A 58 yr old had an MR for back ache. An accidental finding was a mass in the mid rectum. Subsequent investigations showed two left liver lobe mts and a paracaval lymph node met. Histopathology found carcinoid- a non functionig tumour. Apart from radical surgery, would he benefit from any adjuvant treatment?
Yes! Take out the primary and the liver mets - if isolated and start adjuvant/palliative treatment depending on histology with chemo~ or hormone therapy.
There is no clear benefit of radical surgery for more advanced NET-disease (lymphnode paracaval, liver met) - the size of tumour (symptoms?) and patient factors are to be considered!
Surgery is central to the management of this patient if R0resction can be ensured. Decision regarding adjuvant treatment would be guided by the tumor grade.