Treatment for small bowel neuroendocrine tumours
The treatment you have depends on a number of things. This includes where the cancer started, its size and whether it has spread (the stage).
But surgery isn’t always possible. Some small bowel neuroendocrine tumours might have already started to spread when you are diagnosed. Or you might not be well enough to have it. You continue to have treatment to help your symptoms if surgery isn’t an option.
Deciding which treatment you need
A team of doctors and other professionals discuss the best treatment and care for you. They are called a neuroendocrine multidisciplinary team (MDT). The neuroendocrine MDT can talk to your doctors and recommend the best treatment options for you. This means that not everyone with a small bowel NET will need to travel to a neuroendocrine specialist hospital for treatment.
The treatment you have depends on:
- where the small bowel NET is and its size
- whether it has spread
- your general health
- any symptoms you are having
You might have a clinical nurse specialist (CNS). They go to the MDT meetings. They can help answer your questions and support you. And can be your main point of contact throughout your treatment.
Surgery
Surgery is the only treatment that can cure a small bowel neuroendocrine tumour. The type of surgery you have depends on the size of the tumour, where it is and whether it has spread to other parts of the body.
You might have surgery to remove all of the tumour or tumours. It is likely you will have open surgery. This means having a large cut in your tummy (abdomen). During the operation, your surgeon might also remove the nearby lymph nodes.
Some people might have keyhole surgery. Keyhole surgery is also called laparoscopic surgery. Surgeons use a laparoscope to do it. This is a narrow telescope that lights and magnifies the inside of your body, which your surgeon can see on a TV screen.
To do this type of surgery your surgeon makes a number of small cuts through your skin. They put the laparoscope and other small instruments through these to carry out the surgery.
Some people also have surgery to remove the bile duct. This aims to prevent gallstones developing later on.
If the small bowel NET has spread to the liver, you might be able to have the liver tumour removed at the same time you have the main surgery. Your surgeon might remove just the tumour, or part of the liver too.
How you will feel and how quickly you recover depends on the type of surgery you have. Your surgeon will be able to give you information about surgery and your recovery afterwards.
Treatments to help with symptoms
You might have treatments to help with symptoms before, during or after you have surgery. And you might have treatment to help with symptoms if:
- you can’t have surgery to remove the tumour
- the small bowel tumour has spread to another organ – such as the liver
- the cancer comes back after treatment
Treatments you might have include:
Somatostatin is a protein made naturally in the body. It does several things including slowing down the production of hormones. Somatostatin analogues are man made versions of somatostatin.
You may have somatostatin analogues to try to slow down the tumour and help with symptoms. They include:
- octreotide (Sandostatin)
- lanreotide (Somatuline)
Radiofrequency ablation uses heat made by radio waves to kill cancer cells. You might have this if the small bowel NET has spread to the liver.
Trans arterial embolisation aims to block the blood supply to a NET that has spread to the liver. The tumour can’t survive without a blood supply. Blocking the blood supply also stops the tumour releasing its hormones into the blood system. It’s also called hepatic artery embolisation.
Doctors might give a chemotherapy drug directly into the liver 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 tumour.
Laser therapy destroys the cancer cells in the liver by heating them to high temperatures. It is also called laser induced interstitial thermotherapy (LITT) or interstitial laser photocoagulation.
You might have a type of internal radiotherapy called peptide receptor radionuclide therapy (PRRT). Internal radiotherapy means having radiotherapy from inside the body.
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 and normally would slow down the production of hormones by the cell.
By attaching the radioactive substance to a man made form of the hormone somatostatin (a somatostatin analogue) it can deliver the radiotherapy directly inside the neuroendocrine cell and destroy it.
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.
You might have a type of targeted drug called everolimus.
Rarely, you might have a type of targeted cancer drug called interferon. Doctors might use interferon if somatostatin analogues are not helping your symptoms.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy is not often used as a treatment for small bowel NETs. But it can help some people with high grade tumours.
You might have chemotherapy if the NET continues to grow despite having other treatments. The chemotherapy drugs you might have include:
- streptozocin
- doxorubicin
- fluorouracil
- temozolomide
- capecitabine
Somatostatin analogues for carcinoid syndrome
Some neuroendocrine tumours release hormones that cause symptoms. Doctors call this collection of symptoms carcinoid syndrome. This is uncommon in small bowel NETs. But, it is more likely to happen if the tumour has spread to other parts of the body, especially the liver.
The symptoms of carcinoid syndrome include:
- flushing of the skin
- diarrhoea
- wheezing
- a fast heart beat
- dizziness due to sudden low blood pressure
Somatostatin analogues work by slowing down the production of hormones, particularly growth hormone and serotonin. Reducing these hormones helps to control the diarrhoea and skin flushing. They might also shrink the tumour.
Clinical trials
Doctors are always trying to improve treatments and reduce the side effects. As part of your treatment, your doctor might ask you to take part in a clinical trial. This might be to test a new treatment or look at different combinations of existing treatments.
