Treatment for large bowel and rectal neuroendocrine cancer

What are large bowel and rectal neuroendocrine cancers?

Large bowel and rectal neuroendocrine cancers are rare cancers that develop in the ​large bowel (colon) or ​back passage (rectum).   

Read more about the difference between NETs and NECs

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

• where the cancer is in your large bowel or rectum

• the type of neuroendocrine cancer

• whether it has spread (stage)

• how fast the cells are growing (the grade)

• the symptoms you have

• your general health and fitness

You are likely to have a clinical nurse specialist (or CNS). They go to the MDT meetings. They can help answer your questions and support you. They are often your main point of contact throughout your treatment.

Read about grades, stages and types of large bowel and rectal neuroendocrine cancer

Types of treatment for large bowel and rectal neuroendocrine cancer

The main treatment for large bowel and rectal neuroendocrine cancer is surgery. Surgery might be all the treatment you need if your cancer hasn’t spread.

You might need more than one operation. This depends on whether the surgeon removes all the cancer in your first operation. It also depends on other test results such as the grade and ​stage​ of your cancer. Grade refers to how fast or slow your cancer is growing.

The treatment options depend on whether you have a NET or a NEC.

Other treatments for large bowel and rectal NETs include:

• ​somatostatin analogues​

• ​chemotherapy​

• ​targeted cancer drugs​

• a radioisotope therapy called peptide receptor radionuclide therapy (PRRT)

• surgery or other treatments for cancer that has spread to your liver

For large bowel and rectal NECs you might have:

• surgery

• chemotherapy

• ​radiotherapy​

• treatment for cancer that has spread to your liver

Read about treatment options for neuroendocrine cancer

Further down this page we include some information about cancer drugs. You can read about these and their side effects by selecting the drug name from our A-Z list below.

Go to our A - Z list of cancer drugs to read more about the drug treatments

Removing cancer by endoscopy or surgery

There are different ways to remove the cancer. The procedure or operation you have depends on several factors. These include:

• where the cancer is in your bowel

• the size of your cancer

• the grade of your cancer 

Your surgeon might be able to remove the cancer using a ​colonoscope. This is called an endoscopic resection.

Or you might have a larger operation to remove a section of your bowel or rectum. There are different types of surgery. The surgeon might remove:

• part of your bowel - a colectomy

• a small part of your rectum - a trans anal endoscopic microsurgery (TEMs)

• a section of the rectum - a total mesorectal excision (TME)

For some operations, you might need to have a type of stoma called a colostomy. It might be temporary. This means you may have another operation a few months later to join the ends of the bowel back together. This is called a stoma reversal.

Read more about having a colostomy in the bowel cancer section

Other treatments for large bowel and rectal neuroendocrine tumours (NETs)

The following treatments might be options for large bowel and rectal NETs. The treatment for neuroendocrine carcinomas (NECs) is different. We have more information about NEC treatment further down the page.

You might have treatments to help with symptoms if:

• you can’t have surgery to remove the NET

• the NET has spread to another part of the body

• the NET came back after the initial treatment

These treatments can control your symptoms and help you feel better but won’t get rid of the neuroendocrine cancer. 

There are a number of different treatment options:

• somatostatin analogues - drugs include octreotide and lanreotide

• peptide receptor radionuclide therapy (PRRT) - this uses a radioactive medicine to treat the NET

• chemotherapy  – drugs include temozolomide, fluorouracil, capecitabine and streptozotocin

• a targeted cancer drug called everolimus 

For cancer that has spread to your liver you might have:

• trans arterial embolisation (TAE) to cancer in your liver

• radiofrequency ablation 

• surgery to remove cancer from your liver

• a liver transplant – this is a rare treatment for NETs

Read about the different treatments for neuroendocrine cancer

Treatment for large bowel and rectal neuroendocrine carcinomas (NECs)

Treatment depends on your individual situation. Unfortunately, large bowel and rectal NECs are harder to treat than large bowel and rectal NETs. This is because these cancers are faster growing and more likely to spread.

You might have surgery if your cancer hasn’t spread. You can read about different types of surgery higher up this page.

You usually also have chemotherapy treatment as well as surgery. You might have this:

• before surgery – this is called neoadjuvant chemotherapy

• after surgery – this is called adjuvant chemotherapy

You have chemotherapy on its own or combined with radiotherapy. This is called chemoradiotherapy.

Chemotherapy drugs include:

• carboplatin or cisplatin

• etoposide

• irinotecan

Read more about neuroendocrine carcinoma (NEC) and treatment

Follow up for large bowel and rectal neuroendocrine cancers

You might have follow up appointments every few months after treatment. For some people, the appointments might be less often than this.

This is to check how you are and see whether you have any problems or worries. The appointments also give you the chance to raise any concerns you have about your progress.

How often you see your doctor depends on:

• the grade of the large bowel or rectal neuroendocrine cancer

• whether it has spread to other parts of the body

You might also have tests on some visits. The tests might include:

• colonoscopy

• a ​CT scan​ or ​MRI scan​

• a blood test to check for the amount of ​chromogranin A (CgA)

• ​endoscopic ultrasound (EUS)

Read more about follow up

Research and 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 to look at different combinations of existing treatments.

Find out about the latest UK research into neuroendocrine cancer

Coping with neuroendocrine cancer

You might have physical changes to your body because of your cancer or the treatment. These changes can be hard to cope with and can affect the way you feel about yourself. It can help to talk to friends and family. Or join a support group to meet people in a similar situation.

We have a discussion forum called Cancer Chat. It is a place for anyone affected by cancer. You can share experiences, stories and information with other people with cancer.

Visit Cancer Chat

You might need practical advice about benefits or financial help. There is help and support available. There are also organisations to support and provide information to people affected by neuroendocrine cancer.

We have information about living and coping with a neuroendocrine cancer