Carcinoid Tumors

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Carcinoid Treatment

Surgical removal (resection) of the tumor is the preferred method of treatment for carcinoid tumors. If the entire tumor cannot be removed, carcinoid treatment may include removing as much of the tumor as possible (debulking), chemotherapy, biological therapy, and radiation therapy. In cases of disease that has spread (i.e., metastatic cancer), chemotherapy and/or radiation may be used to relieve symptoms (called palliative treatment).

Surgery
Surgery to treat carcinoid tumors depends on the size and location of the tumor and whether or not the tumor has metastasized. Surgical options may include removal of the tumor (local excision), removal of the tumor and part of the organ (resection), removal of the tumor using electric current (fulguration), or removal of the tumor by freezing the tissue (cryosurgery).

Surgical procedures include the following:

• Removal of all or part of the stomach (gastrectomy)
• Removal of the appendix and part of the colon (hemicolectomy)
• Removal of part of the colon (partial cecectomy)
• Removal of part of the liver (partial hepatectomy)
• Removal of the appendix (simple appendectomy)

Carcinoid tumors that have metastasized to the liver may be treated using hepatic artery ligation or hepatic artery embolization. Hepatic artery ligation involves cutting and tying off the main artery that supplies blood to the liver (i.e., the hepatic artery) to slow tumor growth. Hepatic artery embolization uses drugs or radiation to reduce or block the flow of blood to the liver and destroy cancer cells.

Palliative Treatment for Carcinoid Tumors
Treatment used to relieve symptoms (palliative treatment) for carcinoid tumors may include chemotherapy, biological therapy, and radiation.

Chemotherapy involves using drugs to destroy cancer cells. Chemotherapy drugs may be used alone, or in combination, and are usually administered through an IV (intravenously). Chemotherapy relieves symptoms in less than 30% of cases of metastatic carcinoid tumors, usually for less than 1 year. Drugs that may be used include the following:

• Cisplatin (Platinol®)
• Dacarbazine (DTIC®)
• Doxorubicin (Doxil®)
• Etoposide (Vepesid®, Toposar®)
• 5-fluorouracil (Adrucil®, Efudex®)

Chemotherapy may cause severe side effects such as fatigue, hair loss, nausea vomiting, and low blood counts (e.g., anemia, neutropenia, thrombocytopenia).

Biological therapy, also called immunotherapy, involves using the body's immune system to fight cancer. It reduces the size of carcinoid tumors in as many as 17% of patients and may slow the growth of metastatic tumors and prolong survival. Biological agents that are used include somatostatin analogues (e.g., octreotide [Sandostatin®], lanreotide) and interferon (Roferon®).

Biological agents usually are administered via injection and side effects include cough, headache, low blood count (e.g., anemia, neutropenia), and weakness.

Radiation therapy involves using high-energy x-rays to destroy cancer cells and shrink tumors. Radiation may come from a machine outside the body (called external beam radiation) or from radioactive "seeds" placed into the body (called brachytherapy or internal radiation therapy).

Side effects of radiation include fatigue, swelling (edema), and skin irritations.

Other types of palliative treatment include the following:

• Antidiarrheal agents (e.g., loperamide [Imodium®], diphenoxylate [Motofen®, Lomotil®])
• Avoiding situations and substances that provoke flushing (e.g., stress, alcohol)
• Diuretics (to treat symptoms of heart damage)
• Oral bronchodilators (to treat wheezing)
• Serotonin receptor antagonists (to treat persistent symptoms of carcinoid syndrome)

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