- How are gastrointestinal carcinoid tumors treated?
- Surgery for gastrointestinal carcinoid tumors
- Chemotherapy for gastrointestinal carcinoid tumors
- Radiation therapy for gastrointestinal carcinoid tumors
- Clinical trials for gastrointestinal carcinoid tumors
- Complementary and alternative therapies for gastrointestinal carcinoid tumors
- Treatment of gastrointestinal carcinoid tumors by stage
- More treatment information about gastrointestinal carcinoid tumors
Chemotherapy for gastrointestinal carcinoid tumors
Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or a muscle or taken by mouth to kill cancer cells. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for some types of cancers that have spread to other organs.
Unfortunately, carcinoid tumors often do not respond well to chemo. Because of this, chemo generally is used only for tumors that have spread to other organs, are causing severe symptoms, and have not responded to other medicines.
Some of the chemo drugs used to treat GI carcinoid include:
- Capecitabine (Xeloda®)
- 5-fluorouracil (5-FU)
- Doxorubicin (Adriamycin®)
- Etoposide (VP-16)
- Dacarbazine (DTIC)
- Cyclophosphamide (Cytoxan®)
Some tumors, especially “high-grade” tumors, may be treated with more than one drug. For these, combinations of etoposide plus carboplatin or temozolomide plus capecitabine may be used.
Chemo drugs kill cancer cells but also damage some normal cells, which can cause some side effects. Side effects depend on the type of drugs, the amount taken, and the length of treatment. Short-term side effects might include:
- Nausea and vomiting
- Loss of appetite
- Hair loss
- Mouth sores
- Low blood counts
Because chemo can damage the blood-making cells of the bone marrow, you may have low blood cell counts. This can result in:
- Increased risk of infection (from too few white blood cells)
- Bleeding or bruising after minor cuts or injuries (from a shortage of blood platelets)
- Fatigue or shortness of breath (from too few red blood cells)
Most side effects go away a short time after treatment. Often medicines can help prevent or minimize many of the side effects. For example, your doctor can prescribe drugs to help prevent or reduce nausea and vomiting.
Intra-arterial therapy and chemoembolization
Normally, chemo drugs enter the bloodstream and can travel throughout the body. When carcinoid cancer has spread to the liver, it is sometimes treated by directly injecting the chemo drug into the hepatic artery, which supplies blood to parts of the liver. This exposes the liver tumors to high doses of the drug but limits exposing the rest of the body. This lets patients avoid severe side effects. Sometimes the chemo drug is injected together with a material that plugs up the artery (an approach called chemoembolization). When the arteries leading to them are blocked, the tumors become starved for nutrients and oxygen and many die off.
For more information on chemo, see the American Cancer Society document, Understanding Chemotherapy: A Guide for Patients and Families.
Other drugs for treating carcinoid tumors
Several medicines can help control the symptoms of carcinoid syndrome in patients with metastatic neuroendocrine cancers.
Octreotide (Sandostatin®) is an agent chemically related to a natural hormone, somatostatin. It is very helpful in treating flushing, diarrhea, and wheezing from carcinoid syndrome. While this drug rarely shrinks carcinoid tumors, it may slow or stop their growth. Although this is not curative, it can prolong life. The main side effects are pain at the site of the injection and − rarely − stomach cramps, nausea, vomiting, headaches, dizziness, and fatigue. Octreotide causes sludging (thickening or crystallizing) of bile in the gallbladder which can lead to gallstones (cholelithiasis). It can also result in insulin resistance that can make pre-existing diabetes more difficult to control.
This drug comes in a short-acting version that is given 2 to 4 times a day. It is also available as a long-acting injection (Sandostatin LAR) given only once a month, which may help patients more than the short-acting version. A similar drug, lanreotide (Somatuline®), is also available. It is also given as an injection once a month. A newer drug, pasireotide, that acts in a similar way, is currently being studied.
Interferons are natural substances that normally activate the body's immune system. They also slow the growth of tumor cells. Interferon-alfa is sometimes helpful in shrinking or slowing the growth of metastatic neuroendocrine cancers and improving symptoms of carcinoid syndrome. Its usefulness is sometimes limited by its flu-like side effects, which may be severe. The drug is given by injection.
Cyproheptadine is an antihistamine that can help relieve some of the symptoms of carcinoid syndrome.
Other medicines are also available to control specific symptoms. Please ask your doctor about these, or describe your symptoms and ask about medicines to control them.
Last Medical Review: 08/03/2011
Last Revised: 11/02/2012