Surgery for neuroendocrine cancer

Surgery is a medical procedure to examine, remove or repair tissue. Surgery, as a treatment for cancer, means removing the tumour or cancerous tissue from your body.

Surgery is often used to treat neuroendocrine tumours (NETs). It’s sometimes used to treat neuroendocrine carcinomas (NECs) if they are at an early stage and haven’t spread. The type of surgery you have depends mainly on where the tumour is located. When planning surgery, your healthcare team will also consider other factors, such as your age, overall health and whether the tumour makes and releases hormones (is functional).

Surgery may be the only treatment you have, or it may be used along with other cancer treatments. You may have surgery to:

• completely remove the tumour
• remove lymph nodes that have cancer
• remove as much of the tumour as possible before other treatments
• reduce pain or ease symptoms (called palliative surgery)

Carcinoid crisis is a serious and possibly life-threatening problem that happens when a NET releases too much serotonin and other substances. 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 somatostatin analogues (a type of hormone therapy drug) before surgery.

The following types of surgery are used to treat neuroendocrine cancer.

Resection completely removes the tumour along with some healthy tissue around the tumour. It’s the main treatment for most neuroendocrine cancers that are only in the organ where the cancer started (local tumours).

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 tumour.

A local excision or an endoscopic resection removes early-stage tumours on the inner lining of the organ, often using an endoscope. It can be done for gastrointestinal neuroendocrine cancer, including tumours in the stomach, duodenum, ileum, appendix or rectum.

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

A gastric resection or a gastrectomy removes part or all of the stomach through a cut (incision) in the abdomen. It’s done for neuroendocrine cancer in the stomach. Find out more about surgery for stomach cancer.

An appendectomy removes the appendix. It’s used to treat small tumours of the appendix.

A 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 neuroendocrine cancer of the duodenum or pancreas. Find out more about a Whipple procedure.

A 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.

A lung resection removes part or all of a lung. It’s mainly used for typical and atypical carcinoid tumours. It may be used for large cell NECs that are at an early stage. A wedge resection, lobectomy or pneumonectomy may be done. Find out more about surgery for non–small cell lung cancer.

A total thyroidectomy removes the whole thyroid. It’s usually the first treatment for medullary carcinoma (medullary thyroid cancer). Find out more about surgery for thyroid cancer.

A liver resection removes part of the liver. It may be done when neuroendocrine cancer 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’s 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 neuroendocrine cancer 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’s 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. 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). Find out more about liver-directed therapy for neuroendocrine cancer, 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 (poop), bile or air can flow normally. It may be done to treat or prevent a blockage (obstruction).

Side effects of surgery will depend mainly on the type of surgery, where it’s done in the body and on your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Surgery for neuroendocrine cancer may cause the following side effects:

• infections
• bleeding
• nausea and vomiting
• weight loss
• diarrhea
• constipation

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.