• For patients with bulky or symptomatic liver metastases, one treatment option is tying off the hepatic artery,
placing a tube (catheter) into the artery and injecting a material that blocks the blood flow to the tumor nodules
in the liver. For optimal effectiveness, this is followed by chemotherapy . This can lead to substantial tumor
regression . It can also cause severe toxic effects—abdominal pain, fever, nausea and a short-term worsening of
the syndrome—but many patients do experience substantial relief from symptoms.
Radiation The role of radiation therapy in managing carcinoid tumors with distant metastasis
is restricted to relief from symptoms, most commonly of bone involvement. However, localized metastasis will occasionally respond to radiation therapy.
Supportive Therapy There are a number of ways to manage symptoms from metastatic disease with medication.
• Diarrhea will frequently respond to standard antidiarrheal medications such as Lomotil or tincture of opium
and to dietary changes such as restricting consumption of foods high in fat.
• The somostatin analogue octreotide (Sandostatin) has recently been shown to be useful in improving
symptoms of the carcinoid syndrome and may be life-saving in carcinoid crisis (sudden exacerbation of
symptoms).
• Interferon-alpha preparations may have a role in controlling symptoms of the carcinoid syndrome and/or in
