Lung Carcinoid Tumor

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Treating Lung Carcinoid Tumor TOPICS

Surgery and other procedures for lung carcinoid tumors

Surgery is the main treatment for lung carcinoid tumors whenever possible. If the tumor has not spread, it can often be cured by surgery alone.

Several types of surgery are used to treat people with lung carcinoid tumors. The type of surgery will depend on a number of factors, including the size and location of the tumor and whether you have any other lung problems or serious diseases. Thoracic and cardiothoracic surgeons are likely to have the most experience with these operations.

Surgeons usually have to remove some normal lung tissue along with the tumor, but they try not to remove any more normal tissue than they need to.

These operations require general anesthesia (where you are in a deep sleep) and often require a surgical incision between the ribs in the chest (thoracotomy). You will generally need to spend about 5 to 7 days in the hospital after the surgery.

Sleeve resection

To treat a central carcinoid in a large airway (such as a bronchus), the surgeon may do a sleeve resection. If you think of the large airway with a tumor to be like the sleeve of a shirt with a stain an inch or 2 above the wrist, the sleeve resection would be like cutting across the sleeve above and below the stain and sewing the cuff back onto the shortened sleeve. The surgeon may be able to do this type of operation instead of removing part or all of the lung, in order to preserve more lung function.

Wedge resection

For small carcinoids found at the outer edges of the lungs away from the large airways, the surgeon may remove a wedge-shaped piece of the lung in an operation called a wedge resection or segmental resection.

Lobectomy

If it’s not possible to do a wedge resection because of the size or location of the tumor, the surgeon will usually do a lobectomy, in which an entire lobe of the lung is removed. In some cases 2 lobes may be removed (bilobectomy).

Pneumonectomy

In rare cases where the cancer is in many spots in a lung or is in a place that makes it hard to remove, the entire left or right lung may need to be removed in an operation called a pneumonectomy.

Lymph node sampling

With any of these operations, lymph nodes near the lungs are usually removed to look for possible spread of the cancer. This is important because the carcinoid might have spread to lymph nodes by the time it is diagnosed. (This risk is higher for atypical carcinoids than for typical carcinoids.) If lymph nodes containing cancer are not removed, it will increase the risk of the carcinoid tumor spreading even farther, to other organs. If this happens, you may no longer be able to be cured by surgery. Checking for cancer cells in the lymph nodes can also provide some indication of your risk of having the cancer come back.

Video-assisted thoracic surgery (VATS)

This is a less invasive type of surgery for treating some cancers in the lungs. During this operation, a thin, rigid tube with a tiny video camera on the end is placed through a small cut in the side of the chest to help the surgeon see inside the chest. One or two other small cuts are created in the skin, and long instruments are passed though these cuts to do the same operation that would be done using an open approach (thoracotomy). Because only small incisions are needed, there is less pain after the surgery and a shorter hospital stay – usually around 4 to 5 days.

Most experts recommend that only smaller tumors near the outside of the lung be treated with this method. The cure rate after this surgery seems to be the same as with surgery done with a larger incision. But it is important that the surgeon doing this operation be experienced because it requires a great deal of technical skill.

Possible risks and side effects of lung surgery

Possible complications depend on the extent of the surgery and the person’s health beforehand. Serious complications can include excessive bleeding, wound infections, and pneumonia.

Lung surgery is a major operation, and recovering from the operation typically takes weeks to months. If the surgery is done through a thoracotomy, the surgeon must spread the ribs to get to the lung, so the area near the incision will hurt for some time after surgery. Your activity will be limited for at least a month or two. People who have VATS instead of thoracotomy have less pain after surgery and tend to recover more quickly.

If your lungs are in good condition (other than the presence of the cancer) you can usually return to normal activities after a lobe or even an entire lung has been removed. If you also have non-cancerous diseases such as emphysema or chronic bronchitis (which are common among heavy smokers), you may become short of breath with activity after surgery.

Procedures to relieve symptoms from lung carcinoid tumors

If you can’t have major surgery because you have reduced lung function or other serious medical problems, or if the cancer has spread too far to be removed, other treatments may be used to relieve some symptoms.

