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Neuroendocrine/Carcinoid Tumors that have Spread to the Liver

What are neuroendocrine/carcinoid tumors?

Neuroendocrine/carcinoid tumors are cancers, but are not the same as other cancers like colorectal or hepatocellular tumors. They are relatively rare tumors and are best managed in centers with extensive expertise.

Neuroendocrine tumors may arise in various places, most commonly the pancreas. One specific type of neuroendocrine tumor is a carcinoid tumor. Carcinoid tumors can occur in the appendix, small intestine, rectum, or lung.

Neuroendocrine/carcinoid tumors can spread to the liver and while these tumors may still be treatable, it requires a multidisciplinary approach.

What are the symptoms of neuroendocrine/carcinoid tumors?

Pancreatic neuroendocrine tumor that has spread to the liver, and a carcinoid tumor in the small intestine that has spread to the liver.
A, Metastatic pancreatic neuroendocrine tumor to the
liver; B, metastatic carcinoid tumor to the liver.

Neuroendocrine/carcinoid tumors can be found during examinations for unrelated reasons. Patients may also experience symptoms associated with the disease in their pancreas or small intestine, rather than liver complications. Patients with neuroendocrine/carcinoid tumors can also have specific symptoms characterized as carcinoid syndrome. These symptoms may include:

  • Palpitations ("racing heart")
  • Sweating
  • Flushing (turning red in the face)
  • Diarrhea
  • High blood pressure

How are neuroendocrine/carcinoid tumors diagnosed?

When you see your physician, you will have a routine examination. Your doctor will ask you questions about your general health and your family history of cancer and liver disease. You will also be asked about your lifestyle and habits, including drinking and smoking.

Your physician may order the following tests:

  • Blood work. Blood tests may include a complete blood count, hematocrit, platelet count, liver function tests and chromogranin A, which will be elevated in patients with neuroendocrine/carcinoid tumors.
  • CT scan. This test identifies the tumor(s) and pinpoints their size and location in the liver, as well as their relation to the vascular/biliary structures. It also helps the doctor to determine the overall health of the liver.
  • MRI. This test identifies the tumor(s) and pinpoints their size and location in the liver, as well as vascular/biliary structures. It also helps the doctor to determine the overall health of the liver. A doctor will determine whether to do a CT scan, an MRI or both.
  • PET scan. This is a whole body scan that looks for evidence of active cancer throughout the body.
  • Octreotide scan. This is a type of scan used specifically for neuroendocrine tumors. The scan allows doctors to see inside the body to locate the tumor and see if it has spread elsewhere.
  • Liver biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. The sample removed from the biopsy is analyzed by one of our expert pathologists. Depending on the size of the tumor or mass, your physician may recommend the biopsy be taken one of several ways:
    • By using a minimally invasive surgical technique known as laparoscopy
    • By fine needle or thick needle aspiration (a core biopsy), using a computed tomography (CT or CAT) scan or ultrasound to guide the needle placement.
    • Through an endoscope (a thin, lighted, flexible tube) inserted in the mouth, passed through the stomach, and into the first part of the intestine. A tool can be passed from the endoscope through the intestinal wall to remove a sample of tissue.

What is the treatment for neuroendocrine/carcinoid tumors?

Treatment for neuroendocrine/carcinoid tumors includes a combination of the following:

Your team of physicians will create an individualized treatment plan for you.

Patient Story

Neuroendocrine Tumor | Betsy’s Story

Neuroendocrine tumor cancer survivor Betsey Clark discusses her life-saving experience at The Johns Hopkins Hospital, which included a Whipple procedure and subsequent total pancreatectomy, or removal of her pancreas.