Treatment for Neuroendocrine Tumors

Today, physicians have many options for treating neuroendocrine tumors (NETs). Choosing the right therapies for you can be complex. There is no one-size-fits-all approach. To get the best possible outcome, we tailor your care to you.

Fred Hutchinson Cancer Center is a specialized center for providing care for people with NETs. We recognize that NETs are a long-term, chronic illness. Our NET specialists work closely with you, your family and each other throughout your journey to restore you to health. We provide all standard therapies for NETs and offer you access to the latest innovations through clinical trials.  

NET treatment can vary widely from person to person. Often, we have many options to choose from. For you, options may include surgery, chemotherapy, targeted therapies, peptide receptor radionuclide therapy, medicines to control excess hormones, radiation therapy or special therapies for liver NETs. Not everyone needs all these. We select and combine treatments to fit your unique case.

As you go through treatment, your needs evolve, so your care at Fred Hutch evolves too. For instance, your care team helps to relieve any symptoms or side effects you have. We may suggest adding a new therapy. Even after your NET treatment is complete, we keep seeing you to protect your health over the long term.

Treatment Plan

NETs treatment at Fred Hutch is highly customized to meet each patient’s needs.  

How Do We Create Your Treatment Plan?

Your Fred Hutch medical oncologist works alongside an entire group of NET specialists. They include other medical oncologists, surgeons, radiation oncologists and nuclear medicine specialists. These physicians also get input from pathologists and interventional radiologists. They are joined by advanced practice providers, nurses, supportive care providers and researchers looking for better ways to treat this disease.

Every week, this team gathers in a meeting called a tumor board. Together, dozens of team members discuss patients’ treatment plans. This approach means each patient benefits from the experience of the whole group.

Your physician, supported by the larger team:

  • Assesses whether your disease needs treatment at this time (sometimes watchful waiting is an option) and, if so, when treatment should happen
  • Considers the standard therapy for a NET like yours
  • Determines if any clinical trials match your needs so you can consider taking part

Your medical oncologist will walk you and your caregiver through the treatment plan that the tumor board recommends. You will have a chance to discuss your personal preferences and options, and you will decide together how to move forward.

Why Do Treatment Plans Differ?

The treatment plan we design for you depends on many factors, including: 

  • Your type of NET and where it is
  • Whether your NET is slow growing (low grade) or fast growing (high grade) 
  • Whether your NET is causing symptoms 
  • The stage of your disease 
  • Your age and overall health 
  • Your needs and preferences, like what type of treatment schedule works in your life and whether you want to take part in a clinical trial

What Is The Standard Therapy For NETs?

NETs can arise in many different organs and affect people in different ways. There is no single way to treat everyone. Broadly speaking, however, patients have surgery to remove their tumors when possible. Treatment often includes chemotherapy, targeted therapy or both. If your NET makes excess hormones, we have medicines to help with this too. Some types of NETs respond to radiation therapy or peptide receptor radionuclide therapy. There are other treatments for NETs in the liver specifically.

Some people with NETs do not need any active treatment for years. But they should be carefully monitored over time. This is called watchful waiting.

At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from symptoms and side effects. We also provide many other forms of support, like integrative medicine, nutrition counseling and emotional support.

Patients here have the option to receive promising, new NET therapies that you can get only through a clinical trial. Many people come to Fred Hutch for access to these studies. Your care team will tell you about studies that might be right for you so you can consider joining.

Certain diseases passed down in families can increase the risk for NETs. If you may have one of these diseases, your NET team can refer you to Fred Hutch’s Clinical Genetics and Genetic Counseling Service for help understanding what this means for you and your family.

Treatment Process

Different tumors progress and respond to treatments in different ways. We select, combine and sequence your treatments based on what works for your situation. Your care team makes sure you understand each type of treatment and all your choices. 

Watchful Waiting

This is also called observation or active surveillance. It means you and your physician closely monitor your health for any changes, like faster tumor growth or the start of symptoms. For some people, treatment may not be needed for a long time.

Watchful waiting can sound like an odd concept. But for NET patients who have slow-growing tumors and no symptoms, immediate treatment provides no benefit, according to research. Plus, delaying treatment can spare you from any difficult side effects of treatment that could occur.

