Lung Carcinoid Tumor

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Treating Lung Carcinoid Tumor TOPICS

Treatment of lung carcinoid by type and extent of disease

The treatment of lung carcinoid tumors depends to a large extent on the type (typical versus atypical) and extent of the cancer. Other factors, such as a person’s overall health and ability to withstand surgery, are also important.

Many doctors use the TNM staging system (see the section “How are lung carcinoid tumors staged?”) to formally describe the extent of these cancers. But for treatment purposes most doctors use a simpler system, dividing these tumors into 2 groups: those that can be treated with surgery (resectable cancers) and those that can’t be removed completely (unresectable cancers).

Resectable carcinoid tumors

Resectable carcinoid tumors haven’t spread far beyond where they started and can be removed completely. In the TNM staging system, this includes most stage I, II, and IIIA cancers.

These cancers are treated with surgery. The extent of the surgery depends on the type of carcinoid tumor and the size and location of the cancer. Atypical carcinoids may need more extensive surgery than typical carcinoids. Nearby lymph nodes are usually removed as well, especially if you have an atypical carcinoid.

Most patients with resectable lung carcinoid tumors are cured with surgery alone and don’t need other treatments. Some experts recommend additional treatment for people with an atypical carcinoid that has spread to lymph nodes. This can be chemotherapy, radiation therapy, or both. But it’s not clear if the added therapy lowers the chance of the cancer coming back, or if it helps people live longer.

Unresectable carcinoid tumors

Unresectable carcinoid tumors include those that have grown too much or spread too far to be removed completely by surgery (including most stage IIIB and stage IV cancers), as well as tumors in people who are not healthy enough for surgery.

Treatment depends on where the cancer is and whether you have symptoms of the carcinoid syndrome. In general, this is a slow-growing cancer, and chemotherapy has not proven to be very successful. If you have only a small number of tumors that can be removed, surgery (on both the lung and at the site of metastasis) is likely to be your best option.

Lung carcinoid tumors usually spread to the liver first. If the carcinoid has spread only to your liver but can’t be removed there with standard surgery, another option might be to have a liver transplant. This is a very involved operation that most doctors still consider experimental. It is done at only a few transplant centers.

If the carcinoid is in your liver and is causing symptoms, procedures such as ablation or hepatic artery embolization may be helpful. They may relieve symptoms or slow the growth of the cancer, but are very unlikely to result in a cure. These treatments are discussed in detail in the section on surgery.

If tumors in your liver are too large or numerous to be treated directly, or if the carcinoid has spread to other parts of your body, then drug therapy can be helpful. The drugs octreotide and lanreotide, which can slow the growth of the cancer and stop the secretion of the chemicals that cause the carcinoid syndrome, are often helpful. Sometimes these drugs can actually shrink the cancers. Another drug, interferon alfa, can act the same way. Sometimes these 2 types of drugs are given together. Newer targeted drugs such as sunitinib (Sutent) and everolimus (Afinitor) may be helpful as well, although this still needs to be proven. Adding chemotherapy may also help reduce symptoms, but it seldom shrinks the tumor much more.

For people with earlier stage cancers who can’t have surgery, most doctors recommend radiation therapy for typical carcinoids and chemotherapy plus radiation therapy for atypical carcinoids.

External radiation therapy can also be used to relieve symptoms caused by tumors such as bone pain. For more widespread disease, radioactive drugs may be helpful.

Recurrent carcinoid tumors

When cancer comes back after treatment, it is called a recurrence. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the liver or bone).

Carcinoid tumors can sometimes come back, even several years after the initial treatment. If this happens, further treatment options depend on where the cancer is and what treatments have already been used. Cancers that recur locally or in only 1 or 2 areas can sometimes be treated with further surgery. If surgery is not an option, radiation therapy, chemotherapy, or other drugs may be tried. Because recurrent cancers can often be hard to treat, clinical trials of new types of treatment may be a good option.

Last Medical Review: 11/13/2013
Last Revised: 11/13/2013