We will also consider whether you have symptoms of carcinoid syndrome or overproduction of other hormones as well as taking a look at cells under the microscope. The results of your tests will help a doctor to discuss the most appropriate treatment for you, including clinical trials if available.
More detailed information on your planned treatment will be given to you in clinic and you will need to sign consent prior to some treatments such as invasive procedures or chemotherapy.
Some common treatments
Every patient is different and we tailor a range of treatments to deal with their specific condition. Here are a few of them.
Systemic anti-cancer treatments
- Somatostatin analogues
- Carboplatin & Etoposide
- Streptozocin and Capecitabine
- Capecitabine and Temozolomide
- Oxaliplatin, 5-fluorouracil and folinic acid (OxMdG)
- Irinotecan, 5-fluorouracil, folinic acid (IrMdG)
- Hepatic artery embolisation
- Peptide receptor radioligand therapy (PRRT) Lutetium/Yttrium DOTATATE
- Metaiodobenzylguanidine (MIBG)
Systemic anti-cancer treatments
Oxaliplatin, 5-fluorouracil and folinic acid (OxMdG)
This is given by a slow intravenous infusion through a drip given over a period of 46 hours (at home) via a pump through a central venous catheter. This happens every 2 weeks for a total of 24 weeks. You’ll need to come in to the clinic every 2 weeks, have a CT scan after 12 weeks and then again after your treatment is complete.
For information on treatment side effects please refer to your specific chemotherapy regimen information sheets provided to you at your clinic appointment.
Hepatic artery embolisation
This involves introducing a blocking material to reduce or obstruct the blood flow to the artery supplying the tumour.
Before the treatment, you will need to sign a consent form and not eat for six hours, although you will be allowed to drink clear water up to two hours prior to the procedure. On average this treatment will take 2 hours.
Afterwards, you’ll need to stay with us overnight for some necessary bed rest, and probably for a few days. The treatment will be assessed by a scan.
Peptide receptor radioligand therapy (PRRT) Lutetium/Yttrium DOTATATE
This procedure involves the use of a radioactive labelled peptide which binds to certain receptors on cells called somatostatin receptors.
Before the treatment, you will be given an anti-sickness injection. The treatment itself will then be given into a vein in your arm over a period of 4-5 hours. You will also be given special fluids via drips into your arms to help protect your kidneys from the radiation.
After the treatment, you will need to stay in hospital for 1 to 2 days, although it could be longer and because the treatment leaves you radioactive, you’ll need to be in a room by yourself until your radioactivity has fallen to a safe level.
We’ll take scans to see the distribution of the treatment in your body straight after your treatment, and then again after 24 hours, 3 days and 6 days. The scans are performed with a gamma camera and is very similar to the octreotide scan you had before your treatment.
Finally, because this treatment can lower your blood counts, you will need to have a blood test every 2 weeks afterwards. You can arrange to do this at your local GP surgery.
MIBG is a radioactive substance taken as a drink or injected into the bloodstream. Almost all of the radiation is absorbed by the tumour, and very little goes in to normal healthy tissues. This is why it is called targeted radionuclide therapy.
Before treatment you will need to take something called Lugol’s iodine tablets, as well as the day before, day of and day after your scan to protect your thyroid gland from effects of radiation.
Afterwards, because you will be radioactive, you will need to be in a room by yourself for a few days until your radioactivity has fallen to a safe level. Initial scans will be taken after 4 hours and then more detailed pictures on the second day. For more guidance please see information leaflet provided in clinic.