The treatment of lung carcinoid tumors depends largely on the type (typical versus atypical) and extent of the cancer. Other factors, such as a person’s overall health and ability to withstand surgery, are also important.
Many doctors use the TNM staging system (see Lung Carcinoid Tumor Stages) to formally describe the extent of these cancers. But for treatment purposes most doctors use a simpler system, dividing these tumors into 2 groups:
Resectable carcinoid tumors haven’t spread far beyond where they started and can be removed completely. In the TNM staging system, this includes most stage I, II, and IIIA cancers.
For people who are healthy enough to withstand it, these cancers are treated with surgery. The extent of the surgery depends on the type of carcinoid tumor and the size and location of the cancer. Atypical carcinoids may need more extensive surgery than typical carcinoids. Nearby lymph nodes are usually removed as well, especially if you have an atypical carcinoid.
Most patients with resectable lung carcinoid tumors are cured with surgery alone and don’t need other treatments. Some experts recommend further treatment for people with an atypical carcinoid that has spread to lymph nodes. This can be chemotherapy, radiation therapy, or both. But it’s not clear if the added treatments lower the chance of the cancer coming back, or if they help people live longer.
Unresectable carcinoid tumors include those that have grown too much or spread too far to be removed completely by surgery (including some stage IIIA, most stage IIIB and stage IV cancers), as well as tumors in people who are not healthy enough for surgery.
Treatment depends on the stage of the cancer, where the cancer is, whether it is a typical or atypical carcinoid, and whether you have symptoms of the carcinoid syndrome.
For stage IIIA cancers in people who can’t have surgery, experts typically recommend radiation to treat typical carcinoids, and chemotherapy (chemo) and radiation for atypical carcinoids.
Some type of systemic treatment is often recommended for more advanced cancers (stages IIIB and IV), sometimes along with radiation therapy. Somatostatin analogs like octreotide (Sandostatin) or lanreotide (Somatuline) can be helpful for patients who have carcinoid syndrome or whose tumors can be seen on somatostatin receptor scintigraphy (OctreoScan). Chemo and targeted therapy are also options.
In general, typical carcinoids tend to grow slowly, and chemotherapy is often not very successful. If you have only a small number of tumors that can be removed, surgery (both on the lung and at the site of metastasis) is likely to be your best option.
Lung carcinoid tumors usually spread to the liver first. If the carcinoid has spread only to your liver but can’t be removed with standard surgery, another option might be to have a liver transplant. This is a very complex operation that most doctors still consider experimental. It is done at only a few transplant centers.
If the carcinoid is in your liver and is causing symptoms, procedures such as ablation or hepatic artery embolization may be helpful. They may relieve symptoms or slow the growth of the cancer, but are very unlikely to result in a cure. These treatments are discussed in detail in Supportive Procedures for Lung Carcinoid Tumor Symptoms.
For people with earlier stage cancers who can’t have surgery, most doctors recommend radiation therapy for typical carcinoids and chemotherapy plus radiation therapy for atypical carcinoids.
External radiation therapy can also be used to relieve symptoms caused by tumors such as bone pain. For more widespread disease, radioactive drugs may be helpful.
When cancer comes back after treatment, it is called a recurrence. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the liver or bone).
Carcinoid tumors can sometimes come back, even several years after the initial treatment. If this happens, further treatment options depend on where the cancer is and what treatments have already been used. Cancers that recur locally or in only 1 or 2 areas can sometimes be treated with further surgery. If surgery is not an option, radiation therapy, chemotherapy, or other drugs may be tried. Because recurrent cancers can often be hard to treat, clinical trials of new types of treatment may be a good option.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Fazio N, Ungaro A, Spada F, et al. The role of multimodal treatment in patients with advanced lung neuroendocrine tumors. Journal of Thoracic Disease. 2017;9(Suppl 15):S1501-S1510. doi:10.21037/jtd.2017.06.14.
Hilal T. Current understanding and approach to well differentiated lung neuroendocrine tumors: an update on classification and management. Therapeutic Advances in Medical Oncology. 2017;9(3):189-199. doi:10.1177/1758834016678149.
Horn L, Eisenberg R, Guis D et al. Chapter 72: Cancer of the Lung – Non-small Cell Lung Cancer and Small Cell Lung. In: Niederhuber JE, Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa. Elsevier: 2014.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine and Adrenal Tumors. V.2.2018. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf on July 11, 2018.
Pinchot SN, Holen K, Sippel RS, Chen H. Carcinoid tumors. Oncologist. 2008;13:1255-1269.
Thomas CF, Jett JR, Strosberg JR. Lung neuroendocrine (carcinoid) tumors: Treatment and prognosis. UpToDate website. https://www.uptodate.com/contents/lung-neuroendocrine-carcinoid-tumors-treatment-and-prognosis. Updated Feb. 6, 2018. Accessed July 17, 2018.
Last Revised: August 28, 2018