Treatment for large bowel and rectal neuroendocrine cancer

Large bowel and rectal neuroendocrine cancers are rare cancers that develop in the large bowel (colon ) or back passage (rectum ).   

The treatment you have depends on what type of neuroendocrine cancer you have. And it depends on the stage  of your cancer.

These cancers grow at different rates. For example, rectal NETs can grow very slowly. But NECs grow much faster. This means the treatment and outlook (prognosis ) is different for each type.

Surgery is the main treatment for large bowel and rectal neuroendocrine cancers.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

• where the neuroendocrine cancer started in your large bowel or rectum
• the type of neuroendocrine cancer
• whether it has spread (stage)
• how fast the cells are growing (the grade)
• the symptoms you have
• your general health and fitness

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

You are likely to have a clinical nurse specialist (or CNS). They go to the MDT meetings. They can help answer your questions and support you. They are often your main point of contact throughout your treatment.

Types of treatment for large bowel and rectal neuroendocrine cancer

The main treatment for large bowel and rectal neuroendocrine cancer is surgery. Surgery might be all the treatment you need if your cancer hasn’t spread.

You might need more than one operation. This depends on whether the surgeon removes all the cancer in your first operation. It also depends on other test results such as the grade and stage of your cancer. Grade refers to how fast or slow your cancer is growing.

The treatment options depend on whether you have a NET or a NEC.

Other treatments for large bowel and rectal NETs include:

• somatostatin analogues
• chemotherapy
• targeted cancer drugs
• peptide receptor radionuclide therapy (PRRT)
• surgery or other treatments for cancer that has spread to your liver

For large bowel and rectal NECs you might have:

• surgery
• chemotherapy
• radiotherapy
• treatment for cancer that has spread to your liver

Removing cancer by endoscopy or surgery

There are different ways to remove the cancer. The procedure or operation you have depends on several factors. These include:

• where the cancer is in your bowel
• the size of your cancer
• the grade of your cancer 

Your surgeon might be able to remove the cancer using a colonoscope . This is called an endoscopic resection.

Or you might have a larger operation to remove a section of your bowel or rectum. There are different types of surgery. The surgeon might remove:

• part of your bowel - a colectomy
• a small part of your rectum - a trans anal endoscopic microsurgery (TEMs)
• a section of the rectum - a total mesorectal excision (TME)

Endoscopic resection to remove a small part of the bowel lining

A surgeon or specialist doctor uses a long flexible tube (colonoscope) to remove just the cancer and a border of healthy tissue around it. They call this an endoscopic resection.

Your doctor might suggest this for a small cancer. Small usually means the cancer is smaller than 1 cm. But your doctor also consider other factors such as the grade and your general health. They might offer you:

• an endoscopic mucosal resection (EMR)
• an endoscopic submucosal dissection (ESD)

These are similar and the doctor uses a colonoscope for both. You usually have these procedures under sedation rather than having a general anaesthetic .

Surgery to remove a section of your bowel (colectomy)

Surgery to remove part of your large bowel is called a colectomy. Your surgeon might also call it a hemi colectomy. They might say 'right' or 'left' hemi colectomy, depending on which part of the bowel they remove. 

You might have a colectomy to remove cancer from your large bowel if your:

• surgeon can't remove it during a colonoscopy
• cancer hasn't spread

Your surgeon removes the part of the bowel containing the cancer. How much they take away depends on the exact position and size of the cancer. They might also remove the nearby lymph nodes . 

Surgeons often do this operation using a laparoscope . They insert this through a small cut close to your tummy button. This is also called keyhole surgery.

You might need to have a colostomy , but this isn't common. It is often temporary. This means you may have another operation a few months later to join the ends of the bowel back together. This is called a stoma reversal.

Surgery to remove a small part of the rectum

This surgery is called trans anal endoscopic microsurgery (TEMs). Your surgeon removes the cancer from the back passage, along with a border (margin) of healthy tissue. You have a general anaesthetic .

You might have this operation for a rectal NET that is between 1 and 2 cm if:

• your surgeon can't remove it at endoscopy
• there is a risk that your cancer will come back after an endoscopic resection

Surgery to remove a section of the rectum (total mesorectal excision)

You might have this operation for a rectal NET that is bigger than 2 cm. Or if the cancer has spread to the area just outside the rectum.

During a total mesorectal excision (TME), your surgeon removes:

• the cancer
• a border of healthy tissue around the cancer
• some fatty tissue around the bowel
• a sheet of tissue called mesorectum

You might need to have a colostomy as part of this operation. Your surgeon will talk to you about whether this is likely. And whether the colostomy will be temporary or permanent. They will refer you to a specialist stoma nurse who will provide you with information and support.  

Other treatments for large bowel and rectal neuroendocrine tumours (NETs)

The following treatments might be options for large bowel and rectal NETs. The treatment for neuroendocrine carcinomas (NECs) is different. We have more information about NEC treatment further down the page.

You might have treatments to help with symptoms if:

• you can’t have surgery to remove the NET
• the NET has spread to another part of the body
• the NET came back after the initial treatment

These treatments can control your symptoms and help you feel better but won’t get rid of the neuroendocrine cancer. 

There are a number of different treatment options:

• somatostatin analogues - drugs include octreotide and lanreotide
• peptide receptor radionuclide therapy (PRRT) - this uses a radioactive medicine to treat the NET
• chemotherapy  – drugs include temozolomide, fluorouracil, capecitabine and streptozotocin
• a targeted cancer drug called everolimus 

For cancer that has spread to your liver you might have:

• trans arterial embolisation (TAE) to cancer in your liver
• radiofrequency ablation 
• surgery to remove cancer from your liver
• a liver transplant – this is a rare treatment for NETs

Treatment for large bowel and rectal neuroendocrine carcinomas (NECs)

Treatment depends on your individual situation. Unfortunately, large bowel and rectal NECs are harder to treat than large bowel and rectal NETs. This is because these cancers are faster growing and more likely to spread.

You might have surgery if your cancer hasn’t spread. You can read about different types of surgery higher up this page.

You usually also have chemotherapy treatment as well as surgery. You might have this:

• before surgery – this is called neoadjuvant chemotherapy
• after surgery – this is called adjuvant chemotherapy

You have chemotherapy on its own or combined with radiotherapy. This is called chemoradiotherapy.

Chemotherapy drugs include:

• carboplatin or cisplatin
• etoposide
• irinotecan

Follow up for large bowel and rectal neuroendocrine cancers

You might have follow up appointments every few months after treatment. For some people, the appointments might be less often than this.

This is to check how you are and see whether you have any problems or worries. The appointments also give you the chance to raise any concerns you have about your progress.

How often you see your doctor depends on:

• the grade of the large bowel or rectal neuroendocrine cancer
• whether it has spread to other parts of the body

You might also have tests on some visits. The tests might include:

• colonoscopy
• a CT scan or MRI scan
• a blood test to check for the amount of chromogranin A (CgA )
• endoscopic ultrasound (EUS )

Research and clinical trials

Doctors are always trying to improve treatments and reduce the side effects. 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.

Coping with neuroendocrine cancer

You might have physical changes to your body because of your cancer or the treatment. These changes can be hard to cope with and can affect the way you feel about yourself. It can help to talk to friends and family. Or join a support group to meet people in a similar situation.

We have a discussion forum called Cancer Chat. It is a place for anyone affected by cancer. You can share experiences, stories and information with other people with cancer.

You might need practical advice about benefits or financial help. There is help and support available. There are also organisations to support and provide information to people affected by neuroendocrine cancer.