Carcinoid Tumors: When Surgery Isn't an Option

Medically Reviewed by Brunilda Nazario, MD on December 20, 2011
5 min read

When carcinoid tumors are at a more advanced stage, surgery may not be possible. However, other treatments can help manage these neuroendocrine tumors. Although these treatments don't cure the cancer, they can help slow or stop the growth of the tumor and ease symptoms.

Depending on the location of the tumor and how far it has spread, doctors may use a variety of treatments. Even if surgery can't be used to cure the tumor, it may be used to remove part of the tumor, called debulking.

"I've found the best way to approach carcinoid tumors is to treat them aggressively," says Richard Warner, MD, professor of medicine at the Mount Sinai School of Medicine and medical director of the Carcinoid Cancer Foundation. "We often use a few types of treatments one right after the other. For example, we may use debulking surgery, then radiation, and then chemotherapy. This helps us stay ahead of tumor growth."

Medications can help slow the growth of tumors and ease the symptoms of carcinoid syndrome. Carcinoid syndrome is a set of symptoms -- including flushing of the skin, wheezing, and diarrhea -- that can occur if the tumor produces excess hormones such as serotonin or histamine.

  • Octreotide. The drug most commonly used to treat carcinoid tumors is octreotide (Sandostatin). This drug is similar to a hormone that occurs naturally in the body. It can help relieve the flushing and diarrhea caused by carcinoid syndrome, and slow tumor growth.
  • Interferons.Interferon drugs can help reduce the symptoms of carcinoid syndrome and may help slow the growth of carcinoid tumors. But interferons can have severe side effects, so they may not be helpful for all people.
  • Antihistamines. Some antihistamine drugs can help ease the symptoms of carcinoid syndrome, but they do not stop tumor growth.

Researchers are also looking at other drugs to help slow or stop the growth of carcinoid tumors. "There are a few drugs currently going through clinical trials or awaiting FDA approval," says James Yao MD, associate professor and deputy chair of the Department of Oncology at the University of Texas MD Anderson Cancer Center in Houston. "So we are hoping to have more options for drug treatment in the future."

Ablation is a way to destroy or shrink the tumor by injecting it directly with a substance that will kill it. It is often used for tumors that have spread to the liver, when surgery isn't possible because of their size, location, or number of tumors. There are a few different kinds of ablation.

  • Cryotherapy (cryoablation). This method involves injecting liquid nitrogen into the tumor to kill the cells by freezing them.
  • Percutaneous ethanol injection. This method uses concentrated alcohol to kill the tumor.
  • Radiofrequency ablation. This method uses high-energy radio waves to destroy the tumor.

Chemotherapy uses drugs to help kill cancer cells. These drugs may be injected or taken by mouth. Doctors may use one drug or a combination of drugs. Because these drugs can also harm some normal cells, they can often cause side effects. Some common side effects may include hair loss, fatigue, and nausea and vomiting. Most of the side effects go away after treatment is done. In some cases, medicines can help prevent or control certain side effects, such as nausea and vomiting.

Unfortunately, chemotherapy doesn't always work well against carcinoid tumors.

"Chemotherapy is usually only used for certain types of carcinoid tumors, such as those in the pancreas," says Yao. "It has not been as effective for tumors in other areas."

Sometimes, however, doctors recommend chemotherapy when the tumors are causing severe symptoms, have spread, or other treatments have not worked. Chemo may help prevent the tumor from growing or spreading further.

Chemotherapy can also be helpful in treating tumors that have spread to the liver. In some cases, chemotherapy drugs may be injected directly into the artery that supplies blood to the liver. This gives the tumor a high dose of chemotherapy without exposing the chemotherapy to the rest of the body. In some cases, a substance that plugs up the artery may also be injected along with the chemotherapy. This starves the tumor of oxygen and nutrients and can help kill it.

Radiation therapy is a treatment using high-energy rays to kill cancer cells. It is used to treat many different kinds of cancer. "Radiation therapy isn't really effective for this type of tumor," says Yao. But radiation can help to treat pain if the cancer has spread to the bones. And in some cases, radiation may be more effective when used in combination with other types of treatment.

There are a number of new treatments that may also be helpful in treating carcinoid tumors. New types of drugs, called targeted therapies, are already being used for other types of cancer. Doctors are just beginning to use them to treat carcinoid tumors. "These new drugs can target specific cancer cells more accurately than other drugs, and they're not as harsh as chemotherapy," says Warner.

Researchers are also looking at a new type of radiation, called radiopharmaceuticals. This treatment uses a drug that is attracted to carcinoid tumors. This drug is then attached to a radioactive substance and injected into the body. Once the drug reaches the tumor, it gives off radiation that kills the tumor cells.

In rare cases, an organ transplant may be an option when the carcinoid tumor has spread to the liver. During the transplant, the whole liver is removed and a liver from a donor is put in its place. "While liver transplant is certainly not standard treatment, it can be a benefit for certain patients," says Yao.

Recent advancements in treatments have helped improve the prognosis for patients with carcinoid cancer, even for those with more advanced tumors. Today, people often live for 10 to 15 years with this cancer.

"We've developed many new treatments in the last 10 years," says Warner. "So we're now able to offer a wider variety of treatments for tumors that cannot be surgically removed."