Gastrointestinal Carcinoid Tumors

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Treating Gastrointestinal Carcinoid Tumors TOPICS

Surgery for gastrointestinal carcinoid tumors

Most GI carcinoid tumors can be cured by surgery alone. The type of operation will depend on a number of factors, including the size and location of the tumor, whether the person has any other serious diseases, and whether the tumor is causing the carcinoid syndrome.

Surgeons often try to cure localized carcinoid tumors by removing them completely, which is usually successful. The options for GI carcinoid tumors that have spread locally or distantly are more complex. Because most carcinoid tumors grow very slowly and some do not cause any symptoms, completely removing all metastatic carcinoid tumors may not always be needed. In some patients, surgery to remove all visible cancer is the best option. This is particularly true if removing most of the cancer will reduce the level of hormone-like substances causing symptoms.

Several types of operations may be used to treat GI carcinoid tumors. Some of these remove the primary tumor (where the cancer started), while others remove or destroy cancer spread (metastases) in other organs.

Fulguration (electrofulguration)

This treatment destroys a tumor by heating it with electric current. It is sometimes used for small rectal carcinoid tumors, which can be reached fairly easily.

Endoscopic mucosal resection

In this procedure, the cancer is removed through an endoscope. This is most often used to treat small carcinoid tumors of the stomach and duodenum (the first part of the small intestine) and it can be used to remove small carcinoid tumors of the rectum.

Local excision

This operation removes the primary tumor and some normal tissue around it. The edges of the defect are then sewn together. This usually doesn’t cause any prolonged problem with eating or bowel movements. This operation may be done for small carcinoid tumors (no larger than 2 cm, or a little less than an inch).

Carcinoid tumors are sometimes removed during an operation for some other reason. This often occurs with carcinoid tumors of the appendix. When the appendix is removed (for some other reason), it is examined after surgery, and sometimes a carcinoid tumor is found. Most doctors believe that if the tumor is small — 2 cm or less — removing the appendix (appendectomy) is curative and no other surgery is needed. If the tumor is larger than 2 cm, more surgery may be needed.

Rectal carcinoid tumors may be excised (taken out) through the anus, without cutting the skin. Other GI carcinoid tumors can sometimes be locally excised through an endoscope but usually it is done through an incision (cut) in the skin.

More extensive surgeries

For larger tumors, a larger incision (cut) is needed to remove the tumor along with nearby tissues. This also gives the surgeon the chance to see whether the tumor has grown into other tissues in the abdomen (belly). If it has, the surgeon may be able to remove the areas of cancer spread.

Partial gastrectomy: In this operation, part of the stomach is removed. If the upper part is removed, sometimes part of the esophagus is removed as well. If the lower part of the stomach is removed, sometimes the first part of the small intestine (the duodenum) is also taken. Nearby lymph nodes are also removed. This operation is also known as a subtotal gastrectomy.

Small bowel resection: This is an operation to remove a piece of the small intestine (also called the small bowel). When it is used to treat a small bowel carcinoid, this surgery includes removing the tumor and some of the small bowel around it (called a wide margin resection), plus removing nearby (regional) lymph nodes and the supporting connective tissue (called the mesentery) that contains lymph nodes and vessels that carry blood to and from the intestine. Tumors in the terminal ileum (the last part of the small bowel) may require removing the right side of the colon (hemicolectomy).

Pancreaticoduodenectomy (Whipple procedure): This operation is most often used to treat pancreatic cancer, but it is also used to treat cancers of the duodenum. It removes the duodenum, part of the pancreas, nearby lymph nodes and part of the stomach. The gallbladder and part of the common bile duct are removed and the remaining bile duct is attached to the small intestine so that bile from the liver can continue to enter the small intestine. This is a complex operation that requires a lot of skill and experience. It carries a relatively high risk of complications that could even be fatal.

Segmental colon resection or hemicolectomy: This operation removes between ⅓ and ½ of the colon, as well as the nearby mesentery (the layers of tissue that hold and connect the intestines), which includes blood vessels and lymph nodes.

Low anterior resection: This operation can be used for some tumors in the upper part of the rectum. It removes some of the rectum and the remaining ends are sewn together. This does not have much effect on digestive function.

Abdominoperineal (AP) resection: This surgery is done for large or very invasive cancers in the lower part of the rectum. It removes the anus, rectum, and lower part of the colon. After this operation, the end of the colon is connected to an opening on the skin on the abdomen (called a colostomy). A bag attached over this opening collects stool (feces) as it leaves the body. (For more information, see our document Colostomy: A Guide).

For more information on surgery for treating cancer, see our document Understanding Cancer Surgery: A Guide for Patients and Families.

Treatment for liver metastases

The liver is a common site of spread for GI carcinoid tumors. Treating cancer spread to the liver can help with symptoms and can even help some people live longer.

Ablation

These methods are often useful in destroying carcinoids that have spread to the liver, especially if their number or location makes removing them difficult or impossible. CT scan images are used to guide a needle precisely into the tumor deposits. The cells can then be destroyed by:

  • Cryotherapy (cryoablation): Injecting liquid nitrogen through the needle to kill the carcinoid cells by freezing.
  • Radiofrequency ablation: Using high-energy radio waves released from the end of the needle, which destroy the cancer cells with heat.
  • Percutaneous ethanol injection: Injecting concentrated alcohol through the needle kills the cancer cells.

Embolization

Another approach that can be useful in shrinking these tumors is hepatic artery embolization. In this procedure a catheter (a thin, flexible tube) is put into an artery through a small cut in the inner thigh and threaded up into the hepatic artery in the liver. Once the catheter is in place, tiny particles are injected into a branch of the hepatic artery, which cuts off the tumor's blood supply. This is also known as trans-arterial embolization (or TAE).

Trans-arterial chemoembolization (or TACE) combines embolization with chemotherapy. Most often, this is done by using tiny beads for the embolization that give off a chemotherapy drug. TACE can also be done by giving chemotherapy through the catheter directly into the artery, then plugging up the artery. (See the "Chemotherapy for gastrointestinal carcinoid tumors" section.)

Radioembolization combines embolization with radiation. In the United States, this is done by injecting small radioactive beads (called microspheres) into the hepatic artery. Once infused, the beads lodge in the blood vessels near the tumor, where they give off small amounts of radiation to the tumor site for several days. This is discussed in more detail in the section about radiation therapy.

Liver resection

In this operation, one or more pieces of the liver that contain areas of cancer spread are removed. When it is not possible to remove all areas of cancer spread, surgery may still be done to remove as much tumor as is possible. This is sometimes called cytoreductive surgery. If enough tumor can be removed, the surgery can help reduce symptoms of carcinoid syndrome. Removing liver metastases may help some people with carcinoid tumors to live longer, but more than 9 out of 10 people who have this surgery develop new liver metastases within 10 years.

Liver transplant

This operation removes the liver and puts a liver (or a piece of a liver) from someone else in its place. It is rarely used to treat neuroendocrine cancers that have only spread to the liver after the primary tumor has been completely cut out. It is generally only an option for people who are young and otherwise healthy. Although this is a very difficult treatment to go through, it can be curative and should be considered if you are young. For more information on liver transplants see the American Cancer Society document Liver Cancer.


Last Medical Review: 12/31/2013
Last Revised: 12/31/2013