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Cancer Medicine :: Lung Carcinoid Tumor

Lung Carcinoid Tumor

Making treatment decisions for lung carcinoid tumors

After the tumor is found and staged, your cancer care team will discuss your treatment options with you. The main factors in selecting a treatment for lung carcinoid tumors are the type of carcinoid, the size and location of the tumor, whether it has spread to lymph nodes or other organs, and if you have any other serious medical conditions. Based on these factors, the main treatment options for people with lung carcinoid tumors may include:

Surgery

Chemotherapy

Other drug treatments

Radiation therapy

In some cases, more than one of these treatments may be used.

Selecting a treatment plan is an important decision, and you should take the time to think about all of your choices. Seeking a second opinion is often a good idea if time permits. A second opinion may provide more information and help you feel more confident about the treatment plan you choose.

You may have different types of doctors on your treatment team, depending on the stage of your cancer and your treatment options. These doctors may include:

A thoracic surgeon: a doctor who treats diseases of the lungs and chest with surgery.

A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy.

A pulmonologist: a doctor who specializes in medical treatment of diseases of the lungs.

A radiation oncologist: a doctor who treats cancer with radiation therapy.

Many other specialists may be involved in your care as well, including nurse practitioners, nurses, respiratory therapists, social workers, and other health professionals.

The next few sections describe the various types of treatments used for lung carcinoids. This is followed by a description of the most common approaches based on the extent of the disease.

Surgery for lung carcinoid tumors

Surgery is the main treatment for lung carcinoid tumors whenever possible. If the tumor has not spread, it can often be cured by surgery alone. The type of surgery will depend on a number of factors, including the size and location of the tumor and whether you have any other lung problems or serious diseases. Thoracic and cardiothoracic surgeons are likely to have the most experience with these operations.

Several types of surgery are used to treat people with lung carcinoid tumors. Surgeons usually have to remove some normal lung tissue along with the tumor, but they try not to remove any more normal tissue than they need to.

These operations require general anesthesia (where you are in a deep sleep) and may also require surgical incision between the ribs in the chest (thoracotomy). You will generally need to spend about 5 to 7 days in the hospital after the surgery.

Sleeve resection

To treat central carcinoids in a large airway (such as a bronchus), the surgeon may do a sleeve resection. If you think of the large airway with a tumor to be like the sleeve of a shirt with a stain an inch or 2 above the wrist, the sleeve resection would be like cutting out the sleeve above and below the stain and sewing the cuff back onto the shortened sleeve. The surgeon may be able to do this type of operation instead of removing part or all of lung, as it can preserve more lung function.

Wedge resection

For small carcinoids found at the outer edges of the lungs away from the large airways, the surgeon may remove a wedge-shaped piece of the lung in an operation called a wedge resection or segmental resection.

Lobectomy

If it is not possible to do a sleeve or wedge resection because of the size or location of the tumor, the surgeon will usually do a lobectomy, in which an entire lobe of the lung is removed. In some cases 2 lobes may be removed (bilobectomy).

Pneumonectomy

In rare cases where the cancer is in many spots in a lung or is in a place that makes it hard to remove, the entire left or right lung may need to be removed in an operation called a pneumonectomy.

Lymph node sampling

With any of these operations, lymph nodes near the lungs are usually removed to look for possible spread of the cancer. This is important because about 10% of typical carcinoids and 30% to 50% of atypical carcinoids will have spread to lymph nodes by the time they are diagnosed. If these nodes are not removed, it might increase the risk of the carcinoid tumor spreading even farther, to other organs. If this happens, you may no longer be able to be cured by surgery. Looking under a microscope for cancer cells in the lymph nodes also provides some indication of your risk of having the cancer come back.

Video-assisted thoracic surgery (VATS)

This is a less invasive procedure for treating some cancers in the lungs. During this operation, a thin telescopic tube with a tiny video camera on the end is placed through a small hole in the chest to help the surgeon see inside the chest. One or two other small holes are created in the skin, and long instruments are passed though these holes to remove the tumor. Because only small incisions are needed, there is a little less pain after the surgery. Another advantage of this surgery is a shorter hospital stay – usually around 4 to 5 days.

