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Neuroendocrine tumours that have spread to the liver: treatment options | CION Cancer Clinics
Neuroendocrine tumours that spread to the liver are treated according to how fast they grow. Slow ones may be watched, held back with injections, removed or treated directly in the liver, or treated with PRRT. Faster ones need chemotherapy. This page explains what decides the plan, the main options side by side, and who each one does not suit. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- How are neuroendocrine tumours in the liver treated?
- What decides which treatment is offered?
- What are the main treatment options, and who are they for?
- What are the usual steps after the diagnosis?
- What do families often believe, and what is true?
- Which treatments do not suit which tumours?
- What this page cannot tell you
- Common questions about neuroendocrine tumours in the liver
The short answer
How are neuroendocrine tumours in the liver treated?
The treatment depends mostly on how fast the tumour is growing. Many neuroendocrine tumours (NETs) grow slowly, so options include careful watching, monthly injections that hold the tumour back, treatment aimed at the liver, surgery for some, and a targeted radiation medicine called PRRT. Faster-growing ones are treated more like other cancers, with chemotherapy.
This page is about secondary spread
Here the tumour began somewhere else, most often in the small bowel or the pancreas, and has spread to the liver. Neuroendocrine tumours that begin in the liver itself are rare. Both are explained on neuroendocrine tumours in the liver, primary and secondary.
Why this is different from most liver spread
For most cancers, spread to the liver means the medicines must come first and surgery rarely helps. Slow-growing NETs are an exception. Many people live with liver spots for a long time, and the liver itself is often treated directly. That makes the first conversation about the tumour's grade, not about urgency.
A neuroendocrine tumour in the liver is a long-term condition for many people. Plans are often made over seasons, not weeks.Before a plan is made
What decides which treatment is offered?
The team looks at four things together. No single one decides the plan on its own.
Grade and Ki-67
The pathologist measures how many tumour cells are dividing, using a test called Ki-67, and gives a grade. Grade one is slowest. Grade three and neuroendocrine carcinoma grow fastest and are treated more urgently.
Whether it shows on a DOTA scan
Many NETs carry somatostatin receptors, docking points that a special PET scan can light up. A tumour that shows clearly on this scan is more likely to respond to the injections and to PRRT.
Whether it makes hormones
Some NETs release hormones into the blood, causing flushing, diarrhoea or wheezing. This is called carcinoid syndrome.
Hormone symptoms change the plan
- They are controlled first, for comfort
- They need care before any procedure
- The heart valves may be checked
How much liver is involved, and where it started
A few spots in one part of the liver may be removable. Spots scattered across both sides usually are not. A pancreas starting point opens some different medicines from a bowel one.
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What are the main treatment options, and who are they for?
Treatment
Usually considered when
Watching with regular scans
The tumour is low grade, causing no symptoms and not changing
Somatostatin analogue injections (octreotide, lanreotide)
The tumour shows on a DOTA scan, or hormone symptoms need control
Liver surgery
Most of the liver disease can be safely removed, sometimes with the original tumour
Embolisation or ablation of liver spots
Disease is mostly in the liver and surgery is not possible
PRRT, such as Lu-177 DOTATATE
The tumour grows despite injections and shows strongly on a DOTA scan
Targeted tablets or chemotherapy
Higher grade tumours, pancreatic NETs, or growth on other treatments
What happens next
What are the usual steps after the diagnosis?
Confirming the type and grade
A biopsy of a liver spot is tested for neuroendocrine markers such as synaptophysin and chromogranin, and for Ki-67. CION arranges this through partner hospitals and pathology partners.
The right scans
A DOTA PET-CT shows tumours with receptors, and an FDG PET-CT is sometimes added for faster-growing ones. The reasons are on FDG or DOTA PET-CT for neuroendocrine tumours. CION arranges these scans through diagnostic partners.
Finding where it started
If the starting point is unknown, scans, endoscopy and the biopsy markers help locate it. Removing a small bowel starting point can prevent blockage later.
The tumour board and a long-term plan
The tumour board agrees a first step and when it will be reviewed. Many people move through several treatments over time, one after another.
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Commonly believed
What do families often believe, and what is true?
"If they are only watching it, they have given up."
For a slow, low-grade tumour that causes no trouble, watching is an active choice. It saves treatments, and their side effects, for when they are needed. The scans are how the team keeps control.
"A carcinoid is not really cancer."
Neuroendocrine tumours are cancers, even when they grow slowly. Spread to the liver shows that. They still need a specialist plan and regular follow-up, sometimes for many years.
"The flushing and loose motions are just a stomach problem."
