Treatment for large bowel and rectal neuroendocrine cancer
Large bowel and rectal neuroendocrine cancers are rare cancers that develop in the 
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The treatment you have depends on what type of neuroendocrine cancer you have. And it depends on where it is, its size and whether it has spread (the stage).
These cancers grow at different rates. For example, rectal NETs can grow very slowly. But NECs grow much faster. This means the treatment and outlook () is different for each type.
Surgery is the main treatment for large bowel and rectal neuroendocrine cancers.
Deciding which treatment you need
A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).
The treatment you have depends on:
- where the neuroendocrine cancer started in your large bowel or rectum
- the type of neuroendocrine cancer
- whether it has spread (stage)
- how fast the cells are growing (the grade)
- the symptoms you have
- your general health and fitness
Your doctor will discuss your treatment, its benefits and the possible side effects with you.
You are likely to have a clinical nurse specialist (or CNS). They go to the MDT meetings. They can help answer your questions and support you. They are often your main point of contact throughout your treatment.
Types of treatment
The main treatment for large bowel and rectal neuroendocrine cancer is surgery. Surgery might be all the treatment you need if your cancer hasn’t spread.
You might need more than one operation. This depends on whether the surgeon removes all the cancer in your first operation. It also depends on other test results such as the grade and stage of your cancer.
The treatment options depend on whether you have a NET or a NEC.
Other treatments for large bowel and rectal NETs include:
- somatostatin analogues
chemotherapy targeted cancer drugs - peptide receptor radionuclide therapy (PRRT)
- surgery or other treatments for cancer that has spread to your liver
For large bowel and rectal NECs you might have:
- surgery
- chemotherapy
radiotherapy - treatment for cancer that has spread to your liver
Endoscopic resection and surgery
There are different ways to remove the cancer. The procedure or operation you have depends on several factors. These include:
- where the cancer is in your bowel
- the size of your cancer
- the grade of your cancer
Your surgeon might be able to remove the cancer using a . This is called an endoscopic resection.
Or you might have a larger operation to remove a section of your bowel or rectum. There are different types of surgery. The surgeon might remove:
- part of your bowel - a colectomy
- a small part of your rectum - a trans anal endoscopic microsurgery (TEMs)
- a section of the rectum - a total mesorectal excision (TME)
Endoscopic resection to remove a small part of the bowel lining
A surgeon or specialist doctor uses a long flexible tube (colonoscope) to remove just the cancer and a border of healthy tissue around it. They call this an endoscopic resection.
Your doctor might suggest this for a small cancer. Small usually means the cancer is smaller than 1 cm. But your doctor also consider other factors such as the grade and your general health. They might offer you:
- an endoscopic mucosal resection (EMR)
- an endoscopic submucosal dissection (ESD)
These are similar and the doctor uses a colonoscope for both. You usually have these procedures under rather than having a .
Surgery to remove a section of your bowel (colectomy)
Surgery to remove part of your large bowel is called a colectomy. Your surgeon might also call it a hemi colectomy. They might say 'right' or 'left' hemi colectomy, depending on which part of the bowel they remove.
You might have a colectomy to remove cancer from your large bowel if your:
- surgeon can't remove it during a colonoscopy
- cancer hasn't spread
Your surgeon removes the part of the bowel containing the cancer. How much they take away depends on the exact position and size of the cancer. They might also remove the nearby .
Surgeons often do this operation using a . They insert this through a small cut close to your tummy button. This is also called keyhole surgery.
You might need to have a , but this isn't common. It is often temporary. This means you may have another operation a few months later to join the ends of the bowel back together. This is called a stoma reversal.
Surgery to remove a small part of the rectum
This surgery is called trans anal endoscopic microsurgery (TEMs). Your surgeon removes the cancer from the back passage, along with a border (margin) of healthy tissue. You have a .
You might have this operation for a rectal NET that is between 1 and 2 cm if:
- your surgeon can't remove it at endoscopy
- there is a risk that your cancer will come back after an endoscopic resection
Surgery to remove a section of the rectum (total mesorectal excision)
You might have this operation for a rectal NET that is bigger than 2 cm. Or if the cancer has spread to the area just outside the rectum.