Most experts recommend that only tumors smaller than 4 to 5 cm (about 2 inches) across be treated with this method. This would apply to most carcinoids. The cure rate after this surgery seems to be the same as using older techniques. It is important, though, that the surgeon doing this operation be experienced since it requires a great deal of technical skill.

Possible side effects of surgery

Possible complications depend on the extent of the surgery and the person's health beforehand. Serious complications can include excessive bleeding, wound infections, and pneumonia.

Because the surgeon must spread the ribs to get to the lung in patients having a thoracotomy, the incision will hurt for some time after surgery. Your activity will be limited for at least a month or two.

If your lungs are in good condition (other than the presence of the cancer) you can usually return to normal activities after a lobe or even an entire lung has been removed. If you also have non-cancerous diseases such as emphysema or chronic bronchitis (which are common among heavy smokers), you may become short of breath with activities after surgery.

Procedures to relieve symptoms from lung carcinoid tumors

If you can't have major surgery because of reduced lung function or other serious medical problems, or if the cancer is widespread, other treatments may be used to relieve some symptoms.

For example, if the tumor is blocking airways and it might lead to pneumonia or shortness of breath, removing most of the tumor through a bronchoscope or vaporizing most of it with a laser can be helpful. These treatments, called palliative procedures, can relieve symptoms, but they do not cure the cancer and are recommended only if you cannot have surgery to completely remove the tumor. If you are treated with these procedures you may also get radiation therapy .

Sometimes fluid can build up inside the chest (outside of the lungs), which can affect breathing. 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 a chemotherapy drug 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 preventing further fluid buildup. The tube is generally left in for a day or two to drain any new fluid that might collect.

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 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 the abnormal tissue.

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 than the other ablation techniques, but it sometimes requires general anesthesia (where you are asleep).

Embolization

Arterial embolization, also known as transarterial embolization (or TAE), is another option for tumors that cannot be removed. Embolization can be used for larger tumors – up to about 5 cm (2 inches) across – than the ablative methods. This technique is used to reduce 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 usually injected into the bloodstream at this time 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 combines embolization with radiation therapy. 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.

Chemotherapy for lung carcinoid tumors

Chemotherapy (chemo) is the use of anti-cancer drugs that are injected into a vein or taken by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for some types of lung cancer that have spread to organs beyond the lungs.

Unfortunately, carcinoid tumors usually do not respond very well to chemo. It is mainly used for carcinoid tumors that have spread to other organs, are causing severe symptoms, and have not responded to other medicines. In some cases it may be given after surgery.

Because chemo does not always shrink carcinoid tumors, it is important to ask your doctors if your chances of benefit outweigh the side effects you may have.

Some of the chemo drugs that may be used for advanced lung carcinoids include:

Streptozocin

Etoposide (VP-16)

Cisplatin

Temozolomide

Cyclophosphamide (Cytoxan®)

5-fluorouracil (5-FU)

Doxorubicin (Adriamycin®)

Dacarbazine (DTIC)

In most cases, several chemo drugs are used together, often in combination with other types of medicines.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemo cycles generally last about 3 to 4 weeks, and initial treatment typically involves 4 to 6 cycles. Chemo is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemo.

Possible side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. Common side effects can include:

Hair loss

Mouth sores

Loss of appetite

Nausea and vomiting

Diarrhea

Increased chance of infections (caused by low white blood cell counts)

Easy bruising or bleeding (from low blood platelet counts)

Fatigue (due to low red blood cell counts)

These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects or keep them from occurring. For example, drugs can be given to help prevent or reduce nausea and vomiting.

Some drugs can have other side effects. For example, cisplatin can damage nerves (a condition called neuropathy). This may lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. In most cases this goes away once treatment is stopped, but it may last a long time in some people. You should report this – as well as any other side effects or changes you notice while getting chemotherapy – to your medical team so that it can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.

Other drugs for treating carcinoid tumors

For people with metastatic carcinoid tumors who have carcinoid syndrome (facial flushing, diarrhea, wheezing, rapid heart rate), several medicines can help control the symptoms and may help keep the tumor from growing for a time.

Octreotide

This drug is related to somatostatin, a natural hormone that seems to help slow the growth of neuroendocrine cells. It is very helpful in treating the symptoms of carcinoid syndrome. Sometimes octreotide can temporarily shrink carcinoid tumors, but it does not cure them. Side effects can include pain or burning at the injection site, stomach cramps, nausea, vomiting, headaches, dizziness, and fatigue.

