Neuroendocrine Tumor (NET) Treatment

About Neuroendocrine Tumors (NETs)

At Penn Medicine, patients with neuroendocrine tumors receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of cancer.

Penn's Neuroendocrine Tumor Program treats the following:

  • Gastroenteropancreatic neuroendocrine tumors (GEP-NETs)
    • Alimentary tract (carcinoid tumors)
    • Pancreatic endocrine tumors (PETs)
  • Pheochromocytomas/paragangliomas (PHEOs)
  • Other neuroendocrine tumors (NETs)

Penn Medicine offers one of the only dedicated NET programs in the country with the combined expertise to treat both GEP-NETs and PHEOs. In addition, Penn's program is the first and only one of its kind in the mid-Atlantic region.

Penn Medicine's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

About Neuroendocrine Tumors

Neuroendocrine tumors (NETs) form from cells that release hormones in response to a signal from the nervous system. Some examples of neuroendocrine tumors are carcinoid tumors, islet cell tumors, phechromocytomas and Merkel cell cancers.

Neuroendocrine tumors are often small and can be malignant (cancerous) or benign (non-cancerous). Carcinoid tumors most commonly develop in the gastrointestinal tract including the esophagus, stomach, small intestine, appendix and colon. Rarely, carcinoid tumors occur in the lungs and bronchial tissue. Pancreatic neuroendocrine tumors (PETs) typically develop in the pancreas and duodenum.

Not all NETs cause symptoms. However, because they originate from hormone producing tissues, the symptoms they cause can be linked to the release of various hormones into the blood stream causing:

  • Facial flushing
  • Diarrhea
  • Shortness of breath
  • Abdominal pain
  • Low blood sugar
  • Wheezing
  • A feeling of abdominal fullness

Read more About Neuroendocrine Tumors (NETs)

Diagnosing Neuroendocrine Tumors (NETs)

An accurate diagnosis from trusted tumor specialists is the first step in getting personalized treatment options to treat neuroendocrine tumors.

Patients who choose Penn Medicine, benefit from a multidisciplinary team of cancer and tumor specialists including gastroenterologists, radiologists, pathologists and surgeons who work together to provide a diagnosis and treatment plan designed specifically for each patient with neuroendocrine tumors.

Cancer specialists at Penn Medicine are highly experienced in using the most advanced techniques for diagnosing cancer and are actively researching better and more precise ways to detect neuroendocrine tumors.

Navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right person. Penn Medicine’s contact center has experienced cancer nurses available and ready to guide patients in finding the cancer specialist right for them.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more Diagnosing Neuroendocrine Tumors (NETs)

Neuroendocrine Tumor (NET) Treatment

Penn Medicine offers one of the only dedicated neuroendocrine tumor (NET) programs in the country with the combined expertise to treat both gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and pheochromocytomas and paragangliomas (PHEOs). In addition, Penn Medicine’s program is the first and only one of its kind in the region.

Following the diagnosis and staging of neuroendocrine tumors, cancer specialists at Penn’s Abramson Cancer Center develop a personalized treatment plan. Penn’s treatment options for neuroendocrine tumors include:

  • Surgery
    • Local and local-regional excision
    • Debulking surgery, including liver resection
    • Radiofrequency ablation
    • Liver transplantation
  • Chemotherapy and biologic therapies
    • Hormone therapy
      • Octreotide
      • Proton pump inhibitors (PPIs)
    • Liver-directed therapies
      • Ethanol injection
      • Chemoembolization of the hepatic artery
    • Chemotherapy
    • Targeted therapy
  • External-beam radiation therapy
  • Clinical trials
  • Other treatments
    • Integrative medicine and wellness
    • Palliative care
    • Penn Home Care and Hospice

Because navigating a cancer diagnosis and its treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can assist in making an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN.


Surgery for Neuroendocrine Tumors

Many carcinoid tumors are successfully treated with surgery, and surgery is the first line of treatment for patients with NETs. Complete removal of the entire tumor is the standard treatment whenever possible. When complete removal of the tumor is not possible, surgeons often remove as much of the tumor as they can to provide some relief from symptoms and possibly improve outcomes.

