Medical Oncologist
CION Cancer Clinics
Neuroendocrine tumours in the liver: primary and secondary | CION Cancer Clinics
A neuroendocrine tumour (NET) in the liver has almost always spread there from the bowel or the pancreas. A NET that starts in the liver itself is rare. Either way, it is a different disease from the usual liver cancer, often slower, and treated with different medicines and scans. This page explains how it is confirmed, what the grade means and what the treatment options are. At CION Cancer Clinics in Hyderabad, our oncologists explain liver cancer in plain words and plan care around you and your family.
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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
- What is a neuroendocrine tumour in the liver?
- Where does a neuroendocrine tumour in the liver usually come from?
- How do doctors confirm a NET in the liver?
- What do the words on a NET report mean?
- How are NETs in the liver treated?
- What happens at CION, and what is arranged with partners?
- What this page cannot tell you
- Common questions about NETs in the liver
The short answer
What is a neuroendocrine tumour in the liver?
A neuroendocrine tumour, often shortened to NET, grows from cells that make hormones. When one is found in the liver, it has almost always spread there from somewhere else, usually the bowel or the pancreas. A NET that truly starts in the liver itself is very rare.
Why this is not the usual liver cancer
The liver cancer most people have heard of is hepatocellular carcinoma (HCC), which grows from the liver's own working cells, often in a liver already scarred by cirrhosis. A NET is a different disease. It is treated with different medicines, read on different scans and often behaves much more slowly. Many people live with it for a long time while it is watched and controlled.
Primary or secondary: which one is this page about?
Both, because the first job of your team is to tell them apart. If you have been told you have secondary liver cancer from a bowel, breast or lung cancer that is not neuroendocrine, read what secondary liver cancer means instead. If the word on your report is HCC, this page is not about you.
A NET in the liver is a word on a report, not a forecast. The grade and the place it started matter far more.Where it starts
Where does a neuroendocrine tumour in the liver usually come from?
Neuroendocrine cells are scattered through the gut, the pancreas and the lungs. A tumour in any of them can seed the liver.
The small bowel
The commonest starting point for NETs that reach the liver. The original tumour is often tiny and gave no symptoms of its own. It is sometimes found only after the liver spots are seen.
The pancreas
Pancreatic NETs are a separate disease from ordinary pancreatic cancer, and usually slower. Some make hormones that cause their own symptoms. Read more on pancreatic neuroendocrine tumours.
The large bowel, stomach or lung
Less often, the starting point is the colon, the rectum, the stomach or the lung. Bowel NETs are covered in detail on the colon neuroendocrine tumour page.
The liver itself
A true primary liver NET is rare. Doctors only call it that after a careful search finds no other source, and they often keep looking during follow-up scans.
Sometimes no source is found
- The tumour is treated on its grade and spread
- The search for a source continues quietly
Not sure whether this applies to you?
Ask an oncologistFinding out
How do doctors confirm a NET in the liver?
A biopsy of one liver spot
A thin needle takes a small piece of tissue. Unlike HCC, a NET cannot be named from a scan alone. CION arranges the liver biopsy through its diagnostic partners.
Special stains on the tissue
The pathologist uses stains such as synaptophysin and chromogranin to confirm the cells are neuroendocrine. A growth measure called Ki-67 then sets the grade.
A scan that looks for NET cells
A DOTA PET-CT lights up cells carrying a particular receptor on their surface. It shows where the disease is and whether receptor-targeted medicines are likely to help. See FDG or DOTA PET-CT.
A search for the starting point
CT or MRI of the abdomen, sometimes endoscopy, and blood or urine tests for hormone markers. The tumour board then reviews everything together before a plan is made.
On your report
What do the words on a NET report mean?
- Neuroendocrine tumour (NET)
- A tumour from hormone-making cells. Usually slow growing, though not always.
- Neuroendocrine carcinoma (NEC)
- A fast-growing, high-grade cousin of a NET. It is treated more like other aggressive cancers, usually with chemotherapy.
- Grade
- How quickly the cells are dividing. Grade one is the slowest, grade three the fastest. Grade shapes almost every later decision.
- Ki-67
- A stain that counts how many cells are actively dividing. It is the main measure used to set the grade.
- Functioning
- The tumour releases hormones into the blood that cause symptoms, such as flushing or diarrhoea. Non-functioning tumours do not.
- Somatostatin receptor
- A docking point on the surface of many NET cells. Medicines and scans that target it only work when the receptor is present.
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The main options
How are NETs in the liver treated?