The original version of octreotide (Sandostatin®) is given as an injection under the skin (subcutaneously) at least twice daily. Some people can learn to give this injection themselves at home. A newer, long-acting version of the drug (Sandostatin LAR®) is given as an injection into a muscle once a month by your doctor or nurse. When first starting treatment, most people are given injections every day. Once the doctor finds the correct dose, the longer-acting monthly injection may be used.

Lanreotide

Lanreotide (Somatuline®) is a drug similar to octreotide. It is given as an injection under the skin once a month. It may be given by your doctor or nurse, or you may learn how to give the injection at home. Side effects are similar to those of octreotide, although pain at the injection site is less common.

Interferons

These drugs are natural substances in the body that normally help activate the immune system. They also suppress the growth of some tumors. Interferon alfa is sometimes helpful in shrinking or slowing the growth of metastatic carcinoid tumors and improving symptoms of carcinoid syndrome. But its usefulness is limited by its flu-like side effects, which may be severe. It can also cause depression. Interferon alfa is given by injection, either daily or several times a week.

Targeted drugs

In recent years, anti-cancer drugs that work differently from standard chemotherapy drugs have been developed for some types of cancer. These drugs target specific parts of cancer cells. They are sometimes helpful even when chemotherapy is not, and they often have less severe side effects.

Two targeted therapy drugs, sunitinib (Sutent®) and everolimus (Afinitor®), have been shown to help treat neuroendocrine tumors that start in the pancreas. These drugs may also be helpful against carcinoid tumors, which are a type of neuroendocrine tumor. Studies are now in progress to try to prove this, but some doctors may already be using these drugs for carcinoid tumors.

Other medicines can be used to help control specific symptoms. It is important to describe your symptoms to your doctor so that they can be treated effectively.

Radiation therapy for lung carcinoid tumors

Radiation therapy is the use of high-energy radiation in the form of x-rays or radioactive particles to kill cancer cells. Unfortunately, radiation therapy usually has only a limited effect on lung carcinoid tumors.

Surgery is the main treatment for most carcinoid tumors, but radiation therapy may be an option for those who can't have surgery for some reason. It may also be given after surgery in some cases if there's a chance some of the tumor was not removed. Radiation therapy can also be used to help relieve symptoms such as pain if the cancer has spread to the bones or other areas.

External beam radiation therapy

External beam radiation therapy uses a machine that delivers a beam of radiation to a specific part of the body. This is the type of radiation used most often for lung carcinoid tumors.

Before your treatments start, the radiation team will determine the correct angles for aiming the radiation beams and the proper dose of radiation. Radiation therapy is much like getting an x-ray, but the radiation is more intense (stronger). The procedure itself is painless. Each treatment lasts only a few minutes, but the setup time – getting you into place for treatment – usually takes longer. Most often, radiation treatments are given 5 days a week for several weeks.

The main side effects of lung radiation therapy are fatigue (tiredness) and temporary sunburn-like skin changes. If high doses are given, radiation therapy can cause scar tissue to form in the lungs, which can lead to trouble breathing and an increased risk of infections.

Radioactive drugs

Drugs containing radioactive particles may be useful in treating some widespread carcinoid tumors. For this type of treatment, doctors use some of the same drugs used in radionuclide scans , such as MIBG and octreotide. These drugs attach to carcinoid tumor cells. By using more strongly radioactive particles than are used in the scans, doctors can deliver higher doses of radiation directly to the tumors. Some early results have been promising, but this type of treatment is not widely used at this time.

Treatment of lung carcinoid by type and extent of disease

The treatment of lung carcinoid tumors depends to a large extent 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  to formally describe the extent of these cancers. But for treatment purposes most doctors use a simpler system, dividing these tumors into 2 groups: those that can be treated with surgery (resectable cancers) and those that can’t be completely removed (unresectable cancers).

Resectable carcinoid tumors

Resectable carcinoid tumors haven’t spread far beyond where they started and can be completely removed. In the TNM staging system, this includes most stage I, II, and IIIA cancers.

