A neuroendocrine tumor forms from cells that release hormones in response to a signal from the nervous system. The tumors are usually metastatic disease from small primary tumors that may be difficult to identify and locate. Some examples of neuroendocrine tumors are carcinoid tumors, medullary thyroid carcinomas, pheochromocytomas, and neuroendocrine carcinomas of the skin (Merkel cell cancer). These tumors may secrete higher-than-normal amounts of hormones, which can cause many different symptoms.
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OHSU Neuroendocrinology treats the most neuroendocrine cancers in the Pacific Northwest. Using a multi-disciplinary approach, our team engages specialists from cardiology, interventional radiology, surgical oncology, medical oncology, radiation oncology, pathology, gastroenterologists, anesthesiology and nuclear medicine.
Innovative treatment options can offer new hope to patients with neuroendocrine tumors. In addition to the latest trials of new agents and treatments open for enrollment of eligible patients, we offer a full array of treatments, including:
- Radio-frequency ablation
- Somatostatin analog therapy
- Targeted drug therapy
- Radiation therapy
- Radioactive bead embolization
- Bland embolization
Patients with neuroendocrine tumors are often told they are not candidates for surgery because it’s not possible to remove all the tumors. However, neuroendocrine tumors are different from many other types of cancer in that not all the tumor has to be removed to get good results.
Tumor de-bulking is a surgical procedure in which as much of the tumor as possible is removed. This can help make other treatments more effective. Also, because neuroendocrine tumors make hormones that can make patients ill, de-bulking tumors reduces the amount of hormones released into the blood stream, relieving symptoms and improving quality of life.
Tumor location and resection
The primary tumor is where the neuroendocrine tumor began, and the source of spread of metastases to other organs, such as the liver. Locating and, if possible, removing the primary tumor can be very important for many reasons, including helping to determine the best type of drug therapy. OHSU research shows that we are successful at surgically finding the primary tumor in 80 percent of cases. This can usually be done using a laparoscopic approach.
Neuroendocrine tumors growing in the liver get all their blood from a small artery coming off the aorta, the main artery in the abdomen. Tumor embolization is a non-surgical technique used to treat liver tumors that are not candidates for surgery.
Treatment agents can reach the liver via a small tube inserted through the groin into a blood vessel and delivered directly to the tumors in the liver, leaving the normal liver and the rest of the body largely unaffected. Treatment options include radioactive beads (radio-embolization), chemotherapy beads (chemoembolization) or plugging off the arteries to the tumor to rob them of oxygen and nutrients (bland embolization).
Somatostatin analog therapy
Somatostatin analog therapy is a treatment option for inoperable tumors. It reduces hormone production and secretion by the tumors, improving symptoms such as flushing and diarrhea. OHSU was one of the few centers where somatostatin analog therapy was first tested for treatment of carcinoid patients, leading to its approval by the FDA in 1999. OHSU is also one of the few centers testing new somatostatin analogs for future FDA approval.
Everolimus is a drug that has shown to stop, in some cases even shrink, pancreatic neuroendocrine tumors. It is a targeted therapy, meaning it specifically attacks the neuroendocrine tumors and therefore involves fewer side effects for the remainder of the body. OHSU was one of the top centers for enrollment of patients in the trial that lead to FDA approval of this drug in May, 2011.
OHSU will continue to enroll eligible neuroendocrine patients in new trials using everolimus. These includes everolimus for treatment of carcinoid tumors and combining everolimus and a new somatostatin analog to treat pancreatic neuroendocrine tumors to determine if the combination works better than everolimus alone.
Sunitinib is a targeted drug therapy recently approved for treatment of pancreatic neuroendocrine tumors. It shrinks tumors while keeping them from growing new blood vessels, and has been effective for the treatment of tumors resistant to other drugs.
OHSU is part of all of the major clinical trials for neuroendocrine cancers. We have also published many neuroendocrine studies conducted entirely at OHSU, including chemoembolization treatments, finding occult primary neuroendocrine tumors and preventing and managing carcinoid crisis during surgery and anesthesia.
National clinical trials that are open now or will soon open include trials for patients with:
- Carcinoid syndrome, testing the new somatostatin analog lanreotide
- Progressing carcinoid tumors using everoliums (RADIANT 4 trial)
- Pancreatic neuroendocrine tumors using everolimus alone compared with everolimus combined with SOM230 (pasireotide), a new somatostatin analog.