Option
Who it is usually for
Careful watching with regular scans
Slow, low-grade disease that is not causing symptoms
Octreotide or lanreotide injections
Receptor-positive tumours, to slow growth and calm hormone symptoms
Liver surgery
A limited number of liver spots that can all be removed safely
Embolisation or ablation
Spots that cannot be removed but are mostly in the liver
Lu-177 DOTATATE (PRRT)
Receptor-positive disease that grows despite injections
Everolimus, sunitinib or chemotherapy
Growing disease, chosen by grade and by where it started
Who does what
What happens at CION, and what is arranged with partners?
The medical oncologists at CION plan the overall treatment and give the medicines: somatostatin injections, targeted tablets such as everolimus and sunitinib, and chemotherapy. The tumour board reviews the biopsy, the scans and your liver function together, so the plan is not one doctor's opinion.
Procedures arranged through partners
CION coordinates the DOTA PET-CT, the biopsy, embolisation such as TACE and ablation through accredited partner hospitals and diagnostic centres. PRRT with Lu-177 DOTATATE is given at licensed nuclear medicine centres, and is available in India in a limited number of them. CION's surgical oncologists assess whether liver surgery makes sense; your team will tell you where the operation takes place.
Who this page does not apply to
Children with a liver tumour, where hepatoblastoma is the usual concern, are covered on the hepatoblastoma page. People with HCC or ordinary bowel cancer spread to the liver need different pages, because their treatment is different.
Being straight with you
What this page cannot tell you
It cannot tell you how your own tumour will behave. Two people with a NET in the liver can have very different courses, depending on the grade, where it started, how much of the liver is involved and whether the receptor is present. Only the team that has seen your biopsy and your scans can put those together.
It cannot read your report for you
The difference between a well-differentiated NET and a neuroendocrine carcinoma is large, and it is decided by the pathologist. If the report is unclear, a second pathology opinion on the same tissue is reasonable and common for rare tumours.
It cannot choose between options
Evidence for the order of treatments in NETs is still thinner than for many cancers, and good teams sometimes disagree. Ask why one option is offered first, what comes next if it stops working, and how you will know.
If you are unsure what your report says, call the helpline. Someone will help you get it in front of the right specialist.Questions we are asked
Common questions about NETs in the liver
Is a NET in the liver the same as liver cancer?
Not in the usual sense. Most NETs in the liver have spread there from the bowel or pancreas, so they are a secondary cancer and are treated as a NET, not as HCC. The medicines, scans and outlook are different, which is why the exact name on the biopsy matters so much.
Does spread to the liver mean nothing can be done?
No. Many people with NETs in the liver are treated for a long time with injections, procedures on the liver or targeted medicines. Some can have the liver spots removed. What is possible depends on the grade, the receptor result and how much of the liver is involved.
Why do I need a biopsy if the scan already shows spots?
Because a scan cannot tell a NET from other tumours, and it cannot give the grade. The grade decides whether watching, injections or chemotherapy comes first. Without tissue, the team would be guessing, and the wrong treatment can cost time.
What if the starting point is never found?
This happens, often because the original tumour is very small. Treatment is planned on the grade, the receptor result and the spread, and works the same way. Later scans sometimes reveal the source, and the plan is adjusted if that changes anything.
Is PRRT available in India?
Yes, at a limited number of licensed nuclear medicine centres, usually in larger cities. It is only suitable when the DOTA PET-CT shows the receptor clearly. CION coordinates referral and continues the rest of your care alongside it.
Can a NET in the liver cause symptoms by itself?
Yes. Some tumours release hormones into the blood, causing flushing, diarrhoea or wheezing. This is called carcinoid syndrome, and it is more likely once the tumour is in the liver. Read about carcinoid syndrome and the liver.
Is this inherited?
Most NETs are not. A small group, especially some pancreatic NETs, are linked to inherited conditions. If you were diagnosed young, or relatives have had similar tumours, ask your oncologist whether a genetics referral makes sense.
Where should I start?
Gather every scan, biopsy report and the tissue block if you can. Bring them to a medical oncologist who sees NETs. The CION helpline can arrange a consultation and a tumour board review, and help coordinate any scan still needed.
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
- Macmillan Cancer Support — Secondary 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
Carcinoid syndrome and liver involvementWhen a NET in the liver causes flushing and diarrhoeaSecondary liver cancer: what it meansIf the spread came from a cancer that is not a NETSecond-opinion pathology for a rare liver tumourWhen the biopsy report is unclearPET-CT for neuroendocrine tumours: FDG or DOTA?The scan that decides which medicines can work
Talk to us
Have you been told there is a NET in your liver?
Send us your scans and biopsy report and we will arrange a review by a medical oncologist and the tumour board. One helpline serves every CION centre.