Treatment of Neuroendocrine Tumors (NETs)

Stages of neuroendocrine cancer

To date, there is no clear staging of neuroendocrine cancer. It is known that the formations grow slowly and go through the few stages of development that are common for all cancers.

At the first stage of development, the neuroendocrine tumors are small. In the future, they grow into nearby tissues and metastasize actively to the distant organs, mainly to the liver and bones. As a result, a large number of formations grow in the body.

Patients often die due to a malfunction of the organs in which secondary tumors develop. About 80% of patients already have metastases at the moment of the diagnosis making.

If the tumor is single and has no metastases, then surgical removal is possible. In the presence of multiple metastases, substances that suppress the production of hormones are used, which significantly improves the health condition of patients. In the future, doctors prescribe chemotherapy, which destroys neuroendocrine tumors, and targeted therapy. Targeted therapy acts only on pathological cells, causing their death.

Diagnosis and treatment of neuroendocrine tumors

At the first stage of diagnosis making, the following examinations are often required:

• Tumor marker blood tests
• Hormonal blood and urine tests
• Ultrasound scanning or endoscopy
• Computed tomography or MRI
• Biopsy of the affected organ

Based on the results of the diagnostic procedures, individual therapy is prescribed.

Since neuroendocrine cancer can develop in any organ, the method of treatment is selected taking into account its localization. The spreading of the cancer process is also considered.

In general, the survival rate of patients with neuroendocrine tumors (NETs) is rather high, if the treatment takes place in specialized medical centers with high-precision equipment and professional personnel with the relevant experience.

Surgery for the treatment of neuroendocrine tumors

Radical removal of the tumor is the most preferred method of neuroendocrine cancer treatment. Further it may be complemented by other methods, for a more stable effect of therapy.

The location of the neuroendocrine tumors (NETs) and their size determine primarily how the surgery is carried out. As a rule, surgeons choose the endoscopic method as the most sparing one. The endoscopic method does not require making surgical incisions, as the access to the pathological focus is provided through small, several centimeters wide, tissue incisions.

In case of neuroendocrine tumors (NETs) in the abdominal cavity, laparoscopic surgery can be performed, with making punctures in the peritoneal region. In case of neuroendocrine cancer of the lungs punctures are made near the ribs. This method reduces blood loss, the risk of infection, and postoperative recovery time.

If the lesion is located in a hard-to-reach region and its removal is connected with the high risk of damaging nearby tissues, the da Vinci robotic surgical system can be used. Since the device's components can reach even the areas that are physically impossible to operate on with a conventional scalpel, the tumor is removed as precisely as possible, without damaging healthy tissues.

Stereotactic radiosurgery

The removal of neuroendocrine tumors can be carried out using stereotactic radiosurgery.

This method is usually preferred when conventional surgery cannot provide a positive treatment result or when there are contraindications for traditional surgery. Stereotactic radiosurgery can be used for the treatment of neuroendocrine cancer of the pancreas, pituitary gland, and lungs.

The pathological focus is treated with a high dose of radiation, which allows destroying cancer cells in one or two sessions. Despite the high irradiation dose, the healthy tissues are affected minimally. Only the pathological focus receives a high radiation dose. This can significantly reduce the influence of radiation therapy on the body.

Radiation therapy

Radiation therapy is prescribed for neuroendocrine cancer treatment when it is not possible to remove the tumor.

In patients with neuroendocrine cancer, brachytherapy is used. In brachytherapy a radioactive substance is placed directly near the tumor. Being released gradually, ionizing radiation affects cancer cells much more effectively. Radioactive substances can be placed in microcapsules, which are delivered to the tumor tissue with a special catheter, or injected with a special needle.

Chemotherapy

Chemotherapy can be used as a separate method, as well as in combination with radiation therapy or surgical treatment. Chemotherapy can effectively fight metastases throughout the body.

With the spread of the cancer process in the abdominal cavity, intraoperative chemotherapy can be applied. This allows doctors to make the remission period longer and to make sure that all cancer cells are destroyed.

Modern medical centers use new-generation drugs, so the toxic effect on the patient’s organism is reduced.

Targeted therapy

Targeted therapy in the treatment of neuroendocrine tumors has already demonstrated good results.

Drugs used in targeted therapy affect only cancer cells. However, different drugs have different "targeted" strategies. For example, some of them affect the metabolic processes of cancer cells, i.e. they block the process of intracellular metabolism. Other drugs can deliver chemotherapy or radioactive substances to cancer cells, and also help the immune system recognize atypical cells and destroy them.

A distinctive feature of targeted therapy is the absence of a negative influence on healthy organs and tissues.

Lutetium-177 PSMA therapy

Cells of neuroendocrine tumors often have somatostatin receptors on the surface of their membranes. Somatostatin is a hormone that is produced naturally in the pancreas, hypothalamus, tissues of the digestive tract, as well as in various parts of the CNS. A radioactive isotope Lutetium-177 is considered to be a somatostatin analog.

After the Lutetium-177 is administered to patients, it binds to the receptors on the surface of NETs, and the tumor cells absorb the radioactive substance. Thus, the high dose of radiation goes directly to the cancer cells.

Since the drugs are infused into the patient's bloodstream, Lutetium-177 PSMA therapy is a systemic therapy that reaches all areas of the body. Nevertheless, since these substances are able to identify the specific surface membrane antigens on cells of the neuroendocrine tumors, the effect of radiation on healthy tissues is limited. The intravenous administration of the drug takes about 4-5 hours, after which patients stay in the hospital for about two days to monitor the health condition and undergo follow-up diagnostic tests.

Where can I undergo treatment of neuroendocrine tumors?

Health tourism is becoming more and more popular these days, as medicine abroad often ensures a much better quality of neuroendocrine cancer treatment.

Where you go for treatment matters! The following hospitals show the best success rates in the treatment of neuroendocrine tumors:

1. Memorial Bahcelievler Hospital Istanbul, Turkey
2. University Hospital Duesseldorf, Germany
3. University Hospital of Ludwig Maximilian University of Munich, Germany
4. University Hospital Ulm, Germany
5. Primus Super Speciality Hospital New Delhi, India

You can find more information about the hospitals on the Booking Health website.

The cost of treatment of neuroendocrine tumors

The prices in hospitals on the Booking Health website are relatively low.

The cost of treatment varies, as the prices depend on the hospitals, the specifics of the disease, and the complexity of its treatment.

The cost of treatment of neuroendocrine tumors with chemotherapy in Turkey is 3,766-3,896 EUR.

The cost of treatment of neuroendocrine tumors with chemotherapy in Germany is 6,949-9,893 EUR.

The average cost of treatment of neuroendocrine tumors with chemotherapy in India is 2,330 EUR.

You might want to consider the cost of possible additional procedures and follow-up care. Therefore, the ultimate cost of treatment may differ from the initial price.

To make sure that the overall cost of treatment is suitable for you, you may contact us by leaving the request on the Booking Health website.

How can I undergo treatment of neuroendocrine tumors?

It is not easy to self-organize any treatment abroad. It requires certain knowledge and expertise. Thus, it is safer, easier, and less stressful to use the services of a medical tourism agency.

As the largest and most transparent medical tourism agency in the world, Booking Health has up-to-date information about the treatment of neuroendocrine tumors in the world’s best hospitals. We will help you select the right medical center taking into account your wishes for treatment.

We want to help you and take on all the troubles. You can be free of unnecessary stress, while Booking Health takes care of all organizational issues regarding the treatment.

Medical tourism can be easy! All you need to do is to leave a request on the Booking Health website, and our manager will contact you shortly.

Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko