Surgery with complete removal of the tumor tissue is usually the first line treatment. It can result in permanent cure if it is possible to remove the tumor entirely.
Even when the entire tumor cannot be removed, removing large portions of the tumor (debulking) can effectively relieve the symptoms by decreasing the amount of harmful hormones being produced and flooding the circulation.
There are also some new procedures for treating tumors that have spread or metastasized to the liver.
The mainstay of treatment for advanced carcinoid tumors that cannot be removed surgically is Sandostatin (octreotide) injections. In many cases, this anti-hormone drug inhibits and sometimes reverses the growth of the tumors.
This is given by injection 2-3 times per day, and then the injection may be changed to once a month using a long acting release (LAR) dosage after a 2-4 week period. This often improves symptoms of the carcinoid syndrome, and decreases tumor progression.
Interferon is another drug often given with octreotide. It is referred to as an immuno modulator. Its effect is to suppress or stop the growth of the tumor.
Chemotherapy can be given by intravenous injection or by mouth for carcinoid syndrome. Many combinations have been used. If one combination is ineffective, another combination may be effective, and overall about one-third of patients benefit from chemotherapy.
Increased protein and a low-fat diet are often recommended. Multivitamin mineral and low dose nicotinic acid (niacin) supplements may be prescribed. Other items sometimes recommended are fish oil capsules, electrolyte supplements, and in some cases, large portions of nutmeg. Avoid ingestion of alcohol, large meals, and foods high in tyramine, as these may provoke symptoms.
A serotonin antagonist may be prescribed to control diarrhea and inadequate absorption of nutrients from the intestines (malabsorption).
Sandostatin and similar medications may be effective in reducing the episodes of flushing and diarrhea and in reversing the blood pressure changes. There are other medications that may be prescribed for symptoms as well.
Some common medicines, like selective serotonin reuptake inhibitors (SSRIs, such as Paxil, Serzone, and Prozac) may make symptoms worse by increasing levels of serotonin. However, these medicines should be discontinued only on the advice of your doctor, since stopping them abruptly may cause withdrawal symptoms and since depression can cause health problems as well.
