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, if 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 neuroendocrine tumors/cancers with local or distant spread are more complex. Because most neuroendocrine tumors/cancers 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 neuroendocrine tumors/cancers. Some of these remove the primary tumor (where the tumor/cancer started), while others remove or destroy metastases in other organs.

Local Excision

This operation removes the primary tumor and some surrounding normal tissue. The edges of the defect are then sewn together. This usually doesn’t cause any prolonged problem with eating or bowel movements. This operation is usually done for small carcinoid tumors (no larger than 2 centimeters, or about 3/4 inch).

Carcinoid tumors are sometimes removed unintentionally, such as when an appendix is removed and the carcinoid tumor is discovered after the surgery. Most doctors believe that if the tumor was small -- less than 1.5 centimeters (about 1/2 inch) -- the appendectomy is curative. Larger tumors may require more treatment.

Local excision of rectal carcinoid tumors may be done through the anus, without cutting the skin. Local excision of other GI carcinoid tumors can sometimes be done through an endoscope but usually is done through a skin incision.

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.

More Extensive Excisions

When the neuroendocrine tumor/cancer is larger than 2 centimeters, most surgeons prefer to do a larger operation to make sure they remove it completely. This also gives them the chance to see whether the tumor/cancer has invaded other tissues so they can get to these areas and remove the invading cancer.

Small bowel resection: The surgical treatment of small bowel neuroendocrine tumor/cancer requires wide margin resection, including removal of regional lymph nodes and removal of supporting the connective tissue that contains lymph nodes and vessels that carry blood to and from the intestine (mesentry). Tumors of the terminal ileum may require removal of the right side of the colon (hemicolectomy).

Segmental colon resection or hemicolectomy: This operation removes between 1/3 and 1/2 of the colon, as well as nearby blood vessels and lymph nodes.

Low anterior resection: This operation is used for some tumors of the upper part of the rectum. It removes some of the rectum and the remaining ends are sewn together, without much impact on digestive function.

Abdominoperineal (AP) resection: This surgery is for large or very invasive cancers of the lower part of the rectum. It involves removing 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), where fecal waste can leave the body. (For more information, see our document, Colostomy: A Guide).

Liver resection: This is an operation to remove one or a few metastases from the liver. It is not usually expected to cure the cancer but is often helpful in reducing symptoms of carcinoid syndrome.

Procedures to Destroy Liver Metastases

These methods are often useful in destroying neuroendocrine cancers 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 
• percutaneous ethanol injection (PEI): injecting concentrated alcohol through the needle

Another approach that can be useful in shrinking these tumors is hepatic artery embolization. This involves injecting a material to block off the hepatic artery, which cuts off the tumors' blood supply. Chemotherapy is sometimes injected into the artery before it is blocked off -- this is known as chemoembolization (see below).

Liver Transplant

This rarely used treatment may be effective for young patients with neuroendocrine cancers that have only spread to the liver and in whom the primary tumor has been completely excised. Although this is very difficult treatment for patients to go through, it can be curative and should be considered in young patients. For more information on liver transplants see the American Cancer Society document, Liver Cancer.