Treatment for lung neuroendocrine cancer

Lung neuroendocrine cancers start in the neuroendocrine cells of the lung.

There are also different types of lung NETs and lung NECs.

The treatment you have depends on what type of lung neuroendocrine cancer you have. And it depends on where it is, its size and whether it has spread (the stage).

These cancers grow at different rates. Lung NETs often grow slowly. Some might not grow at all for months or years. So you might not need treatment straight away. Your doctor might just keep an eye on it with regular tests. 

Lung NECs grow much faster, and the treatment is very different.

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 lung

• the type of lung neuroendocrine cancer

• whether it has spread

• how fast the cells are growing - this is the grade

• your symptoms

• your general health and fitness

• what you want to do, especially if there is a choice

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

The main treatment depends on whether you have a lung NET or a lung NEC.

Lung NETs

The main treatment for lung NETs is surgery. Surgery might be all the treatment you need if your cancer hasn’t spread.

Other types of treatment for lung NETs are:

• somatostatin analogues
• chemotherapy
• targeted cancer drugs
• internal radiotherapy 
• surgery or other treatments for cancer that has spread to your liver

Lung NECs

For lung NECs you might have:

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

Surgery to remove cancer from the lung

The type of surgery you have depends on your situation. It is more common to have surgery for a lung NET than a lung NEC.

There are different types of operation to remove cancer from the lung:

• A lobectomy means removing a section (lobe) of the lung.
• A bilobectomy means removing 2 lobes of the lung.
• A segmentectomy means removing an area of the lung along with the veins, arteries and airways.
• A pneumonectomy means removing the whole lung. 
• A lymphadenectomy means removing nearby lymph nodes.

Some operations remove particular areas of the lung:

• A wedge resection means the surgeon removes an area of the lung that includes part of one or more lobes.
• A sleeve resection means they remove the affected section of the airway, and any surrounding cancer in the lobe. You might have this if your cancer is in the central area of your lung and growing into one of your main airways (bronchi).

Treatment for different types of lung neuroendocrine cancer

The 2 main types of lung NET are:

• typical carcinoid (TC)
• atypical carcinoid (AC) 

The 2 main types of lung NEC are:

• small cell lung cancer (SCLC)
• large cell neuroendocrine cancer (LCNEC)

Treatment for typical and atypical lung carcinoids

The main treatment for typical carcinoid (TC) and atypical carcinoid (AC) is surgery. 

The type of surgery you have depends on the size of the cancer, where it is in the lung and whether it has spread. Surgery is usually the only treatment you need for most lung NETs.

You may have also have one or more of the following treatments:

Somatostatin analogues
These medicines include octreotide and lanreotide. If your NET makes large amounts of hormones you might have a group of symptoms called carcinoid syndrome. Somatostatin analogues can help with carcinoid syndrome. 

Chemotherapy
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. It isn't that common to have chemotherapy, but you might have it if your NET:

• is likely to grow quickly and you can’t have other types of treatment
• has a high risk of coming back after surgery

You might have treatment with chemotherapy drugs such as temozolomide or oxaliplatin.

Targeted cancer drugs
You might have a targeted drug called Everolimus if your NET has spread to other body parts. It can help to stop or slow down the growth of lung NETs.

Treatment if your NET has spread to your liver
You might have other treatments if your lung NET has spread to the liver. This includes:

• chemoembolisation (TACE)
• a type of internal radiotherapy called PRRT

Treatment for small cell lung cancer

Small cell lung cancers tend to grow quickly and spread quite early on. So the main treatment is chemotherapy. Chemotherapy drugs circulate in the bloodstream around the body. So, they can treat cells that have broken away from the lung cancer and spread to other parts of the body.

You might have chemotherapy:

• on its own, or together with immunotherapy
• before, after or with radiotherapy
• before or after surgery – this is only for very early small cell lung cancer

There are different chemotherapy drugs. You might have etoposide with either cisplatin or carboplatin.

You may have these drugs together with the immunotherapy drugs atezolizumab or durvalumab.

Treatment for large cell neuroendocrine carcinoma (LCNEC)

Your treatment depends on the stage of your cancer.

Early stage
Early stage means that the cancer is small and hasn’t spread.

You usually have surgery to remove the part of the lung that contains the cancer. This is called a lobectomy. You usually have chemotherapy afterwards and you might also have radiotherapy.

Advanced stage
You have chemotherapy if your cancer is more advanced. You usually have a combination of chemotherapy drugs such as etoposide and either cisplatin or carboplatin.

This is similar to the treatment for small cell lung cancer (SCLC). 

Follow up for lung neuroendocrine cancers

You usually have follow up appointments every few months after treatment for a lung neuroendocrine cancer.

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.

You usually see your doctor about 2 to 6 weeks after treatment finishes.  After that, you have appointments with your doctor or specialist nurse at regular intervals, usually every 2 to 3 months. You are likely to have regular check ups for at least 5 years.

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

• CT scans or MRI scans
• PET scans 
• chest x-rays
• blood tests

Research into lung neuroendocrine cancers

Researchers are looking at improving the diagnosis and treatment of lung neuroendocrine cancers. 

Doctors are always trying to improve treatments, and reduce 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.

Cancer Research UK nurses

For support and information, you can call the Cancer Research UK information nurses. They can give advice about who can help you and what kind of support is available. Freephone: 0808 800 4040 - Monday to Friday, 9am to 5pm.