How To Treat Neuroendocrine Tumors

January 10, 2024

Neuroendocrine tumors are tumors that grow inside the cells that generate hormones. There are multiple places neuroendocrine tumors can grow including the glands, pancreas, lungs, intestines, and stomach. Not all neuroendocrine tumors are cancerous, but some are. Cancerous tumors may spread cells throughout the rest of the body. Benign tumors don't move. Neuroendocrine tumors tend to develop over a span of years, taking longer to form than many other tumors. Neuroendocrine tumors are a wide category of tumors, and there are many specific kinds. Because of this, everyone's circumstances regarding neuroendocrine tumors will be unique. Different treatments have been developed to shrink and remove the tumors, and as such, it's important to talk to a medical professional about the best course of treatment.

Surgery To Remove Tumor

When the neuroendocrine tumor is a pheochromocytoma or a presentation of Merkel cell cancer, the main treatment is surgery to remove the tumor, where a surgical oncologist will remove the tumor and some of the surrounding healthy tissue. The healthy tissue is a margin to make sure the surgeon gets all the cancer cells. Surgical oncologists are surgeons who specialize in treating cancer through surgery.

A less invasive surgery called laparoscopic surgery might be possible for patients who have pheochromocytoma. Rather than using a single large incision, a few smaller incisions are used. The surgeon inserts a camera and surgical tools through the opening to guide them through the surgery process. Prior to any surgery, it's important for patients to be informed of the risk factors and possible side effects. If it's not possible to surgically remove the tumor, another method of treatment must be used.

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It's extremely common for a neuroendocrine tumor to metastasize into the liver. Liver metastasis is an important factor when determining the prognosis for a patient, and patients with liver metastasis may have a severely impaired quality of life. Embolization is a therapy used in patients whose neuroendocrine tumors have metastasized to the liver and is employed when patients cannot undergo surgery. Trans-arterial embolization is a common technique that selectively infuses particles into whatever artery branch is feeding the tumor's lesions. This technique has been shown to reduce the size of tumors and hormone output.

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With chemotherapy, a therapy administered by oncologists, medication is used to destroy the tumor cells. The goal is to stop the cells from being able to divide and grow. Chemotherapy treatments can be given both intravenously and orally. Intravenous chemotherapy involves a tube being inserted into a vein, while oral chemotherapy involves swallowing a capsule or pill. A chemotherapy regimen generally follows a predetermined number of sessions over a pre-scheduled period, and patients are given a combination of drugs simultaneously. Many clinical trials are currently underway to find new medications that are effective against neuroendocrine tumors. Chemotherapy, of course, comes with some side effects, which vary widely depending on the dose and the individual. Patients might be fatigued, have an increased infection risk, experience nausea or vomiting, lose their hair, experience appetite loss, and have diarrhea. In most cases, the side effects subside after the treatment is completed.

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Radiofrequency Ablation

Radiofrequency ablation is not used to treat cancer itself, but it can be used to treat the symptoms, and the goal of the procedure is to reduce a patient's overall pain. Ablation is used in many chronic pain conditions, including arthritis. During the procedure, a radio wave will produce an electrical current, which will heat a small, focused part of an individual's nerve tissue. The result is a decrease in the pain signals sent from that area. The amount of pain relief patients experience varies from case to case, and the pain's location has an impact as well. Radiofrequency ablation generally provides pain relief for periods ranging from six to twelve months. There have been cases reported where the relief lasted for several years. Over seventy percent of patients who undergo radiofrequency ablation treatment have reported pain relief.

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Radiotherapy is another of the most commonly used treatments for cancerous tumors like neuroendocrine tumors. With radiation therapy, x-rays or other high energy rays are used to destroy the cancer cells. A radiation oncologist, a doctor who specializes in treating cancer through radiotherapy, administers this treatment. There are a few circumstances in which radiation therapy may be suggested, such as when surgery is impossible or would be quite difficult or risky. It's also often recommended if a tumor has spread to other parts of the body. Radiation treatments are commonly administered through external beams supplied by a machine. Another type of radiotherapy happens internally by using implants. Like chemotherapy, this treatment has a predetermined number of sessions over a predetermined schedule. Potential side effects include mild dermatological reactions, nausea, loose bowel movements, and fatigue. These symptoms tend to subside after the treatment concludes.

