A group of physicians and practitioners, known as a multidisciplinary team (MDT), discuss with one another regarding the therapy that best suits a patient with a carcinoid tumor and the related pros and cons. The therapeutic decision mainly depends on the site of the primary carcinoid, the advancement of the tumor to other regions, the size and shape of the cancer cell (identified using a microscope), and the symptoms that are experienced by the patient.
The physician should inform the patient about the medications, including their benefits and side effects. A carcinoid specialist nurse takes care of the patient who attends MDT meetings, helps them in finding a solution to the health-related issues, and supports them. They can be approached any time until the treatment is completed.
Types of Treatments
Physicians use many kinds of medications to treat carcinoid tumors. Carcinoid tumors progress at different rates, but mostly they develop gradually and not show their existence for months or years, in which case the growth of the tumor may be tracked through routine scans.
The following are the combination of treatments usually required by the patients:
Patients suffering from liver carcinoid tumors may undergo radiofrequency ablation or hepatic artery embolization treatment.
Somatostatin analogues: Drugs such as octreotide and lanreotid are somatostatin analogues that are used frequently for carcinoid tumor treatment. These drugs are proteins that help to reduce the secretion of the hormones by the tumor. In many patients, these medications are effective in regulating carcinoid tumors and their symptoms.
Interferon: A drug called interferon is used to enhance the body's immune response to act upon the cancer cells. It is administered to a patient provided that the tumor extends to other portions of the body. This drug regulates the symptoms and reduces the growth rate of the tumor cells. It is usually given as a single drug or in combination with somatostatin analogue drugs.
Radiation therapy employs highly intensive rays to destroy the cancer cells. Several methods can be used to cure carcinoid tumors.
Targeted radionuclide therapy
If surgery is not possible or the tumor has developed and extended to other organs, causing symptoms, then the patient usually needs to undergo targeted radionuclide procedure. It is a targeted treatment where the radiation is directed precisely toward the cancer cells that are present in many parts of the body. It has a very meager reaction in other healthy cells.
In targeted radiotherapy, radioactive iodine is chemically attached to MIBG. The cancer cells take in MIBG and are destroyed by the radiation from the radioactive iodine. This type of treatment is possible only when the tumor cells readily absorb MIBG.
The other approach to targeted radionuclide treatment is called selective internal radiotherapy (SIRT); it uses microscopic beads polished with a radioactive material called yttrium-90 to target the tumor cells. These radioactive beads are infused into the blood vessels that supply blood to the cancer cells in the liver. The blood vessels get obstructed by the beads and the rays from the radioactive element cause death of the cancer cells.
Chemotherapy drugs are used to treat certain cancers. The drugs are infused into the bloodstream and circulate to all parts of the body. In the case of rapidly spreading cancers, chemotherapy is the most effective and the best approach because it has a broad spectrum of action. However, this also means that associated side effects may present in any area of the body.
Chemotherapy is highly recommended for patients suffering from pancreatic cancers such as pancreatic neuroendocrine tumors. Often, two or three drugs are combined and provided to the patient in chemotherapy.
In the case of gastrointestinal (GI) tumors, surgical excision is the best method to remove the cancer-affected parts.
Local excision: The physician usually excises the tumor and the surrounding normal tissue during surgery. All the local tumors are removed through an incision in the skin, and in the case of rectal tumor, it is removed through the anus. Endoscope is also used to remove the tumor in the case of GI carcinoid cancer.
Electrofulguration or radiofrequency ablation (RFA): RFA, also known as electrofulguration, makes use of the heat generated by the electric current to eradicate the tumor. This method is frequently suggested for rectal carcinoid tumors.
Abdominoperineal resection: It is used to remove huge mass of cancer in the lower portion of the rectum. The physician excises the parts affected by tumor such as the anus, rectum, and portion of the colon. After the removal of the affected colon, a surgical procedure called colostomy is performed wherein the healthy part of the colon is attached to the opening made in the abdominal wall to excrete the waste out of the body.
Hepatic artery embolization: When the tumors present in the liver are difficult to remove by surgery, they can be treated by hepatic artery embolization. It involves blocking the blood supply to the cancer cells which causes the cells to perish. Also, when chemotherapy is simultaneously administered into the liver, this method is termed as chemoembolization.
Reviewed by Yolanda Smith, BPharm