Supportive Procedures for Lung Carcinoid Tumor Symptoms

If you can’t have major surgery because your lung function is at a low level or you have other serious medical problems, or if the cancer has spread too much to be removed, other treatments may be used to relieve some symptoms.

These treatments, called palliative procedures, can relieve symptoms, but they do not cure the cancer and are recommended only if you can’t have surgery to completely remove the tumor. If you are treated with these procedures you may also get radiation therapy.

Treating airway blockage

If the tumor is blocking airways in the lung, it might lead to pneumonia or shortness of breath. Removing most of the tumor through a bronchoscope or destroying most of it with a laser (on the end of a bronchoscope) can be helpful. In some cases, a bronchoscope may be used to place a stent (a stiff tube) made of metal or silicone in the airway after treatment to help keep it open.

Treating fluid buildup

In rare instances, fluid can build up inside the chest (outside of the lungs), press on the lungs and affect breathing. Usually, a hollow needle is put through the skin and into the pleural space to remove the fluid. (This is known as a thoracentesis.) For most people, removing the fluid can relieve breathing problems right away, but the fluid will often build up again quickly if nothing else is done.

Pleurodesis

To remove the fluid and keep it from coming back, doctors sometimes do a procedure called pleurodesis. A small cut is made in the skin of the chest wall, and a hollow tube is placed into the chest to remove the fluid. Either talc or a drug such as doxycycline or certain chemotherapy drugs (like bleomycin) is then instilled into the chest cavity. This causes the linings of the lung (visceral pleura) and chest wall (parietal pleura) to stick together, sealing the space and limiting further fluid buildup. The tube is often left in for a day or two to drain any new fluid that might collect.

Catheter placement

This is another way to control fluid buildup. One end of the catheter (a thin, flexible tube) is placed in the chest through a small cut in the skin, and the other end is left outside the body. This is done in a doctor’s office or hospital. Once in place, the catheter can be attached to a special bottle or other device to allow the fluid to drain out on a regular basis.

Procedures to relieve symptoms of liver metastases

If the cancer spreads to the liver, treating the liver tumors may help with symptoms. When there are only 1 or 2 tumors in the liver, they may be removed with surgery. If there are more than just a few liver tumors (or if a person is too sick for surgery), other techniques may be used.

Ablation

Ablation techniques destroy tumors without removing them. They are generally not used for large tumors, and are best for tumors no more than about 2 cm (a little less than an inch) across.

• Radiofrequency ablation (RFA) uses high-energy radio waves for treatment. A thin, needle-like probe is placed through the skin and into the tumor. Placement of the probe is guided by ultrasound or CT scans. The tip of the probe releases a high-frequency current that heats the tumor and destroys the cancer cells.
• Ethanol (alcohol) ablation (also known as percutaneous ethanol injection) kills the cancer cells by injecting concentrated alcohol directly into the tumor. This is usually done through the skin using a needle guided by ultrasound or CT scans.
• Microwave thermotherapy uses microwaves to heat and destroy cancer cells.
• Cryosurgery (cryotherapy) destroys a tumor by freezing it with a metal probe. The probe is guided through the skin and into the tumor using ultrasound. Then very cold gasses are passed through the probe to freeze the tumor, killing the cancer cells. This method may be used to treat larger tumors compared to the other ablation techniques, but it sometimes requires general anesthesia (where you are asleep).

Embolization

Arterial embolization (also known as transarterial embolization or TAE): This is another option for tumors that can’t be removed completely. It can be used for larger tumors (up to about 5 cm or 2 inches across). This technique reduces the blood flow to the cancer cells by blocking the branch of the hepatic artery feeding the area of the liver containing the tumor. Blood flow is blocked (or reduced) by injecting materials that plug up the artery. Most of the healthy liver cells will not be affected because they get their blood supply from the portal vein.

In this procedure a catheter is put into an artery in the inner thigh and threaded up into the liver. A dye is then injected into the bloodstream to allow the doctor to monitor the path of the catheter via angiography, a special type of x-ray. Once the catheter is in place, small particles called microspheres are injected into the artery to plug it up.

Radioembolization: In the United States, this is done by injecting small radioactive beads into the hepatic artery. The beads travel to the tumor and give off small amounts of radiation only at the tumor sites.