These treatments, called palliative procedures, can relieve symptoms, but they do not cure the cancer and are recommended only if you cannot have surgery to completely remove the tumor. If you are treated with these procedures you may also get radiation therapy.

Treating airway blockage

If the tumor is blocking airways in the lung, it might lead to pneumonia or shortness of breath. Removing most of the tumor through a bronchoscope or destroying most of it with a laser (on the end of a bronchoscope) can be helpful. In some cases, a bronchoscope may be used to place a stent (a stiff tube) made of metal or silicone in the airway after treatment to help keep it open.

Treating fluid buildup

Sometimes fluid can build up inside the chest (outside of the lungs), which can press on the lungs and affect breathing. Usually, a hollow needle is put through the skin and into the pleural space to remove the fluid. (This is known as a thoracentesis.) Removing the fluid can relieve breathing problems right away in most patients, but the fluid will often build up again quickly if nothing else is done.

Pleurodesis: To remove the fluid and keep it from coming back, doctors sometimes do a procedure called pleurodesis. A small cut is made in the skin of the chest wall, and a hollow tube is placed into the chest to remove the fluid. Either talc or a drug such as doxycycline or a chemotherapy drug is then instilled into the chest cavity. This causes the linings of the lung (visceral pleura) and chest wall (parietal pleura) to stick together, sealing the space and limiting further fluid buildup. The tube is often left in for a day or two to drain any new fluid that might collect.

Catheter placement: This is another way to control the buildup of fluid. One end of the catheter (a thin, flexible tube) is placed in the chest through a small cut in the skin, and the other end is left outside the body. This is done in a doctor’s office or hospital. Once in place, the catheter can be attached to a special bottle or other device to allow the fluid to drain out on a regular basis.

Procedures to relieve symptoms of liver metastases

If the cancer spreads to the liver, treating the liver tumors may help with symptoms. When there are only 1 or 2 tumors in the liver, they may be removed with surgery. If there are more than just a few liver tumors (or if a person is too sick for surgery), other techniques may be used.

Ablation

Ablation techniques destroy tumors without removing them. They are generally not used for large tumors, and are best for tumors no more than about 2 cm (a little less than an inch) across.

Radiofrequency ablation (RFA) uses high-energy radio waves for treatment. A thin, needle-like probe is placed through the skin and into the tumor. Placement of the probe is guided by ultrasound or CT scans. The tip of the probe releases a high-frequency current that heats the tumor and destroys the cancer cells.

Ethanol (alcohol) ablation (also known as percutaneous ethanol injection) kills the cancer cells by injecting concentrated alcohol directly into the tumor. This is usually done through the skin using a needle guided by ultrasound or CT scans.

Microwave thermotherapy uses microwaves to heat and destroy the abnormal tissue.

Cryosurgery (cryotherapy) destroys a tumor by freezing it with a metal probe. The probe is guided through the skin and into the tumor using ultrasound. Then very cold gasses are passed through the probe to freeze the tumor, killing the cancer cells. This method may be used to treat larger tumors than the other ablation techniques, but it sometimes requires general anesthesia (where you are asleep).

Embolization

Arterial embolization, also known as transarterial embolization (or TAE), is another option for tumors that cannot be removed. Embolization can be used for larger tumors – up to about 5 cm (2 inches) across – than the ablative methods. This technique is used to reduce the blood flow to the cancer cells by blocking the branch of the hepatic artery feeding the area of the liver containing the tumor. Blood flow is blocked (or reduced) by injecting materials that plug up the artery. Most of the healthy liver cells will not be affected because they get their blood supply from the portal vein.

In this procedure a catheter is put into an artery in the inner thigh and threaded up into the liver. A dye is usually injected into the bloodstream at this time to allow the doctor to monitor the path of the catheter via angiography, a special type of x-ray. Once the catheter is in place, small particles called microspheres are injected into the artery to plug it up.

Radioembolization combines embolization with radiation therapy. In the United States, this is done by injecting small radioactive beads into the hepatic artery. The beads travel to the tumor and give off small amounts of radiation only at the tumor sites.

For more general information about surgery, please see our document Understanding Cancer Surgery: A Guide for Patients and Families.


Last Medical Review: 11/13/2013
Last Revised: 11/13/2013