For slow-growing, small tumors, we may recommend active surveillance (watching the tumor but not yet treating it).

The goal of surgery is to remove the tumor completely or remove as much of it as possible. Your doctor may combine surgery with other treatments, such as medications or radiation therapy.

Types of neuroendocrine tumor surgery include:

• Surgical excision or resection: Your surgeon removes the tumor and its margins (small amount of normal tissue around it) or part of the organ with the tumor. They also remove nearby lymph nodes if cancer has spread to them.
• Endoscopic resection: Your doctor may remove NETs in the lining of the GI tract with an endoscope (a long, narrow tube with a light, camera, and specialized tools). Your doctor inserts the endoscope in the mouth or anus, directs it to the tumor, and removes the tumor.
• Radioguided surgery: This type of surgery uses radioactive markers to “tag” cancerous cells. Your surgeon uses a probe to spot and removed the tagged cells.
• Debulking surgery: Your doctor may recommend this type of surgery to make a tumor smaller, especially when a neuroendocrine tumor has spread to the liver. Debulking surgery can decrease discomfort and other symptoms of a neuroendocrine tumor.
• Liver transplant: If the neuroendocrine tumor is in the liver, you may be a candidate for liver transplantation. A liver transplant removes your liver and replaces it with a healthy liver from a donor.

People with carcinoid syndrome have a risk of experiencing extreme syndrome-related symptoms (a carcinoid crisis) during invasive procedures such as surgery. The intense symptoms are caused by an overwhelming release of hormones that regulate heart rate and blood pressure. Our NET experts are highly skilled in preventing and treating carcinoid crises.

Medical therapy uses various types of medicine to destroy cancer cells or slow their growth. You may take medications in conjunction with other cancer treatments. Cancer drugs may include:

• Somatostatin analogs: These drugs treat symptoms caused by the hormones that the NET releases. Somatostatin analogs may also slow a tumor's growth.
• Immunotherapy: These medications fight cancer by either stimulating the immune system or targeting specific molecules on cancer cells.
• Targeted therapy: These medications target certain proteins on cancerous cells to block cancer’s growth without harming nearby tissues.
• Chemotherapy: These medications shrink or destroy cancerous cells. Chemotherapy can also prevent cancer from spreading to other parts of your body.

Radiation therapy is a painless treatment that uses high-energy X-rays or other types of radiation to destroy cancer cells. Our team is skilled at treating neuroendocrine tumors with several types of radiation therapy, including:

External radiation

• 3D conformal radiation therapy (3D-CRT): With this method, 3D images help the doctor better target the tumor. We create the images using a computed tomography (CT) or magnetic resonance imaging (MRI) machine. Your doctor can aim the radiation beams from many angles to match the exact shape of the cancer.
• Intensity-modulated radiation therapy (IMRT): IMRT is similar to 3D-CRT, but your doctor can adjust how much radiation you get from each beam. In certain situations, this adjustment enables the doctor to avoid nearby healthy cells, reducing the risk of side effects.
• Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy (SABR): This type of radiation therapy works like the first two methods. The total amount of radiation you get is similar, yet you receive radiation in fewer but stronger doses.

Internal radiation

• Peptide receptor radionuclide therapy (PRRT): This specialized drug attaches to and enters the neuroendocrine tumor's cells. Once inside the cancerous cells, the drug releases high doses of radiation to destroy them. Since PRRT targets cancerous cells and avoids healthy cells, it may cause fewer side effects than other treatments. Stanford Medicine researchers helped develop this therapy to treat NETs that have spread to other areas.

We sometimes use a probe to kill tumors with extreme temperatures. Radiofrequency ablation emits radio waves to destroy tumors with intense heat. Cryoablation destroys tumors with freezing cold.

Sometimes neuroendocrine tumors spread to the liver. We offer treatments to block blood flow to the tumor, including:

• Hepatic artery embolization: Your doctor injects a material into the tumor’s main blood vessel to block the tumor’s blood supply. Without oxygen-rich blood, the tumor shrinks and dies.
• Chemoembolization: Your doctor injects anticancer medication into the tumor to block its blood supply.

Many people who develop NETs have inherited (passed down in families) genetic syndromes. Our dedicated cancer geneticists have special training in the genetics of neuroendocrine tumors and ways to help you assess your family's risk. Test results can guide treatment, identify affected family members, and help with family planning.