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 additional 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 therapy lowers the chance of the cancer coming back, or if it helps people live longer.

Unresectable carcinoid tumors

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

Treatment depends on where the cancer is and whether you have symptoms of the carcinoid syndrome. In general, this is a slow-growing cancer, and chemotherapy has not proven to be very successful. If you have only a small number of tumors that can be removed, surgery (on both 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 there with standard surgery, another option might be to have a liver transplant. This is a very involved 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 the section on surgery.

If tumors in your liver are too large or numerous to be treated directly, or if the carcinoid has spread to other parts of your body, then drug therapy can be helpful. The drugs octreotide and lanreotide, which can slow the growth of the cancer and stop the secretion of the chemicals that cause the carcinoid syndrome, are often helpful. In some cases, they can sometimes actually shrink the cancers. Another drug, interferon alfa, can act the same way. Sometimes these 2 types of drugs are given together. Newer targeted drugs such as sunitinib (Sutent) and everolimus (Afinitor) may be helpful as well, although this still needs to be proven. Adding chemotherapy may also help reduce symptoms, but it seldom shrinks the tumor very much more.

For people with earlier stage cancers who can’t have surgery, most doctors recommend radiation therapy for typical carcinoids and chemotherapy and 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).

Some carcinoid tumors come back, sometimes 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.

What happens after treatment for lung carcinoid tumors?

For many people with carcinoid tumors, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.

It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are living full lives.

For other people, the cancer may never go away completely. These people may get regular treatments with chemotherapy, radiation therapy, or other therapies to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful. It has its own type of uncertainty.

Follow-up care

When treatment ends, your doctors will still want to watch you closely. It is very important to go to all of your follow-up appointments. During these visits, your doctors will ask questions about any problems you may have and may do exams and lab tests or x-rays and scans to look for signs of cancer or treatment side effects.

Your doctor will most likely want to see you fairly often (every couple of months or so) at first. The time between visits may be extended if there are no problems. Lung carcinoid tumors are often cured by the initial treatment, but in a small portion of cases the cancer can come back (recur) many years later, which is why doctors often advise close follow-up for at least 10 years.

Almost any cancer treatment can have side effects. Some may last for a few weeks or months, but others can last the rest of your life. During your doctor visits, talk to your cancer care team about any changes or problems you notice and let them know about any questions or concerns you have.

It is important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.

If lung carcinoid tumor treatment stops working

If cancer keeps growing or comes back after one kind of treatment, it is possible that another treatment plan might still cure the cancer, or at least shrink the tumors enough to help you live longer and feel better. But when a person has tried many different treatments and the cancer has not gotten any better, the cancer tends to become resistant to all treatment. If this happens, it’s important to weigh the possible limited benefits of a new treatment against the possible downsides, including treatment side effects. Everyone has their own way of looking at this.

This is likely to be the hardest part of your battle with cancer – when you have been through many medical treatments and nothing's working anymore. Your doctor may offer you new options, but at some point you may need to consider that treatment is not likely to improve your health or change your outcome or survival.

If you want to continue to get treatment for as long as you can, you need to think about the odds of treatment having any benefit and how this compares to the possible risks and side effects. In many cases, your doctor can estimate how likely it is the cancer will respond to treatment you are considering. For instance, the doctor might say that more treatment might have about a 1 in 100 chance of working. Some people are still tempted to try this. But it is important to think about and understand your reasons for choosing this plan.

No matter what you decide to do, it is important that you feel as good as you can. Make sure you are asking for and getting treatment for any symptoms you might have, such as nausea or pain. This type of treatment is called palliative care.

Palliative care helps relieve symptoms, but it is not expected to cure the disease. It can be given along with cancer treatment, or can even be cancer treatment. The difference is its purpose – the main goal of palliative care is to improve the quality of your life, or help you feel as good as you can for as long as you can. Sometimes this means using drugs to help with symptoms like pain or nausea. Sometimes, though, the treatments used to control your symptoms are the same as those used to treat cancer. For instance, radiation might be used to help relieve bone pain caused by cancer that has spread to the bones. Or chemo might be used to help shrink a tumor and keep it from blocking the bowels. But this is not the same as treatment to try to cure the cancer.

