Treatment for stomach NETs that have spread

There are a number of different treatment options if you have a stomach neuroendocrine tumour (NET) that has spread. The best treatment for you depends on where in your body the NET has spread to.

Debulking surgery

You might have surgery to remove the stomach NET if it has spread to another part of the body, such as the liver or lymph nodes. The aim of surgery might not be to cure your cancer, but to give you a good quality of life for as long as possible. The surgeon removes as much of the tumour as possible.

Surgery might help prevent a blockage in your bowel if you have a fast growing NET.

Somatostatin analogues for carcinoid crisis

Some neuroendocrine tumours release hormones that cause symptoms. Doctors call this collection of symptoms carcinoid syndrome. This is uncommon with stomach NETs. But, it is more likely to happen if the cancer has spread to other parts of the body, especially the liver.

Somatostatin analogues work by slowing down the production of hormones, particularly growth hormone and serotonin. Reducing these hormones helps to control the diarrhoea and skin flushing. They might also shrink the tumour.

Liver surgery

You might have surgery to your liver if your NET has spread there. This is called a liver resection. Your surgeon might try to remove the NET completely. Or the aim of surgery might be to help with symptoms.

Hepatic artery embolisation

Hepatic artery embolisation aims to block the blood supply to a neuroendocrine tumour that has spread to the liver. The cancer can’t survive without a blood supply. Blocking the blood supply also stops the cancer releasing its hormones into the blood system.

Doctors might give a chemotherapy drug directly to the liver at the same time. This is called chemoembolisation or trans arterial chemoembolisation (TACE).

You are likely to have hepatic artery embolisation if you can’t have surgery.

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy tumour cells. You might have chemotherapy if you have symptoms. Or if somatostatin analogue treatment isn’t controlling the NET well.

The most common chemotherapy drugs for this type of tumour are:

• streptozotocin
• doxorubicin
• fluorouracil
• capecitabine
• temozolomide

Targeted cancer drugs

Everolimus is a type of treatment called a signal transduction inhibitor. Signal transduction inhibitors stop some of the signals within cells that make them grow and divide.  Everolimus stops a particular protein called mTOR from working properly. mTOR controls other proteins that trigger cancer cells to grow. So everolimus helps to stop the cancer growing or may slow it down.

You might have everolimus if you have a stomach NET that has spread and other treatments aren’t working. 

Internal radiotherapy

You might have a type of internal radiotherapy called peptide receptor radionuclide therapy (PRRT). Internal radiotherapy means having radiotherapy from inside the body. 

PRRT uses a radioactive substance called lutetium-177 or yttrium-90. This is attached to a man made form of the hormone somatostatin (a somatostatin analogue).  

You might have PRRT if the stomach NET has spread to other parts of the body and you can’t have surgery.

Clinical Trials

Doctors are always trying to improve treatments, and reduce the side effects of treatment. As part of your treatment your doctor might ask you to take part in a clinical trial. This might be to test a new treatment or to look at different combinations of existing treatments.