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

Active surveillance

If the cancer is very slow growing, 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. You might feel anxious about not having any treatment. We have information on having active surveillance and managing anxiety.

Surgery

Surgery is the main treatment for most NETs. There are different types of surgery, depending on where the cancer is. If the cancer hasn’t spread, surgery will aim to cure it. Surgery can also be used to relieve symptoms. Read more about surgery for NETs.

Drug treatments

Somatostatin analogues

These drugs can lower the amount of hormones produced by some types of NET. They can help to treat the symptoms of carcinoid syndrome, such as diarrhoea and hot, flushing skin. They can also help to reduce the risk of heart problems caused by some NETs (carcinoid heart disease) or to control them. They can also be used to control advanced or metastatic cancer. They are usually given by injection.

Chemotherapy

Chemotherapy drugs may be given for fast growing (poorly differentiated) NETs or for cancer that has spread. Usually you will have a combination of different drugs, depending on the type of tumour. Chemotherapy may be given as an infusion into a vein or as tablets that you take at home, depending on the drug. You may have chemotherapy along with other treatments. Read more about chemotherapy.

Targeted therapies

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. It 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. 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.

Radiotherapy

Radiotherapy is sometimes used for NETs that have spread. For NETs, radiotherapy usually involves a type of internal radiotherapy called targeted radiotherapy (or radionuclide treatment). A radioactive substance is put into your bloodstream through a drip.

External beam radiotherapy may be used to control symptoms such as bone pain, to help you feel better. Read more about external radiotherapy.

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.

Hepatic arterial embolisation blocks or slows the blood supply to the tumour by injecting material into the main blood vessel to the liver (hepatic artery). Sometimes chemotherapy drugs are injected into the artery during the embolisation procedure. This is called chemoembolisation.

Radiofrequency ablation (RFA) uses heat to destroy cancer cells. Read more about ablation treatments

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