Surgery for neuroendocrine tumours (NETs)

Surgery is usually used to treat neuroendocrine tumours (NETs). Most people with NETs benefit from surgery when it can be done. The type of surgery you have depends mainly on where the cancer is located. When planning surgery, your healthcare team will also consider other factors, such as your age, overall heath and whether the tumour makes and releases hormones (is functional).

Surgery may be done for different reasons. You may have surgery to:

• completely remove the tumour
• remove as much of the tumour as possible before other treatments
• relieve or prevent symptoms

Carcinoid crisis is a serious and possibly life-threatening problem that happens when too much serotonin and other substances are released by a tumour. It causes a severe case of flushing of the skin, low blood pressure, difficulty breathing and an irregular heartbeat. Carcinoid crisis may happen when an anesthetic is given or the tumour is touched during surgery. To control hormone levels and prevent carcinoid crisis, doctors usually give a somatostatin analogue drug such as octreotide (Sandostatin) or lanreotide (Somatuline Autogel) before surgery.

The following types of surgery are used to treat NETs. You may also have other treatments before or after surgery.

Resection is surgery that completely removes the tumour along with some healthy tissue around the tumour. It is the main treatment for most NETs that are only in the organ where the cancer started (local tumours). Resection is also called curative surgery.

The type of resection done usually depends on where the tumour is located and the size of the tumour. One of the following types of resection may be done to remove a NET.

Local excision or endoscopic resection removes early stage tumours on the inner lining of the organ often using an endoscope. It can be done for small gastrointestinal (GI) NETs, including those in the stomach, duodenum, ileum, appendix or rectum.

Bowel resection removes part of the small intestine, large intestine or both. It is used for tumours of the small intestine, appendix, colon or rectum. Find out more about a bowel resection.

Gastric resection or gastrectomy removes part or all of the stomach through a cut (incision) in the abdomen. It is done for NETs in the stomach. Find out more about surgery for stomach cancer.

Appendectomy removes the appendix. It is used to treat small NETs of the appendix.

Whipple procedure removes all or part of the pancreas along with part of the stomach, the duodenum, the gallbladder and part of the bile duct. It may be used for NETs of the duodenum or pancreas. Find out more about a Whipple procedure.

Distal pancreatectomy removes the narrow part of the pancreas (called the tail). Sometimes part of the middle section of the pancreas (called the body) is also removed. Find out more about surgery for pancreatic cancer.

Lung resection removes part or all of a lung. It is mainly used for typical and atypical carcinoid tumours. It may be used for early stage large cell neuroendocrine carcinomas. A wedge resection, lobectomy or pneumonectomy may be done. Find out more about surgery for lung cancer.

Total thyroidectomy removes the whole thyroid. It is usually the first treatment for medullary carcinoma (medullary thyroid cancer). Find out more about surgery for thyroid cancer.

Liver resection removes part of the liver. It may be done when a NET has spread to the liver (called liver metastases). Find out more about liver metastases.

A lymph node dissection is surgery to remove lymph nodes. It is usually done when the doctor thinks there is cancer in nearby lymph nodes based on the results of imaging tests and the size of the primary tumour. A lymph node dissection is often done at the same time as a resection.

The type of lymph node dissection done depends on where the NET started.

Find out more about a lymph node dissection.

Cytoreductive surgery removes a large amount of the cancer or as much cancer as possible. It is sometimes called debulking. Cytoreductive surgery is done when a complete resection can’t be done, but doctors think the cancer can be completely destroyed with treatments (called curative intent). It may be done to help other treatments, such as chemotherapy or radiation therapy, work better.

Cytoreductive surgery for liver metastases may be done using other surgical techniques, such as radiofrequency ablation (RFA). These techniques are done by surgeons with special experience so may not be available at all treatment centres. Find out more about liver directed therapy, including RFA.

Palliative surgery is done to control and relieve symptoms of advanced neuroendocrine cancer and improve quality of life rather than treat the disease. It may include the following.

Debulking removes as much cancer as possible. It may be done if a large tumour causes symptoms or blocks the intestine, an airway or other vital structure.

Bypass surgery creates a bypass or passage to go around a blocked (obstructed) area. It can also be used to relieve pain or pressure caused by a tumour.

Stent placement has the doctor place a metal mesh-like tube (stent) in the organ or duct to keep it open so substances like stool, bile or air can flow normally. It may be done to treat or prevent a blockage (obstruction).

Side effects can happen with any type of treatment for NETs, but everyone’s experience is different. Some people have many side effects. Other people have only a few side effects.

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type of surgery, where it is done in the body and your overall health.

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.