How are NETs treated?

A team of specialists (multidisciplinary team, or MDT) will recommend the best treatment or combination of treatments for you, based on:

• Where the tumour is and its size
• If it has spread and where it has spread
• How fast the cancer cells are growing
• Your symptoms
• Whether or not the tumour is producing hormones (functional or non-functional)
• Your general health

Active surveillance

If your NET is not causing you problems, you may not start treatment straight away. Instead your medical team will monitor your cancer closely with tests such as scans and blood tests. You can start treatment if the cancer starts to grow, spread or cause problems. 

Active surveillance means you can avoid or delay unneccesary treatment and treatment side-effects that can affect your quality of life. 

You might feel anxious about not having any treatment. We have information on having active surveillance and managing anxiety.

Surgery

Removing some or all of the tumour. For early-stage tumours, surgery may cure the disease.  Surgery can also be used to relieve symptoms of later-stage NETs. There are many different types of surgery, depending on the type of NET and where it is. Read more about surgery for NETs.

Drug treatments

Somatostatin analogues

Drugs that can lower the amount of hormones produced by some types of NET. This can reduce symptoms caused by the hormones, such as diarrhoea and hot, flushing skin. They can also control the growth of some types of NETs.

Examples of somatostatin analogue drugs are lanreotide and octreotide. These drugs are given by injection, usually once a month. Your GP or practice nurse will give you the injection. Patients or carers can also be shown how to do it. You will stay on these drugs as long as they continue to control your tumour and your symptoms.

Follow the advice from your NET team about how to take and store your medicines correctly. You should also check the information leaflet that comes with your medicine. Ask your NET team if you have any questions.

Chemotherapy

Chemotherapy drugs may be given for some fast growing (poorly-differentiated) NETs or for cancer that has spread. You may also have chemotherapy after surgery, to reduce the risk of the cancer coming back or spreading, depending on the drug. You may have chemotherapy along with other treatments. Read more about chemotherapy.

Targeted therapy drugs

These drugs target certain parts of cancer cells that make them different from normal cells.  They can block substances that help the cancer to grow or stops the blood supply to the tumour. They are usually used to control cancer that has spread. 

They may be used for treatment of advanced NETs of the GI tract, lung and pancreas when surgery can’t be done, and the cancer continues to grow and spread. Examples of targeted therapy drugs used for some type of NETs are sunitinib (Sutent) and everolimus (Afinitor). They are taken as pills. Some targeted therapy drugs are given into a vein through a drip. Read more about targeted therapies.

Supportive drugs

These are drugs that help to improve or prevent side-effects such as diarrhoea, high blood pressure, fast or irregular heart rate and high levels of certain hormones.

Liver directed therapy

Liver directed therapy is often used to treat NETs that have spread to the liver. It is mainly used when surgery can’t be done, to control symptoms and the growth of the cancer in the liver.

Liver directed therapy works by slowing or blocking the blood supply to the tumour. 

Hepatic arterial embolisation (HAE)

HAE blocks or slows the blood supply to the tumour by injecting tiny particles called microspheres into the main blood vessel to the liver (hepatic artery). 

The microspheres are passed into the artery through a thin catheter tube. Without a blood supply, the tumour will shrink or die.

This procedure is done with a local anaesthetic and sedation. You should be able to go home once the sedation has worn off.

Transcatheter arterial chemoembolisation (TACE)

This is similar to HAE, but chemotherapy drugs are injected into the artery during the embolisation procedure. You will probably stay in hospital after TACE.
 

Radiofrequency ablation (RFA) 

RFA uses heat to destroy cancer cells. 

Read more about ablation treatments

Peptide receptor radionuclide therapy (PRRT)

PRRT is a type of internal radiotherapy. PRRT may be used for NETs that have spread. PRRT will only be considered if you have receptors on your cancer cells that allow them to be targeted by the radiation. 

A radioactive substance is put into your bloodstream through a drip. Most patients have 4 treatments (infusions), about 8 weeks apart. The time between treatments may be longer, depending on how you are responding to treatment and availability of treatment. You will usually stay overnight in hospital for the first infusion. For the remaining 3 infusions you may stay in hospital overnight or go home the same day.

You will be checked at the PRRT clinic in between treatments. You will have a scan to check the amount of radioactivity delivered to certain organs. Your bloods will also be checked regularly, to make sure you are well enough to have the next infusion.

More information on PRRT

External beam radiotherapy

External beam radiotherapy may be used to control symptoms such as bone pain, to help you feel better. With external beam radiotherapy, the radiation comes from machines which aim rays directly at your tumour or the tumour site.


For symptom relief (palliative radiotherapy), you will usually only need a short course of radiotherapy. You may have a single dose or a dose divided into a few sessions.
 

Read more about external radiotherapy.

Clinical trials

Clinical trials are research studies that try to find new or better ways of treating cancer or reducing side-effects. Ask your consultant if there are any trials suitable for you. Read more about clinical trials.

Will I get side-effects from treatment?

The type of side-effects you get will depend on the type of treatment, the dose, the duration and your own general health.

Your doctor or nurse will discuss any possible side-effects with you before your treatment. Some treatments may cause nausea, vomiting, diarrhoea, constipation, loss of appetite and hair loss. A lot of treatments cause fatigue. Read more about Coping with side-effects and symptoms