During watchful waiting, you visit your physician for exams and have blood tests and imaging tests on a regular schedule. The schedule depends on your individual needs.

In between scheduled visits, you are not on your own. We are here. If you notice health changes, you can always call us. In fact, we encourage you to call so we can check whether you do need active treatment.

Some people do not need active treatment for many years. The main benefits of watchful waiting are:

  • You can keep living your life without much disruption. You do not have side effects from treatments you do not need.
  • When you do need treatments later, they will still be just as effective.
  • More effective options might be available in the future.

Somatostatin Analogs

Hormone-related symptoms can range from diarrhea to high or low blood sugar to skin rash to anxiety. Your care team works closely with you to identify and relieve any symptoms you have. We have options that can help. These include the medicines octreotide and lanreotide. Both are given as shots (injections).


Chemotherapy uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing (which is how cancers grow). 

Your medical oncologist prescribes your chemotherapy (and other medicine-based treatments) and sets your treatment schedule. For NETs, chemotherapy is often given in pill form but at times may be given by infusion (put into a vein through an intravenous line). Your oncologist will determine what is best based on the features of your disease and your preferences. They will explain your treatment schedule and any side effects in detail.  

Who Needs Chemotherapy?

You might have chemotherapy if: 

  • Your NET has spread beyond where it started and cannot be taken out by surgery. 
  • Your NET was removed and has a high risk of coming back. 
  • You NET causes symptoms which cannot be controlled with other medicines.
Learn More About Chemotherapy

Targeted Therapy

Targeted therapies work in one of these ways: 

  • They target a gene or protein responsible for cancer growth. 
  • They directly damage cancer cells. 
  • They prompt your immune system to attack certain cells. This is also called immunotherapy. 

Targeted therapies are usually given as a pill that you take at home. Some are given by infusion in repeating cycles. Such treatments include everolimus and sunitinib. 

Researchers at Fred Hutch are working to find more ways to target NETs and develop new therapies.

Learn More About Targeted Therapy

Peptide Receptor Radionuclide Therapy (PRRT)

PPRT is a way to get radiation straight to your tumor cells.

Certain NETs respond to PRRT with lutetium-177 dotatate. The drug dotatate targets tumor cells in your body. It delivers the radioactive part, lutetium 177 (Lu-177), into these cells. There, the Lu-177 damages the cells, causing cell death.

Physicians use this treatment for some advanced gastrointestinal and pancreatic NETs and some lung carcinoids. It is sometimes used for other types of NETs, such as pheochromocytomas and paragangliomas.

Lu-177 dotatate is given by infusion. Liquid medicine is put into a vein through an intravenous (IV) line. It is done every eight weeks for four cycles.

The U.S. Food and Drug administration approved this treatment for NETs in 2018. We offer it at our South Lake Union clinic. 

Learn More About Lu-177 Dotatate

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. A radiation oncologist decides on the type, dose and schedule of your treatment. 

Usually this means a machine aims rays precisely at your tumor. This is external-beam radiation therapy. You get this treatment daily, Monday through Friday, for several weeks. 

If you have a NET that responds to radiation therapy, your team might recommend this form of treatment:

  • If surgeons cannot remove your tumor
  • To help relieve symptoms caused by a NET that has spread 
Learn more about Radiation Therapy

Liver-Directed Treatment

If NETs have spread to your liver, several options may help control tumors there. 

For Fred Hutch patients, these are done at UW Medical Center - Montlake: 

  • Radiofrequency ablation — This uses heat to treat liver tumors. An interventional radiologist or a surgeon inserts a needle-like probe into the tumor. They use an ultrasound or CT (computed tomography) scan to guide the probe to the right place. Radiofrequency energy creates heat created at the tip of the probe. The heat kills the cancer cells.  
  • Hepatic artery embolization — This blocks the main artery that brings blood to your liver.  It cuts off the blood supply that the tumor needs to survive. (Your liver still gets blood from another main blood vessel.)  An interventional radiologist places a catheter into an artery in your groin. They thread it up into your hepatic artery.  Then, they put in medicines to create the blockage. In some cases, they put in anticancer medicine first (chemoembolization).  
  • Radioembolization — This can slow or stop tumor growth and shrink tumors by getting radiation directly to the liver.  An interventional radiologist places a catheter into an artery in your groin. They thread it up into your hepatic artery close to your tumor. Then, they inject small radioactive particles.  These lodge inside the tumor. They block blood flow and emit radiation that damages the cancer cells. 

