Neuroendocrine Tumors

Advanced diagnostics for neuroendocrine cancer

At UCSF Health, we have experience diagnosing all forms of neuroendocrine cancers, including the different grades and subtypes of NETs and NECs. Our expertise in accurately distinguishing between tumor types helps us choose the most effective therapies and deliver individualized care, greatly improving outcomes for our patients.

We use the latest diagnostic tools and techniques to make an accurate diagnosis as quickly as possible, including:

• Gallium 68-Dotatate PET/CT. During this nuclear imaging procedure, we use a radioactive substance (tracer) that binds to tumor molecules called somatostatin receptors. This scan allows us to locate and stage tumors faster and with greater accuracy.

• Molecular profiling. We use sophisticated tests to analyze molecules in high-grade tumors, looking for genetic changes (mutations) or markers that can help us determine the most effective treatments.

• Germline genetic testing. Some neuroendocrine tumors are related to inherited syndromes. Based on your age, family history and diagnosis, we may recommend genetic counseling and testing. Our genetic counselors interpret your results and explain how they may affect you and your family.

Personalized treatment for neuroendocrine tumors

Our specialists offer leading-edge therapies and have expertise in planning the optimal timing and sequence of treatments. They meet regularly at tumor boards to ensure care is tailored to your needs.

Surgery for neuroendocrine tumors

Surgery is the main treatment for many NETs. Whenever possible, our team uses minimally invasive techniques to remove tumors. These can include endoscopic procedures where we remove tumors through natural openings in your body, such as during a colonoscopy, or through laparoscopic procedures that allow us to operate through small incisions. These approaches help patients recover faster and with a lower risk of complications.

Our surgeons are also skilled in open surgical techniques, which they may use for large, complex or hard-to-reach tumors. Their expertise in both minimally invasive and open approaches enables them to select the best procedure to address each patient's needs.

Radioligand therapy

Radioligand therapy (RLT) is a form of targeted, internal radiation therapy that's typically delivered by intravenous infusion (through a vein). It involves attaching a radioactive particle to a carrier that binds to specific targets on tumor cells.

Peptide receptor radionuclide therapy (PRRT) is a type of RLT that involves attaching a radioactive substance (radionuclide) to a peptide. In PRRT, this peptide is an artificial version of a hormone called somatostatin. Together, these substances form a "radiopeptide" that binds to specific receptors on NETs (somatostatin receptors). PRRT precisely delivers radiation to tumor cells to destroy them while minimizing damage to healthy cells.

PRRT can shrink tumors, delay tumor growth and improve quality of life for people with certain types of NETs. When appropriate, our nuclear medicine physicians and oncologists work together to incorporate PRRT into your care plan.

Somatostatin analogs

Some NETs make excess hormones, such as serotonin, insulin or glucagon, that can cause side effects such as diarrhea, flushing and dangerous blood sugar fluctuations. Somatostatin analogs (SSAs) are drugs used to treat these symptoms by blocking hormone secretion.

SSAs have also been shown to delay tumor growth and are often the first type of therapy we give to patients with advanced diseases. We may recommend SSAs in combination with other treatments, such as surgery or PRRT.

Liver-directed therapy

These treatments specifically target tumors in your liver, including neuroendocrine liver metastases (NETs that have spread to your liver). At UCSF Health, we offer a range of liver-directed therapies, including:

• Hepatic artery embolization blocks blood flow to liver tumors, depriving them of oxygen.

• Stereotactic body radiation therapy (SBRT) precisely targets liver tumors using highly focused radiation.

• Histotripsy destroys liver metastases using noninvasive ultrasound waves.

Additional therapies and supportive care for neuroendocrine cancers

Our team uses many approaches to provide individualized neuroendocrine cancer care. Depending on your needs, we may recommend radiation therapy, chemotherapy or other treatments available through clinical trials.

We also offer a wide range of services to support every aspect of your well-being. From symptom management and holistic, mind-body therapies to dedicated social workers, you'll find all the resources you need for whole-person care at UCSF Health.