Digestive Diseases - Gastroenterology

Diagnosis and Treatment

With reported symptoms that indicate neuroendocrine (NET) and carcinoid tumors, your specialist will want to perform confirming tests before developing your treatment plan.

Diagnosis

To make a proper diagnosis, we perform special laboratory blood tests. In addition, we may use diagnostic radiological tests such as X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), ultrasound, and isotope to detect these tumors.

Treatments We Offer

Currently, surgery to remove the entire tumor and any effected tissue that has spread is the most effective treatment. Our surgeons perform two main types of surgery to treat NETs: EVOTE and liver resection.

Surgery for NET

In select cases, surgery may cure the disease if the tumor is localized and low-grade.

  • EVOTE: Endovascular occlusion tumor excision (EVOTE) procedure involves the blocking (occlusion) of blood vessels to aid in the removal (resection) of neuroendocrine tumors. Mount Sinai is the first in the world to offer EVOTE.
  • Liver resection: This surgical procedure involves removing segments of the liver when the tumors originated in the liver or have metastasized to the liver.

Medicine for NET

If NETs cause carcinoid syndrome by continuing to progress or metastasize, we prescribe somatostatin analogues (SSA) medications. SSA inhibits the release of hormones from NETs, thereby often providing symptom relief.

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

Treating NET complications

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.

Interventional radiation

Mount Sinai has a robust interventional radiology program. We are 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) to block or destory the tumor.

Embolization

When most tumors remain in the liver, we may perform an embolization procedure. This process involves decreasing the blood supply to the tumors of the liver. We access a blood vessel (artery) to deliver the embolization or blockage to cut off the blood supply to the tumor. We may use radiation or chemotherapy during this procedure. We use three types of embolization: bland embolization that uses a catheter, radioembolization that uses radiology, and chemoembolization that uses chemotherapy.

Peptide receptor radionuclide therapy

At Mount Sinai, we also administer a systemic radiation therapy for NETs known as peptide receptor radionuclide therapy (PRRT). We administer radiation through the bloodstream along with a protein that is drawn to carcinoid tumors.

At Mount Sinai, we offer the treatment that is right for you based on your condition and personal needs.