Diagnosis and Treatment

Diagnosis

The presence of such tumors is detected on the basis of the patient’s symptoms, and special laboratory blood tests. Radiological tests such as X-rays, CT scans, MRI, ultrasound and isotope can often detect these tumors.

Surgical Treatment Options

At present the only cure for a carcinoid or any other NET is the removal of the entire tumor and any spread by surgery. In select cases, surgery may cure the disease if the tumor is localized and low-grade. The Mount Sinai is the first in the world to offer a procedure called EVOTE (Endovascular Occlusion Tumor Excision) for NETs. This procedure involves occlusion of blood vessels to aid in the resection of neuroendocrine tumors.

Liver resection may also be performed in conditions where NETs have metastasized to the liver. This entails removing segments of the liver containing the tumors.

Medical Treatment Options

In cases where NETs cause carcinoid syndrome, continue to progress or metastasize, medications called somatostatin analogues (SSA) are often prescribed. SSAs inhibit the release of hormones from NETs, thereby often providing symptom relief.

Targeted chemotherapy drugs such as everolimus or sunitinib may be administered. Compared to classic chemotherapy drugs, these drugs generally have fewer toxic effects. In cases where tumors have a higher grade, conventional chemotherapy drugs such as capecitabine, temozolomide, cisplatin, carboplatin and etoposide are considered.

A potential complication of carcinoid tumors is scarring of the heart valves, specifically the right side of the heart. When this happens, carcinoid heart disease occurs. The scarring is due to hormones such as serotonin and bradykinin, which are among the hormones overproduced by NETs. When there is carcinoid heart disease, consultation with cardiology and cardiac valve replacement are necessary.

Mount Sinai has a robust interventional radiology program. It is recognized as one of the leaders in image-guided therapies in the country. NET procedures offered at the program include embolization and Peptide Receptor Radionuclide Therapy (PRRT).

When most tumors are confined to the liver, a procedure called embolization may be done. This process involves decreasing the blood supply to the tumors of the liver. A blood vessel called an artery is accessed to deliver embolization. Radiation or chemotherapy may be added in this procedure. Thus, three types of embolization are available: bland embolization, radioembolization and chemoembolization.

At Mount Sinai, we also administer a systemic radiation therapy for NETs. This is called Peptide Receptor Radionuclide Therapy (PRRT). A radiation is administered through the bloodstream, and the radiation is coupled with a protein that is drawn to carcinoid tumors. At our institution, we have an expanded access program for PRRT, allowing more patients to be candidates for this treatment.