Carcinoid tumors are a type of neuroendocrine tumor that most often arise in the gastrointestinal tract or lungs. Treating these tumors involves a variety of approaches depending on the tumor’s size, location, whether it has spread, and the symptoms it causes. The goal of treatment is to remove or control the tumor, relieve symptoms, and improve quality of life.
**Surgery** is the primary and most common treatment for carcinoid tumors. When the tumor is localized and operable, surgery aims to remove the primary tumor and any nearby lymph nodes that may contain cancer cells. This can involve removing part of the affected organ, such as a section of the intestine or lung. Surgery is often the best chance for cure if the tumor has not spread extensively. In cases where the tumor has metastasized, surgery may still be used to reduce tumor burden and alleviate symptoms caused by hormone secretion or obstruction[1][2][5].
For tumors that have spread to the liver, specialized procedures like **radioembolization with Yttrium-90** can be used. This involves injecting tiny radioactive beads directly into the arteries feeding the liver tumors. The radiation selectively kills cancer cells while sparing healthy liver tissue. This approach can control liver metastases and delay the need for more toxic systemic treatments[1].
**Medical therapies** play a crucial role, especially when surgery is not feasible or when tumors have spread. One of the mainstays is the use of **somatostatin analogs**, such as octreotide and lanreotide. These drugs mimic the natural hormone somatostatin, which inhibits the release of several hormones and growth factors. While they usually do not shrink tumors significantly, they can slow tumor growth and control symptoms related to hormone secretion, such as flushing and diarrhea seen in carcinoid syndrome. These medications are typically given as injections, with long-acting formulations available for monthly dosing. Newer oral somatostatin analogs are being developed and tested, which could improve convenience for patients[1][2][4].
**Interferon therapy** is another option that can stimulate the immune system to attack tumor cells and sometimes slow tumor progression. However, it is less commonly used due to side effects and the availability of other treatments[1].
For more aggressive or advanced carcinoid tumors, **chemotherapy** may be considered. Chemotherapy uses drugs that kill rapidly dividing cells and is generally reserved for tumors that have spread widely or are not responding to other treatments. Platinum-based chemotherapy regimens have shown some effectiveness, especially in neuroendocrine carcinomas with high-grade features. Research is ongoing to find better chemotherapy combinations and targeted agents for these tumors[2][3].
**Targeted therapies** are a newer class of treatments that interfere with specific molecules involved in tumor growth. For example, drugs that inhibit the mTOR pathway or block blood vessel growth (anti-angiogenic agents) have been used in some cases. These treatments aim to slow tumor progression by disrupting the tumor’s ability to grow and spread[1][2][3].
Another advanced treatment is **peptide receptor radionuclide therapy (PRRT)**, which involves attaching a radioactive isotope to a molecule that binds to somatostatin receptors on tumor cells. This allows targeted delivery of radiation directly to the tumor, minimizing damage to normal tissues. Lutathera is an FDA-approved PRRT agent for neuroendocrine tumors. PRRT can be particularly effective for tumors that express somatostatin receptors and have spread to multiple sites[6][7].
**Radiation therapy** may be used in certain situations, such as when tumors cannot be fully removed surgically or to relieve symptoms caused by tumor growth pressing on nearby structures. It uses high-energy rays to kill cancer cells or shrink tumors[5].
Throughout treatment, patients require careful monitoring with imaging studies and blood tests to assess tumor response and detect any progression. The choice and sequence of treatments depend on
