For many cancers it is important to know the stage of the cancer in order to plan treatment. However, the treatment of gastrointestinal carcinoid tumors is not based on the stage of the cancer. Treatment depends mainly on whether the tumor can be removed by surgery and if the tumor has spread.
Treatment is based on whether the tumor:
Four types of standard treatment are used:
- Can be completely removed by surgery.
- Has spread to other parts of the body.
- Has come back after treatment. The tumor may come back in the stomach or intestines or in other parts of the body.
- Has not gotten better with treatment.
Treatment of gastrointestinal carcinoid tumors usually includes surgery. One of the following surgical procedures may be used:
- Endoscopic resection: Surgery to remove a small tumor that is on the inside lining of the GI tract. An endoscope is inserted through the mouth and passed through the esophagus to the stomach and sometimes, the duodenum. An endoscope is a thin, tube-like instrument with a light, a lens for viewing, and a tool for removing tumor tissue.
- Local excision: Surgery to remove the tumor and a small amount of normal tissue around it.
- Resection: Surgery to remove part or all of the organ that contains cancer. Nearby lymph nodesmay also be removed.
- Cryosurgery: A treatment that uses an instrument to freeze and destroy carcinoid tumor tissue. This type of treatment is also called cryotherapy. The doctor may use ultrasound to guide the instrument.
- Radiofrequency ablation: The use of a special probe with tiny electrodes that release high-energy radio waves (similar to microwaves) that kill cancer cells. The probe may be inserted through the skin or through an incision (cut) in the abdomen.
- Liver transplant: Surgery to remove the whole liver and replace it with a healthy donated liver.
- Hepatic artery embolization: A procedure to embolize (block) the hepatic artery, which is the mainblood vessel that brings blood into the liver. Blocking the flow of blood to the liver helps kill cancer cells growing there.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactivesubstance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Radiopharmaceutical therapy is a type of radiation therapy. Radiation is given to the tumor using adrug that has a radioactive substance, such as iodine I 131, attached to it. The radioactive substance kills the tumor cells.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
Chemoembolization of the hepatic artery is a type of regional chemotherapy that may be used to treat a gastrointestinal carcinoid tumor that has spread to the liver. The anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug is mixed with a substance that embolizes (blocks) the artery, and cuts off blood flow to the tumor. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on the substance used to block the artery. The tumor is prevented from getting the oxygen and nutrients it needs to grow. The liver continues to receive blood from thehepatic portal vein, which carries blood from the stomach and intestine.
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Hormone therapy with a somatostatin analogue is a treatment that stops extra hormones from being made. GI carcinoid tumors are treated with octreotide or lanreotide which are injected under the skin or into the muscle. Octreotide and lanreotide may also have a small effect on stopping tumor growth.
Treatment for carcinoid syndrome may also be needed.
Treatment of carcinoid syndrome may include the following:
- Hormone therapy with a somatostatin analogue stops extra hormones from being made. Carcinoid syndrome is treated with octreotide or lanreotide to lessen flushing and diarrhea. Octreotide and lanreotide may also help slow tumor growth.
- Interferon therapy stimulates the body€™s immune system to work better and lessens flushing and diarrhea. Interferon may also help slow tumor growth.
- Taking medicine for diarrhea.
- Taking medicine for skin rashes.
- Taking medicine to breathe easier.
- Taking medicine before having anesthesia for a medical procedure.
Other ways to help treat carcinoid syndrome include avoiding things that cause flushing or difficulty breathing such as alcohol, nuts, certain cheeses and foods with capsaicin, such as chili peppers. Avoiding stressful situations and certain types of physical activity can also help treat carcinoid syndrome. For some patients with carcinoid heart syndrome, a heart valve replacement may be done.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Several types of targeted therapy are being studied in the treatment of GI carcinoid tumors.