To remove, partially remove or bypass Neuroendocrine Cancer and / or secondary sites of disease (metastases).
In planning treatment, surgery is usually the first option considered as it may offer the only potential chance for cure (in very early stage disease) but also has a role in disease that may have spread (metastases).
There are several aims and types of surgery – all of which will depend on the type and site(s) of Neuroendocrine Cancer you have, how well you are, the risks and benefits of surgery to you and your informed consent.
Aims of Surgery
Remove all visible disease
If you have a single tumour, with no evidence of secondary disease (no lymph nodes or metastases) and it can be completely removed, then surgery may be a potentially curative treatment. The decision on the type and regularity of follow up will be based upon the results of the histopathology review (checking what’s been removed under a microscope).
Expert opinion is essential to assess risk of recurrence.
Remove as much as possible
Partial / Cyto-reductive / De-bulking Surgery – All of these terms refer to surgery designed to reduce the amount of cancer in your body, by removing as much as is safe to do so. This kind of surgery might involve removing:
- All or part of a primary tumour
- All or part of any secondary tumours
- All of the primary tumour and some of the secondary tumours
- Whatever can safely be removed.
This type of surgery is usually undertaken to help improve your symptoms and/or to manage the disease. It is often used in combination with other types of treatment, including; somatostatin analogues, chemotherapy, interventional radiology and/or nuclear medicine therapy.
De-bulking a tumour can improve symptoms that have been caused by the size and position of a tumour or by the release of excess hormones into the blood. It can also improve the effectiveness of other treatments, as they will be targeting a smaller amount of tumour.
Remove possible cause(s) of symptoms
Pre-Emptive/ Bypass Surgery .
Occasionally, Neuroendocrine Cancer develops too close to blood vessels and / or surrounding organs and can interfere with how these structures work – potentially leading to pain and/or other symptoms.
Removing or bypassing these kinds of tumours can help to prevent blockages and other damage, reducing the chance of extra problems developing in the future. This is known as pre-emptive or bypass surgery.
Types of Surgery Explained
Surgery is a treatment in which a part of the body is cut open so that a surgeon can repair, remove, or replace a diseased or damaged part. With any type of surgery, the length of your stay in hospital and the time it takes to recover, will depend on the type and extent of surgery you have, what your general health is like and on whether any complications occur.
Your surgical team will give you full information about any surgery recommended for you.
Many hospitals produce their own information leaflets about the types of surgery they do – if you do not receive any written information, you can ask either your surgeon or specialist nurse.
Surgery is usually done one of four ways:
Keyhole surgery is done through very small incisions in your skin with the use of a fine tube with a light on the end (known as a fibre optic light source). The surgeon carries out the operation by using special instruments inserted through the tube. Keyhole surgery may cause less pain and reduce your length of stay in hospital (when compared to open surgery), and though it is used for an increasing number of conditions – having keyhole surgery will depend on the site and type of cancer you have. If keyhole surgery is offered as the best option for you, you may also be alerted to the possibility that open surgery may happen instead – especially if the surgeon cannot remove, debulk or bypass your cancer through the keyhole procedure.
Open surgery is the most common type of surgery and characterised by a cut (incision) into the body to allow the surgeon to remove, debulk or bypass your cancer – staples or stitches will be used to close the incision.
Laparoscopic surgery is similar to keyhole surgery but refers especially to operations performed inside the abdomen and in the peritoneum (the lining of the abdomen).
Robotic surgery uses small incisions, as in keyhole or laparoscopic surgery, to allow the surgeon to to use several specifically designed robotic arms to carry out the procedure. This procedure is reserved for very specific types of surgery.
There are 2 further considerations :
Combined or Staged Surgery
You might need more than one type of surgery to treat your cancer. If this is the case for you, your surgeon will discuss whether the surgeries can be undertaken at the same time or in stages (which means you’ll have one surgery and then be given time to recover before the next one takes place).
For example; if you have a small bowel primary and liver secondary that are both suitable for removal, the surgeon will assess how much surgery would be required, how long it would take (so how long would you need to have an anaesthetic for), and the potential risks/benefits for you.
Open and Close Surgery
This term refers to surgery being started but not completed, either because of a severe deterioration in your condition during surgery or because your cancer cannot safely be removed, debulked or bypassed.
If surgery is stopped because your condition deteriorates, you’ll be given full care and time to recover .Your team will then need to review and decide, depending on the cause of your deterioration, whether it is safe to re-schedule surgery. This will be fully discussed with you.
However, if an operation is stopped because your cancer cannot safely be removed, debulked or bypassed you’ll be given full care and time to recover and then your care team will discuss alternative treatments with you.
Effects of Treatment
Neuroendocrine Cancer Treatments work in a variety of ways – and whilst we wish it wasn’t the case, side-effects can occur – not will occur – but can occur.
Many of these, if they happen, can be mild and manageable – others may cause an alteration or adjustment in treatment, such as reduced dose or interval – occasionally a treatment may have to stop – either temporarily (a ‘treatment break’) or permanently, because the side-effect is more severe.
You may also be given treatments in a different order to what was first planned or how you may see them given in others – remember – your treatment plan will be personalised to you.
But it is only possible to deal with changes and side-effects, if you are able to talk them through with your specialist nurse or team.
If you notice a change, or don’t feel well, during or after a treatment – it may be tempting to ignore it or not mention it or wait a few weeks to see if things improve. You may be worried that if you do highlight any changes, your treatment may be stopped. However, the sooner your team knows what is happening, the sooner they can help you to deal with any changes – which will not always mean stopping treatment.
Changes or new symptoms may not always be caused by your treatment – Neuroendocrine Cancer itself can cause alterations in health – and other unrelated health issues can also occur. So, it can be helpful to know what to expect from treatment, what to look out for – and, importantly, when and who to contact if changes occur.