Penn Medicine has one of the largest gastrointestinal surgical programs in the United States with a nationally recognized record for high-quality patient care and survivorship. Penn Medicine has better outcomes for patients with resection surgeries.

There are two types of surgery:

  • Resection (to cut off or remove the tumor)  for a cure
  • Debulking (to remove by cutting the major part of a tumor that cannot be completely removed surgically), to control symptoms or improve outcomes

Local and local-regional excision

Surgeons remove the primary tumor and a margin of tissue around the primary location in local NETs. Lymph nodes may also be removed in local-regional surgeries. Most localized tumors can be surgically removed through a skin incision, but rectal or gastroduodenal carcinoid tumors may be removed using an endoscope.

Debulking surgery, including liver resection

Debulking surgery removes resectable (able to be removed) sections of the tumor, in particular areas of metastases or where the tumor has spread. It often helps relieve or reduce hormonal or tumor symptoms and may improve outcomes.

Liver transplantation

A liver transplant removes the entire liver and replaces it with a healthy donated liver. Liver transplantation is rarely used in the treatment of carcinoid tumors, but it may help younger patients whose tumors cannot be removed by resection.

Radiofrequency ablation

Sometimes used for carcinoid tumors and metastases, radiofrequency ablation destroys the tumor by heating it with an electric current.

Chemotherapy and Other Biologic Therapies for Neuroendocrine Tumors

Penn Medicine specializes in a team approach to chemotherapy treatment with interdisciplinary care and innovative approaches to target tumors prior to surgery.

Hormonal therapy

Hormonal therapy manipulates the endocrine system. Because NETs derive from hormonally responsive tissues, and may produce secretions that affect hormone levels in the body, this treatment may alleviate symptoms and inhibit tumor growth.

Octreotide
Octreotide is a synthetic hormone that inhibits the release of multiple peptides in the body relieving symptoms from NETs.

Proton pump inhibitors (PPIs)
PPIs are a group of drugs that reduce gastric acid production .

Liver-directed therapy

Chemoembolization of the hepatic artery
Injecting an anticancer drug into the hepatic artery, which supplies blood to the liver, blocks blood flow to the liver and disrupts the blood supply to the tumor.

Targeted therapies

Penn’s medical oncologists are combining personalized care with personalized medicine to create targeted therapies for the treatment of cancer. Targeted therapies act as certain molecular pathways leading to tumor suppression.

Chemotherapy

Chemotherapy uses drugs delivered through the bloodstream to kill cancer cells throughout the body. Chemotherapy for a carcinoid tumor is most often used when the tumor has spread to other organs or is causing severe symptoms. This type of tumor rarely responds to chemotherapy alone, and other treatments may be necessary.

External-beam radiation therapy

Because NETs can occur in multiple locations, and may be different types of tumors (functioning vs. non-functioning) the type of radiation therapy used for NETs depends on the type of tumor.

Radiation oncologists at Penn Medicine are recognized for developing and using techniques that target radiation precisely to the disease site while sparing nearby tissue.

External beam radiation therapy, most common type of radiation treatment, is delivered by a machine outside the body.  A radiation therapy schedule usually consists of a specific number of treatments given over a specific time. External-beam radiation therapy is the most common radiation treatment for carcinoid tumors, and it is most often used to relieve symptoms from cancer that has spread to the bone.

Clinical Trials for Neuroendocrine Tumors

Today, more and more people are surviving cancer. Clinical trials, many of which are conducted at Penn Medicine, benefit patients through breakthrough therapies and treatments. These new advances in cancer treatment are occurring every day, giving patients hope that even greater discoveries lie ahead. Through clinical trials:

  • Diagnosing cancer has become more precise.
  • Radiation and surgical techniques have advanced.
  • Medications are more successful.
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
  • Strategies to address the late effects of cancer and its treatment are improving quality of life.