During a total mesorectal excision (TME), your surgeon removes:
- the cancer
- a border of healthy tissue around the cancer
- some fatty tissue around the bowel
- a sheet of tissue called mesorectum
You might need to have a colostomy as part of this operation. Your surgeon will talk to you about whether this is likely. And whether the colostomy will be temporary or permanent. They will refer you to a specialist stoma nurse who will provide you with information and support.
Other treatments for large bowel and rectal neuroendocrine tumours (NETs)
The following treatments might be options for large bowel and rectal NETs. The treatment for neuroendocrine carcinomas (NECs) is different. We have more information about NEC treatment further down the page.
You might have treatments to help with symptoms if:
- you can’t have surgery to remove the NET
- the NET has spread to another part of the body
- the NET came back after the initial treatment
These treatments can control your symptoms and help you feel better but won’t get rid of the neuroendocrine cancer.
There are a number of different treatment options:
Somatostatin analogues
These are medicines such as octreotide or lanreotide. You might have somatostatin analogues if your NET picks up somatostatin. Doctors can check for this using special scans.
You may have somatostatin analogues to try to slow down the cancer and help with symptoms.
Internal radiotherapy
You might have a type of internal radiotherapy called peptide receptor radionuclide therapy (PRRT). Internal radiotherapy means having radiotherapy from inside the body.
Chemotherapy
You may have chemotherapy if you can’t have surgery to remove the NET. Or if it has continued to grow despite having other treatments. You might also have it if your NET spreads.
You might have a combination of the following drugs:
- fluorouracil (5-FU) or capecitabine
- temozolomide
- oxaliplatin
- streptozocin
Targeted cancer drugs
You might have a type of targeted drug called everolimus if you have a NET that has spread. And if other treatments aren’t working.
Treatment for large bowel and rectal neuroendocrine carcinomas (NECs)
Treatment depends on your individual situation. Unfortunately, large bowel and rectal NECs are harder to treat than large bowel and rectal NETs. This is because these cancers are faster growing and more likely to spread.
You might have surgery if your cancer hasn’t spread. You can read about different types of surgery higher up this page.
You usually also have chemotherapy treatment as well as surgery. You might have this:
- before surgery – this is called neoadjuvant chemotherapy
- after surgery – this is called adjuvant chemotherapy
You have chemotherapy on its own or combined with radiotherapy. This is called chemoradiotherapy.
Chemotherapy drugs include:
- carboplatin or cisplatin
- etoposide
- irinotecan
Treatment for neuroendocrine cancer that has spread to the liver
Large bowel and rectal neuroendocrine cancer can spread to other parts of the body. One of the most common places of spread is the liver. You might have one of the following treatments:
- surgery to remove the cancer from your liver - you either have this at the same time as the main surgery, or you have a second operation
- radiofrequency ablation (RFA) which uses heat made by radio waves to kill cancer cells
- Trans arterial embolisation (TAE) which blocks the blood supply to a NET in the liver
- liver transplant - this is a big operation and is only suitable for a very small number of people
Follow up for large bowel and rectal neuroendocrine cancers
You might have follow up appointments every few months after treatment. For some people, the appointments might be less often than this.
This is to check how you are and see whether you have any problems or worries. The appointments also give you the chance to raise any concerns you have about your progress.
How often you see your doctor depends on:
- the grade of the large bowel or rectal neuroendocrine cancer
- whether it has spread to other parts of the body
You might also have tests on some visits. The tests might include:
- colonoscopy
- a
CT scan or MRI scan - a blood test to check for the amount of
chromogranin A (CgA ) endoscopic ultrasound (EUS )
Research into large bowel and rectal neuroendocrine cancers
Researchers are looking at improving the diagnosis and treatment of neuroendocrine cancer
Go to Cancer Research UK’s clinical trials database if you are looking for a trial for neuroendocrine tumours in the UK. You need to talk to your specialist if there are any trials that you think you might be able to take part in.
