Treatment for stomach neuroendocrine cancer
Stomach neuroendocrine cancers start in the neuroendocrine cells of the stomach.
Neuroendocrine cancers are a group of cancers that develop in cells of the 
. You might also hear the term neuroendocrine neoplasm (NEN). This means the same as neuroendocrine cancer.
There are 2 key groups of neuroendocrine cancer:
neuroendocrine tumours (NETs ) neuroendocrine carcinomas (NECs )
NETs and NECs are very different. So it is important to know which one you have. Talk to your doctor or specialist nurse if you are not sure.
The treatment you have depends on whether you have a NET or a NEC. And it depends on the of your cancer.
These cancers grow at different rates. For example, NETs often grow very slowly. But NECs grow much faster. This means the treatment and outlook () is different for each type.
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). Your doctor will discuss your treatment with you. They will talk about the benefits and the possible side effects.
The treatment you have depends on:
-
the type of stomach neuroendocrine cancer
-
whether it has spread (the stage)
-
how fast the cells are growing (the grade)
-
the symptoms you have
-
your general health and fitness level
The type of neuroendocrine cancer means whether you have a NET or NEC. There are then different subtypes:
- There are 3 different types of NET. These are type 1, type 2 and type 3.
- There are 2 main types of NEC. These are small cell and large cell NEC.
This affects what treatment you have, so it is important to know your type.
You are likely to have a clinical nurse specialist (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.
Watch and wait
Neuroendocrine cancers grow at different rates. Some NETs grow very slowly. And some might not grow at all for months or years. So, you might not need treatment straight away. Your doctor might ask you to have regular tests to keep an eye on it. They call this ‘watch and wait’ or surveillance.
It can be hard to hear that you have cancer but not have treatment. You might feel worried that you aren't doing anything to stop the cancer. Or you might feel like the doctors are keeping treatment from you. Waiting for test results and check ups can also be difficult.
Types of treatment for stomach neuroendocrine cancer
The treatment options depend on whether you have a NET or a NEC.
The main treatments for stomach NETs are:
- removing it during an
endoscopy - surgery
somatostatin analogues chemotherapy targeted cancer drugs - peptide receptor radionuclide therapy (PRRT)
- surgery or other treatments for cancer that has spread to your liver
For stomach 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 cancer from the stomach. It is more common for a surgeon to be able to remove a stomach NET than a stomach NEC.
The treatment you have depends on your type and stage of cancer. We have more detailed information below about the treatment for each type of stomach neuroendocrine cancer.
Removing cancer by endoscopy
Your surgeon might remove the cancer during an endoscopy. An endoscopy looks at the inside of the food pipe (oesophagus) and stomach. Your doctor uses a long flexible tube that has a light and camera at the end.
Your doctor will use one of the following procedures to do this:
- endoscopic submucosal dissection (ESD)
- endoscopic mucosal resection (EMR)
Surgery to remove cancer from the stomach
The type of surgery you have depends on your situation. It is more common to have surgery for a NET than a NEC.
There are different types of operation to remove cancer from the stomach:
- A subtotal or partial gastrectomy means your surgeon removes part of your stomach.
- A total gastrectomy means your surgeon removes your whole stomach.
Your surgeon will also remove some of the nearby lymph nodes.
Treatment for stomach neuroendocrine tumours (NETs)
There are 3 types of stomach NETs: Type 1, type 2 and type 3.
Watch and wait
You might not have treatment straight away. This is because type 1 NETs are usually small and slow growing. They are unlikely to spread to another part of your body. You have regular check ups with your doctor.
Endoscopic resection
Your doctor might remove the NET during an endoscopy if the NET is larger than 1 cm. Your doctor also consider other factors such as how fast the NET is growing. This is the grade.
Surgery
You might need a bigger operation if your cancer has spread into the muscle layer of the stomach wall.
Your surgeon might suggest an operation to remove part of or all of your stomach. This is called a partial or total gastrectomy.
Type 2 stomach NETs are more likely to spread to other parts of the body after a while. So you usually have treatment straight away.
Type 2 NETs are linked to another type of tumour called a . If you have a gastrinoma in your pancreas or small bowel, your surgeon might be able to remove this. Removing the gastrinoma can cause the stomach NET to shrink. This might be all the treatment you need.
If you need more treatment, your doctor might be able to remove a small stomach NET during an endoscopy.
Or you might need to have a bigger operation to remove the NET. Your surgeon removes either part of or all of your stomach.
Type 3 stomach NETs might already have spread when you are diagnosed. Your treatment depends on several factors including:
- the grade of your NET
- how far it has spread
- the size of the NET
It is most common to need a bigger operation. This is to remove part or all of your stomach, together with nearby .
You might also have chemotherapy as well as surgery.
You might have other treatments 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 NET. There are a number of different treatment options:
- debulking surgery to remove as much of the NET as possible
- 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 stomach neuroendocrine carcinomas (NECs)
Treatment depends on your individual situation. Unfortunately, stomach NECs are harder to treat than most stomach NETs. This is because NECs always grow fast and are more likely to spread.
You might have surgery if your cancer hasn’t spread. But this isn't a common treatment option for NEC because the cancer has often 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:
- cisplatin or carboplatin
- etoposide
- irinotecan
Follow up for stomach neuroendocrine cancer
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.
You might also have tests on some visits. The tests might include:
- blood tests
- CT scan
- MRI scan
- radioactive scan (octreotide scan)
How often you see your doctor depends on:
- the grade of the stomach neuroendocrine cancer
- the type of NET (type 1, 2 or 3)
- whether it has spread to other parts of the body
- what treatment you have had
- any side effects you might have
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.
