Treating Lung Neuroendocrine Tumors

If you’ve been diagnosed with a lung neuroendocrine tumor (NET), your treatment team will discuss your options with you. It’s important to weigh the benefits of each treatment option against the possible risks and side effects.

How are lung neuroendocrine tumors treated?

Treatments might be used alone or in different combinations. The main factors in selecting a treatment are the type, size, and location of the tumor, whether it has spread to lymph nodes or other organs, symptoms it causes, and if other serious medical conditions are present.

Treatment options for people with lung NETs can include:

Treatment of lung neuroendocrine tumors by type and extent of disease

The treatment of lung NETs depends largely on the type (low grade/typical versus intermediate grade/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 to formally describe the extent of these cancers. For treatment purposes, most doctors use a simpler system, dividing these tumors into 2 groups:

• Resectable tumors: those that can be treated with surgery
• Unresectable tumors: those that can’t be removed completely by surgery

Resectable lung neuroendocrine tumors

Resectable NETs 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.

People who are healthy enough to withstand it are treated with surgery. The extent of the surgery depends on the size and location of the cancer. Nearby lymph nodes are usually removed as well. Most patients with resectable lung NETs are cured with surgery alone and don’t need other treatments.

Some experts recommend further treatment for people with an atypical NET 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 lung neuroendocrine tumors

Unresectable lung NETs have grown too much or spread too far to be removed completely by surgery, including some stage IIIA and all stage IIIB, IIIC, and IV cancers). They also include 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 neuroendocrine tumor, and whether you have symptoms of carcinoid syndrome.

Certain types of systemic treatment are often recommended for more advanced cancers (stages III or IV). 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 PET imaging. Chemo, radiation, and targeted therapy are also options.

In general, typical NETs 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 on the lung and at the site of metastasis is likely to be your best option.

If the NET has spread to 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 Ablation, Embolization, and Supportive Procedures for Lung Neuroendocrine Tumor Symptoms.

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.

Recurrent neuroendocrine tumors

When cancer comes back after treatment, it is called a recurrence. A recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or bones).

Sometimes patients with recurrent NETs are treated with surgery. This provides the best chance for a good long-term outcome. If surgery is not possible, the treatments used for distant spread may be helpful.

For more information, see Understanding Recurrence.

Who treats lung neuroendocrine tumors?

Based on your treatment options, you might have different types of doctors on your treatment team. These doctors could include:

• A thoracic surgeon: a doctor who treats diseases of the lungs and chest with surgery
• A medical oncologist: a doctor who treats cancer with medicines
• A pulmonologist: a doctor who specializes in medical treatment of lung disease
• A radiation oncologist: a doctor who treats cancer with radiation therapy

You might have many other specialists on your treatment team as well, including physician assistants (PAs), nurse practitioners (NPs), nurses, nutrition specialists, social workers, and other health professionals.

Making treatment decisions

It’s important to discuss all your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs.

Take your time and think about all your options when you make this important decision. If time allows, it’s often a good idea to get a second opinion. A second opinion may give you more information and help you feel more confident about the treatment plan you choose.

It’s also very important to ask questions if you’re not sure about something.