Neuroendocrine tumour (NET) treatment

The aim of surgery for early-stage NETs is to cure the cancer. If the cancer has spread, removing part of the tumour will help reduce symptoms and the risk of bowel obstruction in small bowel NETs.

Surgery usually involves removing the tumour and some healthy tissue around it to ensure the tumour is completely removed. The type of operation depends on the size of the tumour and where it is. Surgery for pancreatic NETs is the same as for other types of pancreatic cancer.

See pancreatic cancer treatment.

Side effects of NET surgery may include changes to bowel movements, pain and discomfort, fatigue, a higher risk of infection, scarring, and temporary or permanent damage to nearby organs. Talk to your treatment team about how these can be managed.

Learn more about surgery.

Also known as radiotherapy, radiation therapy uses a controlled dose of radiation to kill or damage cancer cells. In external beam radiation therapy (EBRT), the radiation comes from a large machine. You will lie on a treatment table underneath the machine, and you will not see or feel the radiation.

Radiation therapy can shrink the cancer. This may help to relieve symptoms such as pain.

Learn more about radiation therapy.

A type of radiation therapy called peptide receptor radionuclide therapy (PRRT) may be used for people with NETs whose tumours have a positive somatostatin receptor. PRRT involves injecting a protein (peptide) mixed with a small amount of radioactive substance (radionuclide). This targets cancer cells and delivers a high dose of radiation to kill or damage them.

You may have a dose of chemotherapy in tablet form before PRRT as a combined treatment. The most common form of PRRT is ¹⁷⁷Lu-Dota-octreotate (LuTate) therapy.

PRRT is available only at specialised treatment centres in each state, usually in major cities. It may also be available through clinical trials.

NETs, particularly types that affect the GI system and the pancreas, often spread to the liver. These tumours are called metastases. Radionuclide therapy or chemotherapy will also treat tumours in the liver. The choice of treatment depends on a number of factors, including where the tumours have spread. Other treatments to control NETs in the liver may include:

Radiofrequency ablation (RFA) and microwave ablation

Guided by an ultrasound or CT scan, a needle is inserted through the abdomen into the liver tumour. The needle sends out radio waves or microwaves that produce heat and destroy the cancer cells.

Transarterial chemoembolisation (TACE)

In this procedure, a catheter is inserted into the hepatic artery, which supplies blood to the liver. A chemotherapy drug together with tiny particles (called microspheres) are released into the artery, which blocks the flow of blood into the tumour. This may cause the tumour to shrink. TACE is performed by an interventional radiologist. Sometimes the injection uses microspheres alone. This is called transarterial embolisation (TAE) or hepatic artery embolisation (HAE).

Selective internal radiation therapy (SIRT)

Also known as radioembolisation, SIRT is done by an interventional radiologist. The radiologist inserts a catheter into the main artery of the liver and then delivers tiny radioactive beads to the liver through the catheter. The beads give a direct dose of radiation to the tumour.

Also known as systemic therapy, the most common forms of drug therapies for NETs are:

Somatostatin analogues (SSAs) – Somatostatin is a hormone produced by the body. SSAs are medicines that act like this hormone and help slow down or prevent tumour growth. They are usually given as monthly injections.

Targeted therapy – These drugs attack specific molecules within cells and work by blocking cell growth. They are given in capsules that you swallow. People with advanced pancreatic NETs may be offered targeted therapy drugs such as sunitinib and everolimus. Everolimus may also be used to treat advanced GI and lung NETs.

Learn more about targeted therapy.

Chemotherapy – Chemotherapy uses drugs to kill or slow the growth of cancer cells. People with pancreatic, bronchial or high-grade NETs may have one chemotherapy drug, or a combination of drugs and other treatments such as surgery.

Chemotherapy is given through a drip into a vein (intravenously) or as a tablet that is swallowed (oral chemotherapy).

Learn more about chemotherapy or call 13 11 20.

Your doctor or nurse may suggest you take part in a clinical trial. Doctors run clinical trials to test new or modified treatments and ways of diagnosing disease to see if they are better than current methods.

For example, if you join a randomised trial for a new treatment, you will be chosen at random to receive either the best existing treatment or the modified new treatment. Over the years, trials have improved treatments and led to better outcomes for people diagnosed with cancer.

You may find it helpful to talk to your specialist, clinical trials nurse or GP, or to get a second opinion. If you decide to take part in a clinical trial, you can withdraw at any time.

For more information, see Clinical trials and research. To find current clinical trials near you, visit Cancer Institute NSW or Australian Cancer Trials.