This section explains the types of treatments that are considered the network’s standard of care. “Standard of care” refers to the best known treatment, which is usually based on strong evidence from previous clinical trials. When making decisions about a treatment plan, we also encourage you to consider clinical trials as an option. A clinical trial is the research study that tests a new approach to the treatment. Doctors want to know if the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard medications or other treatments. Clinical trials are an option for treatment and care for all stages of cancer. Your doctor can help you think about all of your treatment options.
How is NET treated?
In cancer care, different types of doctors often work together to create a comprehensive treatment plan for the patient that combines different types of treatments. This is called a multidisciplinary team and is especially important for people with .NET. Cancer care teams include a variety of other healthcare professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dieticians, and more.
Treatment is the options and recommendations depend on several factors, including:
- Primary location (where the network originated)
- Whether the tumor is functional or not
- The stage (where the tumor is in the body)
- Degree and degree of differentiation (how quickly cells divide)
- growth rate
- Somatostatin receptor status (whether tumor is bright on 68Ga DOTATATE PET)
- Possible side effects
What is the patient’s preference and general health?
Take time to learn about all treatment options and be sure to ask questions about things that aren’t clear. Talk with your doctor about the goals of each of the treatment and what you can expect while receiving the treatment. These types of conversations are called “joint decision making.” Decision-making is involved when you and your doctor’s work together to choose treatments that best fit the goals of your care. Joint decision making is especially important to the network because there are different treatment options. Learn more about making treatment decisions.
The common types of net treatments used are described below. Your care plan also includes treatment for symptoms and side effects, which are an important part of cancer care. Visit the individual section for a specific type of NET for more information about treatment options (see Introduction for a complete list).
Sometimes, active monitoring may be recommended. This method is also called watchful waiting or watch and wait. It is used most often for someone with low-grade NET that may grow slowly and not spread or cause problems for months or years. Effective treatment usually begins if the tumor shows signs of growth or spread. With this approach, the tumor is closely monitored with the regular tests, which may include:
Imaging the tests, usually CT scans or sometimes MRI scans (see Diagnosis)
Surgery is the removal of the tumor and some surrounding healthy tissue during the operation. A surgical oncologist is a doctor who specializes in the cancer surgery. Removing the entire tumor is the standard treatment, when its possible. Most in situ meshes are successfully treated with surgery alone. The surgeon usually removes some of the tissue surrounding the tumor, called the margin, in an effort to leave no trace of the cancer in the body.
When the tumor cannot be completely removed, sometimes “reduction surgery” is recommended. Volume removal surgery removes as much of the tumor as possible and may provide some symptom relief, but it generally does not cure the NET.
People who have had carcinoid syndrome are at risk of developing a carcinoid crisis during surgery (see Symptoms and Signs). To avoid major complications from a precancerous crisis, the anesthesiology team must be fully aware of this risk prior to surgery, so that they can have treatment on hand to control symptoms. Octreotide is usually given into a vein before surgery to prevent a cancerous attack.
Before surgery, talk with your health care team about possible side effects from the specific surgery you’ll have.
If the NET cannot be removed with surgery, the tumor is called “non-operative.” In these cases, the doctor will recommend another treatment plan.
Treatments with medication
Treatments using drugs are used to destroy cancer cells. The drug can be given through the bloodstream to reach cancer cells throughout the body. When medication is given in this way, it is called systemic therapy. The drug can also be given locally, which is when the drug is applied directly to the cancer or kept in one part of the body.
Targeted therapy is treatment that targets genes or proteins specific to the tumor or tissue environment that contribute to cancer growth and survival. This type of treatment prevents the growth and spread of cancer cells and limits damage to healthy cells.
Not all tumors have the same goals. To find the most effective treatment, your doctor may run tests to identify genes, proteins and other factors in the tumor. This helps the doctors better match each patient with the most effective treatment whenever possible. In addition, the research studies continue to discover more about the specific molecular targets and new treatments directed at them. Learn more about the basics of targeted therapies. Talk to your doctor about the potential side effects of a particular medication and how they can be managed.
Everolimus (Afinitor) is a targeted therapy approved by the US Food and Drug Administration (FDA) for the treatment of advanced NETs of the gastrointestinal tract, lung, and pancreas. This drug targets a protein called the mTOR that is important for the cell growth and survival. This medication can help slow the growth of these tumors in some patients, but it does not usually shrink the tumors. Side effects include mouth sores, low blood counts, and fatigue.