They may be hormone symptoms from the tumour. Tell your oncologist about them, because they can usually be controlled, and they matter for safety before any procedure.
"PRRT is a last resort that nobody in India can get."
PRRT is given at some nuclear medicine centres in India, and is used in the middle of the treatment sequence for suitable tumours. Access and timing vary. Read more on Lu-177 DOTATATE therapy.
Who this is not for
Which treatments do not suit which tumours?
Somatostatin injections and PRRT do not suit tumours that do not show on a DOTA scan, because the medicine has nothing to attach to. Watching does not suit fast-growing tumours or those causing symptoms. Liver surgery does not suit people whose spots are scattered too widely to leave enough healthy liver behind.
Neuroendocrine carcinoma is a different illness
Poorly differentiated neuroendocrine carcinoma, small cell or large cell type, behaves more like an aggressive cancer. It is treated urgently with chemotherapy, and the slow, stepwise approach on this page does not apply to it.
Who this page does not apply to
A NET found only in the pancreas or bowel, without liver spread, is covered on the pancreatic neuroendocrine tumour page and the colon cancer section. For tablet treatments, see targeted therapy for neuroendocrine tumours.
Being straight with you
What this page cannot tell you
It cannot tell you how your tumour will behave, or which treatment comes first for you. Those depend on the grade, the scans, where the tumour began and how you are feeling. NETs are uncommon, and the evidence for the order of treatments is still being built.
It cannot read your report
The words "neuroendocrine tumour" and "neuroendocrine carcinoma" look similar and mean very different things. Bring your pathology report and scan discs to an oncologist who sees these tumours, and ask for a pathology second opinion if the grade is unclear.
If you are unsure whether your plan fits your tumour's grade, call the helpline and describe what your report says.Questions we are asked
Common questions about neuroendocrine tumours in the liver
Is a neuroendocrine tumour in the liver curable?
Occasionally, when all the liver spots and the original tumour can be removed. Even then it can come back, so follow-up continues. For most people the aim is long-term control: keeping the tumour quiet and symptoms settled, often for a long time, using different treatments in turn.
What does the Ki-67 number on my report mean?
It shows how many tumour cells are actively dividing. A low number means a slower tumour and a lower grade. A high number means faster growth. It is one of the most important results for planning, so make sure it is reported, and ask your oncologist which grade it places you in.
Are the monthly injections a kind of chemotherapy?
No. Octreotide and lanreotide copy a natural hormone that tells tumour cells to slow down and stop releasing hormones. They do not cause hair loss and are usually well tolerated, though loose stools and gallstones can occur. They are given at regular intervals, often for a long time.
Can a liver transplant be done for neuroendocrine spread?
Only in very rare, carefully selected cases at licensed transplant centres, when the tumour is low grade, the original tumour has been removed and nothing is outside the liver. Most people are not candidates. CION cannot influence any transplant waiting list.
What is carcinoid crisis?
A sudden surge of hormones that can drop the blood pressure, cause severe flushing or wheezing. It can be triggered by anaesthetic, surgery or procedures on the liver. Teams prevent it by giving an injection of octreotide beforehand, which is why your anaesthetist must know about the tumour.
Is TACE used for neuroendocrine liver spread?
Yes, embolisation is used when the liver holds most of the disease and surgery is not possible. It can shrink spots and ease hormone symptoms. CION coordinates it through partner hospitals. How it is done is explained in the embolisation section.
Do family members need to be tested?
Usually not. A small number of NETs, mostly in the pancreas, are linked to inherited syndromes such as MEN1. A genetic referral is worth discussing if the person was diagnosed young, has tumours in other glands, or has relatives with similar tumours.
How often will scans be needed?
It depends on the grade and on how the tumour has behaved so far. Slow, stable tumours are scanned less often, and faster ones more often. Bring every earlier scan disc to each review, because comparing scans side by side is how slow growth is noticed.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- NHS — Neuroendocrine cancers
- Cancer Research UK — Secondary liver cancer
- National Cancer Institute — Metastatic Cancer: When Cancer Spreads
- National Cancer Institute — Targeted Therapy for Cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Neuroendocrine tumours in the liver: primary and secondaryHow the two kinds are told apartLiver-directed treatment for metastasesEmbolisation, ablation and radiation aimed at the liverWhen liver metastases can be removed by surgeryWho is considered for an operationLu-177 DOTATATE therapy for neuroendocrine tumoursHow PRRT works and who it suits
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Not sure your plan fits your tumour's grade?
Send us the pathology report and scans, and an oncologist will go through the options in order with you. One helpline serves every CION centre.