Neuroendocrine Tumor Treatment Options
Advances in the understanding of neuroendocrine tumors (NETs) have expanded the range of treatment options available to patients. Because these cancers are rare and can vary significantly in how they grow and behave, treatment is highly individualized. The best approach depends on several factors, including the tumor type, location, and severity.
At Compass Oncology, our specialists develop personalized treatment plans based on your cancer's unique characteristics and overall health. We take time to explain your diagnosis, discuss your options, and help you make informed decisions about your care.
There is no one-size-fits-all approach to treating neuroendocrine tumors. As your needs change, we will adjust your plan to help you achieve the best possible outcome.
Factors That Impact Your Neuroendocrine Tumor Treatment Plan
Before recommending treatment, your oncologist will carefully evaluate several aspects of your diagnosis to determine what therapies may be the most effective.
Location of NET tumors in the body
Neuroendocrine tumors can develop in many different organs, most commonly the gastrointestinal tract, lungs, and pancreas. The location of the primary tumor influences the symptoms you may experience, the likelihood of hormone production, and the available treatment options. Some NETs can be treated with surgery, while others may respond better to approaches such as chemotherapy, targeted therapy, or radiation therapy. Understanding where the tumor originated is an important step when creating an effective treatment plan.
NETs Grade
The grade of a NET describes how abnormal the cancer cells appear under a microscope and how quickly they may grow. Well-differentiated, low-grade tumors typically grow slower and generally respond well to treatment. Poorly-differentiated tumors are often more aggressive and may require advanced therapies. Determining the tumor grade helps your oncologist select treatments most likely to be effective. If a certain treatment isn’t working as expected, your oncologist may recommend other options.
Presence of Symptoms
Symptoms are another important consideration when developing a treatment plan. Some patients may have few or no symptoms, while others might experience stomach-related issues due to the overproduction of hormones. Many of these symptoms can sometimes be misdiagnosed as other illnesses. It’s essential to discuss all of your symptoms with your oncologist, even if they seem unrelated to one another, to receive a proper diagnosis and treatment plan.
Types of Treatment for Neuroendocrine Tumors
Neuroendocrine tumors are often diagnosed after they have spread (metastasized) to other areas of the body. Even when this occurs, treatment can often successfully manage the disease for years. Because NETs tend to grow slowly, patients typically have multiple treatment options available.
NET treatment generally falls into two categories: systemic and local treatments. Your treatment plan may include one therapy or a combination of several approaches, including:
Active Surveillance (Watchful Waiting)
Not every neuroendocrine tumor requires immediate treatment. If detected early, some slow-growing NETs may be safely monitored through active surveillance or watchful waiting.
During active surveillance, your oncology team will closely monitor the tumor through regular office visits, blood work, imaging, and other tests. Treatment begins only if the tumor shows signs of growth or begins to cause symptoms.
Surgery
When possible, surgery is often the preferred treatment approach for neuroendocrine tumors. The type of surgery depends on the size and location of the tumor, and whether the cancer has spread. Even if the tumor can only be partially, rather than fully, removed, surgery may still help relieve symptoms, prevent problems, and even slow tumor progression.
Liver-Directed Therapy
The liver is one of the most common sites where neuroendocrine tumors spread. When cancer spreads to the liver, liver-directed therapies may help.
Several advanced liver-directed techniques may be recommended, including:
- Bland embolization, which uses oil, gelatin, or other small particles to block the blood supply that feeds liver tumors
- Chemoembolization, which combines embolization with chemotherapy delivered directly to the tumor
- Radioembolization, which delivers radioactive particles to the tumor through the bloodstream
Hormonal Therapy–Somatostatin Analogs (SSAS)
Biotherapy using somatostatin analogs (SSAS) is a standard treatment for managing symptoms of neuroendocrine tumors. It has also been shown to slow tumor growth. Biotherapy is a type of treatment that uses materials derived from living organisms to treat the disease. There are two types of SSAS available:
- Octreotide: This medication is available in both short-acting and long-acting doses. The short-acting version provides immediate relief that lasts 4 to 6 hours and must be given 2 to 4 times a day. This option may be more suitable for managing flare-up symptoms.
- Lanreotide: This medication is available only in a long-acting dose. Long-acting medications are ideal for managing chronic symptoms that are more regular and persistent.
Chemotherapy
Chemotherapy is often recommended for more aggressive (fast-growing) NETs, which are sometimes referred to as neuroendocrine carcinomas. Chemotherapy may also be considered for pancreatic neuroendocrine tumors. Depending on your treatment plan, these medications may be given either orally or through an IV.
Your oncologist may suggest chemotherapy if:
- The tumor is growing rapidly
- There is a likelihood of recurrence
- The cancer has spread to other organs
- Surgery is not an option
- Symptoms are severe and hard to control
- Other treatments have not been effective
Targeted Therapy for Neuroendocrine Tumors
Targeted therapy is designed to specifically attack the genes or proteins that help cancer cells grow and spread. Unlike traditional chemotherapy, which can affect both cancerous and healthy cells, targeted therapies focus on characteristics unique to the tumor, while limiting damage to surrounding healthy tissues.
Before recommending targeted therapy, your oncologist may perform biomarker testing to identify specific genes or proteins in the tumor that may respond well to targeted therapy.
One example of a targeted therapy is Lutathera®. Lutathera is a radioisotope therapy used to treat cancers affecting neuroendocrine cells in the pancreas and parts of the stomach. This medication has been shown to slow or stop tumor growth. It works as a targeted radioactive therapy, delivering medication directly to the tumor while sparing healthy cells.
Immunotherapy for NETs
Immunotherapy is a type of biologic therapy that helps the immune system recognize and attack cancer cells. Depending on your diagnosis, your oncologist may use materials produced naturally by your body or in a research laboratory to strengthen your immune system. Once the immune system is strong enough, it can effectively fight cancer cells and reduce symptoms. One potential treatment for NETs is Interferon, which may also help in shrinking tumors.
Radiation Therapy
While radiation therapy is not the primary treatment for many neuroendocrine tumors, it may be used to alleviate pain or pressure associated with your cancer. This treatment is particularly effective for patients with pancreatic NETs that have spread to the bone. Radiation therapy can also be useful for treating tumors that have penetrated deeper into the body.
Typically, treatment involves using external beam radiation therapy (EBRT) daily on a set schedule over several weeks. Sometimes, radiation may be combined with other therapies like chemotherapy.
The side effects of radiation therapy are generally mild and can include fatigue, nausea, and redness in the treated area. Most patients report that these side effects subside after completing their treatment.
Clinical Trials for NETs
Clinical trials can be an option for NET patients. These trials connect with new and emerging treatment options. You may want to consider participating in a clinical trial if other treatments do not provide relief. Speak with your oncologist to learn more about clinical trials that may be available for NET patients at our clinics throughout Portland and Vancouver.
Find a Neuroendocrine Tumor Specialist
At Compass Oncology, we understand that there is no one-size-fits-all approach to treating NETs. If you or a loved one has recently been diagnosed with a neuroendocrine tumor, request an appointment with one of our specialists. We offer comprehensive care, including personalized treatment plans, second opinions, clinical trials, and supportive cancer care for patients in the Portland, OR, and Vancouver, WA, areas.