At some point, you may benefit from hospice care. This is special care that treats the person rather than the disease; it focuses on quality rather than length of life. Most of the time, it is given at home. Your cancer may be causing problems that need to be managed, and hospice focuses on your comfort. You should know that while getting hospice care often means the end of treatments such as chemo and radiation, it doesn’t mean you can’t have treatment for the problems caused by your cancer or other health conditions. In hospice the focus of your care is on living life as fully as possible and feeling as well as you can at this difficult time. 

Staying hopeful is important, too. Your hope for a cure may not be as bright, but there is still hope for good times with family and friends – times that are filled with happiness and meaning. Pausing at this time in your cancer treatment gives you a chance to refocus on the most important things in your life. Now is the time to do some things you’ve always wanted to do and to stop doing things you no longer want to do. Though the cancer may be beyond your control, there are still choices you can make.

What’s new in lung carcinoid tumor research and treatment?

Many medical centers across the nation are researching the causes and treatment of lung carcinoid tumors. This is a challenging disease to study because it is not common. But each year, scientists find out more about what causes the disease and how to improve treatment.

Genetics

Researchers have made great progress in understanding how certain changes in DNA can cause normal cells to become cancerous. DNA is the molecule that carries the instructions for nearly everything our cells do. We usually look like our parents because they are the source of our DNA. But DNA affects more than how we look.

Some genes (parts of our DNA) contain instructions for controlling when our cells grow and divide into new cells. Certain genes that cause cells to grow and divide are called oncogenes. Others that slow down cell division or cause cells to die at the right time are called tumor suppressor genes. Cancers can be caused by DNA changes that turn on oncogenes or turn off tumor suppressor genes. Researchers have characterized many of the DNA changes in lung carcinoids in the past few years. Continued research in understanding these changes will lead to new tests for earlier diagnosis and new drugs for more effective treatment.

Diagnosis

Because the outlook and treatment of lung carcinoids and other types of lung cancer are very different, accurate diagnosis is important. Researchers have made great progress in developing tests that can detect specific substances found in the cells of carcinoid tumors but not other lung cancers. Most of these tests treat tissue samples with special man-made antibodies in the lab. The antibodies are designed to recognize specific substances in certain types of tumors.

Treatment

Doctors are learning how to treat lung carcinoids more effectively. For example, newer surgical techniques allow doctors to remove parts of the lung through smaller incisions, which can result in shorter hospital stays and less pain for patients. And new radiation therapy techniques help doctors focus the radiation more precisely on tumors, lowering the amount of radiation that normal tissues get and reducing side effects.

Metastatic carcinoid tumors remain hard to treat. Most carcinoid tumors grow fairly slowly. Because standard chemotherapy drugs work by attacking quickly growing cells, they are not very effective against carcinoid tumors.

Newer drugs called targeted therapies may prove to be more effective against carcinoids. Targeted therapies attack the cancer cells’ inner workings – the programming that makes them different from normal, healthy cells. These drugs attack cancer cells, often while doing little damage to normal cells. Each type of targeted therapy works differently, but all alter the way a cancer cell grows, divides, repairs itself, or interacts with other cells in some way.

Two targeted therapy drugs, sunitinib (Sutent®) and everolimus (Afinitor®), have recently been shown to be helpful in treating neuroendocrine tumors that start in the pancreas. Studies of these drugs in carcinoid tumors (which are a type of neuroendocrine tumor) are in progress.

Targeted drugs called angiogenesis inhibitors affect the growth of new blood vessels (angiogenesis), which tumors need to grow larger. Some of these drugs are already used to treat other types of cancer and are now being studied for use against carcinoid tumors. Examples of these drugs include bevacizumab (Avastin®), pazopanib (Votrient®), and axitinib (Inlyta®).

Researchers are also looking to try to improve upon drugs related to somatostatin, which helps some people with carcinoid tumors. An example is pasireotide, which may prove to be more potent than current drugs such as octreotide. Another new treatment being studied is 90Y-edotreotide. This pairs a drug similar to octreotide with a radioactive atom. The drug binds to the carcinoid cells, delivering the radiation to those cells and lessening the effect on normal cells. In early studies, this treatment has helped patients with advanced carcinoid tumors that were no longer responding to other treatments.

These and other new drugs are now being studied in clinical trials.

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