Surgery: Surgery plays a major role in the treatment of both localized and metastatic NETs. The surgeons perform the margin-negative resection and lymphadenectomy (if cancer is suspected of spreading to lymph nodes). Chemotherapy may follow surgery, especially in patients with fully resected tumors. The type of surgery depends upon the location of the tumor. The surgical interventions include endoscopic resection, gastric resection, bowel resection, appendectomy, lung resection, distal pancreatectomy, Whipple procedure, liver resection, and thyroidectomy.
Chemotherapy: Chemotherapy drugs arrest the cell division cycle and stop their division. Some chemotherapy drugs also kill the tumor cells. The drugs are delivered orally or through injection. Chemotherapy may be used as an adjuvant to surgery. Further, these drugs may also be prescribed when patients are ineligible for surgery.
Radiation therapy: Some, but not all NTEs, respond to radiation therapy. It involves the use of high-energy radiation to kill cancer cells. Radiation therapy, especially conventional external beam radiation therapy, relieves pain and other symptoms caused due to tumor metastases to the bone or brain.
Targeted therapy: Molecularly targeted biologic therapy is an important treatment consideration for NETs. These drugs inhibit angiogenesis, cell proliferation, and cell metabolism and are highly effective in reducing the risk of progression and improving survival.
Peptide receptor radionuclide therapy (PPRT): It is a radionuclide therapy used to manage NETs. The therapy involves delivering the radiolabelled somatostatin analogue for its accumulation into the neuroendocrine tissue. The radionuclide attached then delivers the cell-damaging radiations locally to the NET. Studies have reported that these drugs increase progression-free survival. The drugs are delivered through intravenous injection. These drugs are used for the management of advanced NETs. It is also used for well-differentiated tumors when surgery is not viable or some tumor cells remain after the surgery. The patients undergo an octreotide scan to ensure the tumor responds to this therapy.
Medications: The patients may be prescribed certain medications to manage the symptoms caused due to excessive release of hormones by the tumor. These medications include medications for controlling diarrhea, gastric acid, blood pressure, and heart rate.
Liver-directed therapy: The liver is the most common site for NET metastasis. Liver-directed therapy manages the tumors that have spread to the liver. It is generally used when the patients are not eligible for surgery. Liver-directed therapy helps in stopping or slowing the growth of the tumor.
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