Penn Medicine is the only health care facility in the country that is using proton therapy to treat recurrent gastrointestinal tumors in clinical trials. Also, radiation oncologists at Penn Medicine will soon use proton therapy to treat gastrointestinal cancers in the upper digestive tract.

Other Treatments for Neuroendocrine Tumors

In addition to standard treatments and clinical trials, patients at Penn Medicine may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy. These therapies do not have curative intent, and are designed to complement standard treatments, not take their place.

Integrative Medicine and Wellness Programs

At Penn Medicine, integrative medicine and wellness services can supplement traditional cancer treatments such as chemotherapy, surgery and radiation therapy. While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer patients ways to enhance the quality of their lives, minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

Cancer specialists at Penn Medicine are knowledgeable and supportive of complementary cancer treatments. The cancer team works with patients and families to integrate these supportive programs into the overall care plan, while ensuring the safety and health of patients.

The Abramson Cancer Center’s range of integrative supportive services is designed to help patients cope with the cancer experience and improve their overall sense of well-being. Services include:

The Abramson Cancer Center at Pennsylvania Hospital at Pennsylvania Hospital offers a variety of supportive care programs for patients and families, from diagnosis through survivorship. These programs are available at no cost to the patients treated at Pennsylvania Hospital, and some are open to patients treated elsewhere. These services include social work counseling, nutrition counseling, psychological counseling and spiritual counseling.

The Cancer Appetite and Rehabilitation Clinic focuses on patients experiencing loss of appetite and weight.

The Supportive Care Clinic helps to manage cancer-related symptoms. Integrative support programs include:

Support groups and educational programs are available at Pennsylvania Hospital throughout the year.

Palliative Care

Palliative care provides medical and non-medical interventions to ease the symptoms of cancer and its treatment. Palliative care includes physical, emotional and spiritual care that can enhance the quality of life for cancer patients.

Palliative care can be used to complement traditional cancer therapies, to treat symptoms or to improve quality of life and when curative therapies are no longer an option.

Palliative care is an approach to patient care that can be integrated with curative therapies at any point from diagnosis to survivorship or end-of-life care.

Palliative care services include chemotherapy, radiation therapy and surgery as well as psychological counseling, art therapy and support groups for patients and families. The goals of palliative care are to enhance the quality of life for cancer patients and their families, and provide emotional and spiritual support to enhance personal growth.

Palliative care services are offered at Pennsylvania Hospital, and at the Hospital of the University of Pennsylvania.  

Penn Home Care and Hospice Services

Penn Home Care and Hospice Services offer a full range of home health care needs by partnering three top-level home health care services under one roof:

Penn Home Care and Hospice Services offer an array of specialized therapies and medications for patients with cancer and cancer-related conditions.

Oncology Navigation Specialists

Every step of cancer treatment – from cancer diagnosis, through treatment to forming a survivorship plan – comes with different needs and issues that should be addressed.

Oncology Navigation Specialists at the Abramson Cancer Center are available to the experience as seamless as possible. As experts in navigating complex health care situations, Patient Navigation specialists serve as a consistent point of contact and a reliable source for advice, support and direction for patients and families. They can help in a variety of ways including provide emotional support, identify resources, and ensure access to information, support services, educational programs and community resources.

Learn more about Patient Navigation specialists at the Abramson Cancer Center.

Neuroendocrine Tumor Survivorship

Patients with neuroendocrine tumors may require more follow-up care than other patients.

Some neuroendocrine tumor patients may require follow-up treatment using biotherapies, or other medications. Others may require more frequent imaging tests. Patients at Penn Medicine receive a personalized survivorship care plan that addresses all issues from follow-up care to the physical, emotional and financial complications that can occur long after their therapy is complete.

Survivorship programs at Penn Medicine are a distinct phase of neuroendocrine tumor care and are designed to help patients' transition from treatment to a post-treatment lifestyle.

Read more Neuroendocrine Tumor (NET) Survivorship


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