Carcinoid and Neuroendocrine Tumor Program

Comprehensive Treatment and Innovative Therapies for Rare Cancers

The Cedars-Sinai Carcinoid and Neuroendocrine Tumor Program provides comprehensive multidisciplinary care for patients with carcinoid and neuroendocrine tumors. Our team has access to the most current techniques for diagnosis and treatment and is one of the few such programs in the United States.

Neuroendocrine Tumors and Carcinoids

Neuroendocrine tumors are cancers of certain endocrine cells. In addition to growing and spreading like other cancers, they can produce hormones. Neuroendocrine tumors in adults commonly originate in the small intestine (carcinoid), pancreas, lung, colon, rectum, appendix and stomach, but many other primary sites are possible.

Although most neuroendocrine tumors grow more slowly than many other cancers, some (e.g., high grade, poorly differentiated or small cell cancer) grow very quickly. Some neuroendocrine tumors are named by the hormones that they produce, such as gastrinoma (gastrin), insulinoma (insulin), glucagonoma (glucagon), VIPoma (VIP) and carcinoid (serotonin).

Adrenal pheochromocytoma, paraganglioma and medullary carcinoma of the thyroid are names of other rare neuroendocrine tumors.

Diagnosis

Most carcinoid and neuroendocrine tumors are very difficult to diagnose when they are small and are not visible on routine types of imaging studies. However, advanced endoscopic procedures at Cedars-Sinai will usually find the hidden primary tumor causing intestinal obstruction or bleeding. These procedures include double balloon push enteroscopy, endoscopic ultrasound of the pancreas and wireless capsule endoscopy.

Computed tomography scans (CT), advanced types of magnetic resonance imaging (MRI) scans and positron emission tomography (PET) scans, MIBG scan and octreotide scans are used as needed to diagnose primary tumors and those that have spread, known as metastases. Neuroendocrine tumors that originate in the intestine and pancreas frequently spread to the liver.

Treatment

The Carcinoid and Neuroendocrine Tumor Program provides comprehensive treatment for all types of neuroendocrine tumors. At Cedars-Sinai, we have access to the most sophisticated types of laparoscopic and minimally invasive surgery for primary tumors and liver metastases.

Specialized interventional radiology is available for Y-90 radio-embolization, hepatic artery chemo-embolization, radio frequency and microwave ablation, and other techniques for treating liver metastases. For carcinoid and neuroendocrine tumors, we have access to treatments including hormone therapies (somatostatin analogs), biotherapy, immunotherapy, targeted biologic agents and peptide receptor radiotherapy using Lu-177.

In addition, we use the latest endocrine techniques for managing hormone production syndromes from these tumors. The program's patients also have access to other Cedars-Sinai services, including the Samuel Oschin Comprehensive Cancer InstituteEndocrinology Services, the Comprehensive Transplant Center and the S. Mark Taper Foundation Imaging Center.

Research

The Cedars-Sinai Carcinoid and Neuroendocrine Tumor Program has one of the largest and most comprehensive clinical research programs in the country devoted to these rare diseases, bringing leading-edge treatments to our patients.

Among the treatments under study are the new somatostatin analogs pasireotide and lanreotide, and multiple oral targeted biological agents that prevent cancer cells from multiplying without the toxicity of traditional chemotherapy. These include many types of m-TOR inhibitors, including everolimus and TORC-1+TORC-2 inhibitors, and peptide receptor radiotherapy PRRT. We also have clinical trials using immune stimulants and anti-angiogenic agents.

Cedars-Sinai is involved in numerous laboratory research studies related to neuroendocrine tumors. Some of these studies are funded by the National Institutes of Health (NIH). Researchers at the Carcinoid and Neuroendocrine Tumor Program are investigating the molecular genesis of carcinoid and neuroendocrine tumors, as well as innovative subcellular therapy.

For example, through translational research, we have discovered a novel disease involving pancreatic neuroendocrine tumors. An animal model of the tumor has been identified here and is used by our researchers to study pathogenesis and treatment. Other research conducted at Cedars-Sinai has helped identify genetic mechanisms involved in tumor growth and resistance to treatment.

Physician Referral

The Cedars-Sinai Carcinoid and Neuroendocrine Tumor Program — led by Edward M. Wolin, MD (medical oncology) — works closely with referring physicians to coordinate management, typically remaining in close touch by letter and phone. For new patient referrals, please call the Samuel Oschin Comprehensive Cancer Institute at 310-423-0709.