any post-procedure discomfort or side effects.

Benefit from world-class care at Moffitt Cancer Center

Moffitt is widely regarded as a leading institution in the clinical development of therapies that continue to shape the landscape of neuroendocrine tumor treatment. We offer the latest surgical techniques, chemotherapy drugs and drug combinations, radiation-based treatments, targeted therapies and interventional radiology procedures. Additionally, through landmark clinical trials, our scientists and clinicians are investigating novel cellular therapies that harness the power of the body’s immune system to target neuroendocrine tumors. In recognition of our numerous research breakthroughs, the National Cancer Institute has designated Moffitt a Comprehensive Cancer Center, and we are the only cancer center based in Florida to have earned this prestigious distinction.

If you would like to learn more about neuroendocrine tumor treatment, you can request a consultation with a specialist in our renowned Gastrointestinal Oncology Program by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.