Monitoring Your Health

While you are in active treatment, your NET care team sees you regularly for exams and tests to check: 

  • How well your treatment is working 
  • If there is any reason to change your treatment 
  • If you are having any symptoms from NETs and need care to relieve these 
  • If you need help with side effects or supportive care services, like nutrition care or mental health counseling 

We refine your treatment plan based on the best scientific evidence as well as how your disease responds, how you feel and what you prefer. 

Possible Results of Treatment

For NETs that surgeons may be able to remove, the aim is to cure the cancer. However, the cancer can come back (recur) and often does. For NETs that surgeons cannot remove or that have spread to other organs, the goal is to control the disease and make it a chronic condition.

Managing Side Effects

You might be wondering about possible side effects from treatment, like hair loss or nausea from chemotherapy. If you are, it might be helpful to know that many of today’s treatments are more targeted to cancer cells and affect your body differently than standard chemotherapy.  

You are always at the center of everything we do. NET physicians, nurses and advanced practice providers are here to help prevent or relieve side effects of treatment.  

Get Help with Side Effects

Before you begin treatment, we talk with you about what to expect, based on your treatment plan, and what measures can help if you experience side effects. 

At your appointments, we want you to tell us about any side effects you have. If you have questions or concerns between appointments, you can call or email us. We make sure you know how to reach care providers at Fred Hutch after hours, if that is when you need us.  

We have many tools to help you feel better, such as: 

  • Antibiotics, vaccines and antiviral drugs to prevent or treat infections 
  • Transfusions, steroids and medicines that stimulate the immune system to treat low levels of blood cells (low blood counts) 
  • Nutrition care and medicines to help with digestive problems 
  • Conventional and integrative therapies for pain 

Coping with Side Effects

Common Side Effects

Side effects vary depending on which treatment you get and other factors, like how strong your immune system is. These are some of the common side effects of NET treatment: 

  • Unusual tiredness (fatigue) 
  • Hair loss 
  • Higher risk of infection (due to low levels of white blood cells) 
  • Anemia (due to low levels of red blood cells) 
  • Easy bruising or bleeding (due to low levels of platelets) 
  • High blood sugar 
  • Problems in your digestive tract, like sores in your mouth, nausea, vomiting, constipation or diarrhea 
  • Rash or other skin changes 

Supportive Care Services

Along with treating your NET, Fred Hutch provides a range of services to support you and your caregiver, before, during and after treatment. This is part of how we take care of you — not just your disease. 

From dietitians to chaplains, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need. 

Learn more about Supportive Care

Caregiving During Treatment

If your loved one is receiving care for a NET, there are many ways you can help. Caregiving during active treatment for a NET often means doing tasks like these:

  • Keeping track of your loved one’s appointments, and driving them to and from treatment 
  • Watching for changes in their condition, and reporting symptoms to their care team 
  • Providing physical care, like helping them take medicines 
  • Spending time with them and giving encouragement 
  • Taking care of things at home that they might not be able to do, like grocery shopping and cleaning 

Continuing Care

Even if you are not on active treatment, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see the same Fred Hutch team who treated your NETs. They will check your overall health and look for signs that your cancer may be changing.

Your team will also help with any long-term side effects from prior treatment.

Schedule For Follow-up Visits

Just as we personalize your treatment plan for you, we personalize your follow-up schedule too. Your medical oncologist will base your schedule on many factors, including: 

  • Your type of NET
  • Whether your disease was slow growing (low grade) or fast growing (high grade) 
  • Which treatments you had and how your disease responded  
  • How the disease and treatments affected you  
  • How long it has been since your treatment ended 

Most patients have follow-up appointments for at least five years after cancer treatment. It is common to have visits more often at first. 

What Happens at Follow-up Visits

Follow-up for a NET typically means seeing your medical oncologist for a physical exam and having blood tests. 

Your physician will talk with you about whether you need any imaging tests. You might have tests like an X-ray, CT (computed tomography) scan or PET (positron-emission tomography) scan. These can help check for recurrence, but they also expose you to some radiation. Together, you and your physician will weigh the benefits and risks. 

Meet the Neuroendocrine Tumors Care Team