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Targeted Therapy

Targeted therapy can be used in the treatment of a patient's neuroendocrine tumor. Treatment that works by targeting the tissue environment, proteins, or specific genes of the neuroendocrine tumor is called targeted therapy. This type of therapy is most effective at inhibiting the growth and metastasis of the malignant cells with the ability to reduce damage to healthy cells in the body. Everolimus is a type of targeted treatment therapy often used in individuals with advanced neuroendocrine tumors that affect the digestive tract, pancreas, and lung. Everolimus is known to help inhibit the growth of an individual's neuroendocrine tumor, but it does not actually reduce the size of the tumor. Sunitinib is another type of targeted therapy that utilizes the presence of a protein called VEGF in the malignant cells of a neuroendocrine tumor in a patient's pancreas. Other types of targeted therapy are being tested in clinical trials that target neuroendocrine tumors by intervening in the process of new blood vessel development, or by blocking specific survival pathways of malignant cells.

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Hormone Therapy

Neuroendocrine tumors may be able to be treated with the use of hormone therapy. Hormone therapy is a type of treatment for cancer that takes advantage of the endocrine properties many neuroendocrine tumors have. Neuroendocrine tumors are known to release excess and or dysfunctional hormones into the patient's bloodstream that can wreak havoc on their body. Medications called somatostatin analogs are concomitant to the hormone in the body called somatostatin. This type of hormone therapy inhibits the release of excess hormones into the patient's bloodstream. Hormone therapy is similar to targeted therapy in the aspect of not having the ability to physically reduce the size of an individual's neuroendocrine tumor. This type of therapy is more effective at slowing the growth of neuroendocrine tumors and helping manage the adverse symptoms that occur with this type of malignancy.

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The use of gastroenterology can be helpful in the treatment process in individuals affected by neuroendocrine tumors. Over two-thirds of all neuroendocrine tumors occur in an individual's gastrointestinal tract. Gastroenterologists are a type of specialized physician that help treat issues that arise in the digestive tract. Almost forty percent of neuroendocrine tumors start in the small intestine, while fifteen percent originate in the tissues of the rectum. Seven percent of neuroendocrine tumors start in the appendix, while between five and seven percent occur in the colon. Between two and four percent of neuroendocrine tumors originate in the stomach. Tumors in these organs can damage their structure and functionality. Neuroendocrine tumors in the stomach can cause the development of ulcers and subsequent pain, and a gastroenterologist can prescribe medication to help prevent and treat this. Tumors in the intestines can result in vomiting, bleeding, diarrhea, and dehydration. These complications can also be managed through gastroenterology.

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Symptomatic Relief

Symptomatic relief is a critical factor of a patient's neuroendocrine tumor treatment. Neuroendocrine tumors have the tendency to produce a wider array of symptoms that occur on a more frequent basis than those of other types of malignant tumors. The mechanism that causes this involves the function of hormones in the body. Hormones are substances secreted by glands located throughout the body that tell all the organs what they need to do and when to do it. Neuroendocrine tumors not only produce the general symptoms of cancer itself, but also those that occur in conditions and illnesses that disrupt the normal processes of hormone production, secretion, and function. Therefore, symptomatic relief can present a challenge. Surgical procedures to reduce the size of the tumor can help manage numerous symptoms associated with excessive hormone production and release. Radiation therapy may be used to shrink the tumor to relieve symptoms caused by hormone abnormalities. Sometimes neuroendocrine tumors have to be treated through the complete removal of a hormone-producing gland such as the pancreas. The symptomatic consequences of such treatment also have to be managed since the gland is no longer present.

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Gene Therapy

Neuroendocrine tumors in some patients may be able to be treated with the use of gene therapy. Proteins in the body are specialized molecules that control the way cells work, and genes are the coded instructions that tell the cells how to produce proteins. Genes control cell division, growth, differentiation, and apoptosis. Malignant cells in neuroendocrine tumors have alterations in their genes that cause them to behave the way they do. Gene therapy is the use of genes to boost a patient's immune response to malignant cells, make other cancer treatments more effective, provide the ability for cells to activate cancer-fighting drugs, help block mechanisms that protect cancerous cells, and alter viruses to infect and kill cancerous cells. In order for gene therapy to work, the genes have to be placed into the patient's neuroendocrine tumor cells or immune system cells. Gene therapy is helpful to treat neuroendocrine tumors that may not respond to other types of treatment because researchers are gaining a better understanding of how these malignant cells are different from healthy cells.

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