Treatment of Lung Carcinoid, by Type and Extent of Disease

The treatment of lung carcinoid tumors depends largely 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 Lung Carcinoid Tumor Stages) to formally describe the extent of these cancers. But for treatment purposes most doctors use a simpler system, dividing these tumors into 2 groups:

• Resectable tumors: those that can be treated with surgery
• Unresectable tumors: those that can’t be removed completely by surgery

Resectable lung 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.

For people who are healthy enough to withstand it, 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 further 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 treatments lower the chance of the cancer coming back, or if they help people live longer.

Unresectable lung carcinoid tumors

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

Treatment depends on the stage of the cancer, where the cancer is, whether it is a typical or atypical carcinoid, and whether you have symptoms of the carcinoid syndrome.

For stage IIIA cancers in people who can’t have surgery, experts typically recommend radiation to treat typical carcinoids, and chemotherapy (chemo) and radiation for atypical carcinoids.

Some type of systemic treatment is often recommended for more advanced cancers (stages IIIB and IV), sometimes along with radiation therapy. Somatostatin analogs like octreotide (Sandostatin) or lanreotide (Somatuline) can be helpful for patients who have carcinoid syndrome or whose tumors can be seen on somatostatin receptor scintigraphy (OctreoScan). Chemo and targeted therapy are also options.

In general, typical carcinoids tend to grow slowly, and chemotherapy is often not very successful. If you have only a small number of tumors that can be removed, surgery (both on 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 with standard surgery, another option might be to have a liver transplant. This is a very complex 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 Supportive Procedures for Lung Carcinoid Tumor Symptoms.

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.