Treating Neuroendocrine Tumors: Top Surgical Options For Patients

A neuroendocrine tumor, also known as a NET, is a rare tumor that begins in specialized cells called neuroendocrine cells. These cells are found throughout the body, and they release hormones in response to signals from the nervous system. There are many types of NETs and their behavior can vary. They can be both benign (non-cancerous) and malignant (cancerous). NETs most commonly develop in the lungs, gastrointestinal tract and pancreas.

Developing a neuroendocrine tumor is rare, but if you or a loved one has been faced with this diagnosis, the Ochsner Neuroendocrine Tumor Program and its team of experts can develop a treatment plan tailored to the needs of each patient.

Treating NETs with surgery

There are several surgical options for patients with neuroendocrine tumors. The Neuroendocrine Tumor Research Foundation says the type of surgery performed will depend on the tumor’s location and stage of advancement. A surgeon may also consider a patient’s age and overall health. During surgery, the tumor and surrounding healthy tissue is removed. Removing the entire tumor is the standard treatment, when possible. When removing the tumor is not possible, debulking surgery is sometimes recommended. Debulking surgery removes as much of the tumor as possible and may provide some relief from symptoms. However, it does not cure neuroendocrine cancer and requires monitoring to detect new growth.

For neuroendocrine tumors in the pancreas, patients may undergo one or more of these surgeries:

• Cytoreduction: Surgery to remove cancer that has spread to the other parts of the body, including the liver.
• Distal pancreatectomy: Surgery to remove a portion of the pancreas. This type of surgery may also be performed if a tumor is found in the spleen.
• Whipple surgery: (also known as a pancreatoduodenectomy) is a surgical procedure in which the head of the pancreas, the gallbladder, nearby lymph nodes and part of the stomach, small intestine and bile duct are removed.

During surgery, a doctor may discover the cancer has grown too far to be completely removed. If this happens, the operation may be stopped, or the surgeon might continue with a smaller operation to help prevent or relieve symptoms. This is because the planned operation would be unlikely to cure the cancer and could still lead to major side effects. It would also make the recovery time longer, which could delay other treatments. Many of these types of surgery are complex and can be difficult for patients. They can cause complications and can take weeks or months to make a full recovery.

Surgery can be performed on patients who have a neuroendocrine tumor in their lung(s). One such procedure is a lobectomy. Your surgeon will remove a whole lobe, or section, of the affected lung. A lymph node dissection is a different form of surgery where lymph nodes are removed to check for or prevent the cancer from spreading. Other surgeries can include:

• Pneumonectomy: Surgery to remove one whole lung
• Sleeve resection: Surgery to remove the tumor and part of the bronchus (airway). It is also called a “lung-sparing” surgery.
• Wedge resection: Surgery to remove a tumor and some of the healthy tissue around it in the shape of a small wedge. If a larger amount of tissue is taken, it is called a segmental resection.

Many gastrointestinal tumors can be cured with surgery. Many of these surgical options will depend on several factors, including the size and location of the tumor and if the patient has other serious diseases. Because neuroendocrine tumors grow slowly and some do not cause any symptoms, removing the full tumor may not always be needed. In some patients, surgery to remove all signs of cancer is the best option. Several types of operations can be used to treat gastrointestinal tumors, including:

• Endoscopic resection: The tumor is removed through an endoscope (a thin, tube-like instrument with a light). This is most often used to treat small tumors of the stomach and duodenum (the first part of the small intestine) and it also can be used to remove small tumors of the rectum.
• Local excision: This operation removes the primary tumor and some normal tissue around it. This usually does not cause any prolonged problems with eating or bowel movements. This operation is usually done to remove small tumors.
• Partial gastrectomy: Part of the stomach is removed. If the upper part is removed, sometimes part of the esophagus is removed as well. If the lower part of the stomach is removed, sometimes the first part of the small intestine (the duodenum) is also taken out. Nearby lymph nodes may also be removed. This operation is known as a subtotal gastrectomy.
• Small bowel (intestine) resection: An operation to remove a piece of the small intestine (also called the small bowel). When it is used to treat a small bowel NET, this surgery includes removing the tumor and some of the small bowel around it. It will also remove nearby lymph nodes and the tissue that contains lymph nodes and vessels that carry blood to and from the intestine. Tumors in the last part of the small bowel may require removing the right side of the colon.
• Segmental colon resection or hemicolectomy: This operation removes between one-third and one-half of the colon, as well as the nearby layers of tissue that hold and connect the intestines, which includes blood vessels and lymph nodes.
• Low anterior resection: This operation can be used for some tumors in the upper part of the rectum. It removes some of the rectum and the remaining ends are sewn together.

The Ochsner Neuroendocrine Tumor Program team takes an aggressive approach to the treatment of NETs. Most patients will benefit from a combined treatment approach that incorporates both non-surgical and surgical options. The Ochsner Neuroendocrine Tumor Program is one of the largest NET programs in the country, a leader in the diagnosis and management of all forms of neuroendocrine tumors. Our team’s dedication has led to superior outcomes for patients with NETs in the United States and abroad. To learn more about our program, visit Ochsner.org/nets.

Learn more about our team of surgeons, medical oncologists, radiologists and nuclear medicine physicians: https://www.ochsner.org/services/neuroendocrine-tumor-program/meet-the-team.

Learn more about Dr. Jacob Dowden.