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 carcinoid tumors hat 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 metastases in other organs.

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 is usually done for small carcinoid tumors (no larger than 2 centimeters, or about ¾ inch).

Carcinoid tumors are sometimes removed unintentionally. This often occurs with carcinoid tumors of the appendix. When the appendix is removed (for some other reason), a carcinoid tumor may be found when the appendix is examined after the surgery. Most doctors believe that if the tumor was small -- less than 1.5 centimeters (about ½inch) -- removing the appendix (appendectomy) is curative and no other surgery is needed. If the tumor is larger than 1.5 cm, more treatment may be needed.

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 tumor 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 has grown into other tissues. If it has, they may be able to remove the areas of cancer spread.

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 the small bowel around it (called a wide margin resection), plus removal of nearby (regional) lymph nodes and the supporting connective tissue that contains lymph nodes and vessels that carry blood to and from the intestine (mesentery). Tumors in the terminal ileum (the last part of the small bowel) may require removal of the right side of the colon (hemicolectomy).

Segmental colon resection or hemicolectomy: This operation removes between ⅓and ½ of the colon, as well as the nearby mesentery (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).

Liver resection: In this operation, a piece of the liver is removed. This surgery can be used to remove areas of metastasis (cancer spread) in 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 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.

Percutaneous ethanol injection: injecting concentrated alcohol through the needle.

Another approach that can be useful in shrinking these tumors is hepatic artery embolization. Material is injected to block off a branch of the hepatic artery, which cuts off the tumor's blood supply. Chemotherapy is sometimes injected into the artery before it is blocked off. This is known as chemoembolization.

Liver transplant

This operation removes the patient's 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 young patients who are otherwise healthy. 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.

Last Medical Review: 06/19/2009
Last Revised: 06/19/2009