The treatment of lung carcinoid tumors depends to a large extent on the type (typical versus atypical) and extent of the cancer. Other factors, such as a person's overall health and ability to withstand surgery, are also important.
Many doctors describe the extent of these cancers using the TNM staging system (see the section called "How are lung carcinoid tumors staged?"). But for treatment purposes most doctors divide these tumors into localized cancers and metastatic cancers.
Localized carcinoid tumors
Localized carcinoid tumors haven't spread beyond where they started. In the TNM staging system, this includes stages I, II, and some stage III cancers.
These cancers are treated with surgery whenever possible. The extent of the surgery depends on the size and location of the cancer. Nearby lymph nodes are typically removed as well, especially if you have an atypical carcinoid.
Most patients with localized lung carcinoid tumors are cured with surgery alone and don't need other treatments. Some experts recommend additional treatment for people with an atypical carcinoid that has spread to lymph nodes. This can be chemotherapy, radiation therapy or both. But it's not clear if the added therapy helps people live longer.
For people with localized cancers who can't have surgery, most doctors recommend radiation therapy for typical carcinoids and chemotherapy and radiation therapy for atypical carcinoids.
Metastatic carcinoid tumors
The treatment of a metastatic carcinoid tumor depends on where the cancer is and whether you have symptoms of the carcinoid syndrome. In general, it is a slow-growing cancer, and chemotherapy has not proven very successful. If you have only a small number of tumors that can be removed, surgery (on both the lung and at the site of metastasis) is your best option.
Lung carcinoid tumors usually spread to the liver first. If the carcinoid has spread only to your liver but can't be removed there with standard surgery, another option might be to have a liver transplant. This is a very involved operation that most doctors still consider experimental. It is done at only a few transplant centers.
If the carcinoid is in your liver and is causing symptoms, a procedure called hepatic artery embolization may be helpful. It may relieve symptoms or slow the growth of the cancer, but it is very unlikely to result in a cure. Ablative techniques may also be helpful. (These treatments were discussed in detail in the section called "Surgery.")
If your liver cannot be treated directly, or if the carcinoid has spread to other parts of your body, then drug therapy can be helpful. The most useful are octreotide or lanreotide, which can slow the growth of the cancer and stop the secretion of the chemicals that cause the carcinoid syndrome. In some cases, they can sometimes actually shrink the cancers. Another drug, interferon alfa, can act the same way. Sometimes these 2 types of drugs are given together. Adding chemotherapy may also help reduce symptoms, but it seldom shrinks the tumor very much more.
External radiation therapy can be used to relieve symptoms caused by tumors such as bone pain. For more widespread disease, radioactive drugs may be helpful.
Recurrent carcinoid tumors
When cancer comes back after treatment, it is called a recurrence. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the liver or bone). Some carcinoid tumors come back, sometimes several years after the initial treatment. If this happens, further treatment options depend on where the cancer is and what treatments have already been used. Cancers that recur locally or in only 1 or 2 areas can sometimes be treated with further surgery. If surgery is not an option, radiation therapy, chemotherapy, or other drugs may be tried. Because recurrent cancers can often be hard to treat, clinical trials of new types of treatment may be a good option.
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