Neuroendocrine Tumour Treatment in Delhi, India

A Neuroendocrine Tumour (NET) is a rare type of cancer that develops from neuroendocrine cells, which are found throughout the body and play a vital role in controlling hormone production. NETs can occur in organs such as the gastrointestinal tract, pancreas, lungs, and sometimes other parts of the body.

Some NETs grow slowly and may not cause noticeable symptoms for years, while others may be more aggressive. Depending on their behaviour, they may produce excess hormones (functional NETs) or not (non-functional NETs). Early detection and proper management can significantly improve outcomes.

Neuroendocrine tumours (NETs) are classified based on three key factors. These distinctions help your medical team understand the tumour's behavior and choose the most effective treatment plan.

Classification by Anatomic Location (Where the Tumour Started)

NETs are named according to the organ or part of the body where they first develop. Identifying the primary site is important because it influences both treatment and prognosis.

• Gastroenteropancreatic (GEP) NETs: These are the most common NETs and occur in the digestive system, including the stomach, small intestine, appendix, colon, and rectum. They may or may not produce hormones and often grow slowly.
• Pancreatic NETs (pNETs): Originating in the pancreas, these tumours may be functional (hormone-producing) or non-functional. Functional pancreatic NETs can cause symptoms like low blood sugar, stomach ulcers, or diarrhoea depending on the hormones released.
• Lung NETs: These tumours start in the lungs and are typically classified as typical or atypical carcinoid tumours based on their growth pattern. Lung NETs may cause symptoms such as persistent cough, wheezing, or shortness of breath.
• Other Rare NETs: Less commonly, NETs can develop in the thyroid (medullary thyroid carcinoma), adrenal glands (pheochromocytoma or paraganglioma), skin (Merkel cell carcinoma), or reproductive organs. Although rare, these tumours can be aggressive and may require specialised care.

Classification by Functional Status (Hormone Production)

This classification indicates whether the tumour is producing hormones in sufficient quantities to cause specific clinical symptoms.

• Functional NETs: These tumours release hormones such as insulin, gastrin, serotonin, or VIP (vasoactive intestinal peptide), which can lead to noticeable symptoms. Common signs may include flushing, diarrhoea, wheezing, heart palpitations, or low blood sugar. Functional NETs are often detected earlier because of these hormone-related symptoms.
• Non-Functional NETs: These tumours do not produce hormones or release them in amounts too small to cause symptoms. Because they may not produce early warning signs, non-functional NETs are often discovered incidentally during imaging or once the tumour grows or spreads.

Classification by Grade and Differentiation (Growth Rate)

The grade of a NET is determined by examining a tumour sample under a microscope. It reflects how quickly the tumour cells are dividing and how similar or different they look compared to normal cells. Tumour grade is a critical factor in planning treatment.

• Grade 1 (G1) – Low Grade: These tumours grow slowly and are usually well-differentiated (closely resemble normal cells). Many patients with G1 NETs live for years with proper monitoring and treatment.
• Grade 2 (G2) – Intermediate Grade: These tumours grow at a moderate rate and may behave more aggressively than G1 tumours. They often require active treatment and close follow-up.
• Grade 3 (G3) – High Grade: High-grade tumours grow and spread more quickly. They are often poorly differentiated, meaning the cells look less like normal cells. G3 NETs may require intensive treatment such as chemotherapy, targeted therapy, or a combination of approaches.

The exact cause of Neuroendocrine Tumours (NETs) is not fully understood. In most cases, NETs occur when neuroendocrine cells undergo changes (mutations) in their DNA. These mutations cause the cells to grow and multiply uncontrollably, forming a tumour.

While many NETs appear sporadically (without a known cause), some may be linked to inherited genetic syndromes. These syndromes increase the likelihood of abnormal cell growth in hormone-producing glands and tissues.

Other factors such as long-term inflammation or environmental influences may play a role, but these links are still being studied.

Although NETs can develop in anyone, certain factors can increase the risk of developing this condition:

• Inherited genetic conditions: People with syndromes such as Multiple Endocrine Neoplasia type 1 (MEN1), von Hippel–Lindau disease, neurofibromatosis type 1, or tuberous sclerosis are at a higher risk.
• Family history: A close relative with an inherited endocrine syndrome or NET can increase the likelihood of developing the disease.
• Age: NETs are more common in adults over 50, although they can occur at any age.
• Gender: Some types of NETs, such as certain gastrointestinal NETs, are slightly more common in women.
• Autoimmune or endocrine disorders: A history of hormonal or autoimmune conditions may be associated with a higher risk.
• Lifestyle factors: Smoking has been linked to a higher incidence of lung NETs.
• Long-standing health conditions: Chronic atrophic gastritis or Zollinger–Ellison syndrome can increase the risk of certain gastrointestinal NETs.

Having one or more risk factors does not mean a person will definitely develop a neuroendocrine tumour. Many people with NETs have no identifiable risk factors. Regular health checks and early evaluation of symptoms are key to timely diagnosis and treatment.

The symptoms of Neuroendocrine Tumours (NETs) depend on where the tumour is located and whether it produces hormones. Some NETs cause noticeable changes early on, while others remain silent for years and are discovered incidentally.

General Symptoms

• Ongoing abdominal pain or discomfort
• Unexplained weight loss
• Persistent tiredness
• Changes in bowel habits (such as diarrhoea or constipation)
• Feeling full after eating small amounts

Hormone-Related Symptoms (Functional NETs)

When NETs produce excess hormones, they can cause additional signs such as:

• Flushing of the skin (especially face and neck)
• Frequent diarrhoea
• Rapid heartbeat or palpitations
• Low blood sugar symptoms like sweating or dizziness

Location-Specific Symptoms

• Lung NETs: Persistent cough or shortness of breath
• Digestive system NETs: Bloating, pain, or changes in bowel movements
• Pancreatic NETs: Hormonal symptoms like low blood sugar or ulcers

These symptoms can often mimic other, less serious conditions. If they persist or worsen, it’s important to see a specialist for further evaluation.

A precise diagnosis is the first step toward effective treatment and management of a Neuroendocrine Tumour (NET). At Max Hospitals, we combine a thorough medical evaluation, advanced diagnostic tests, and expert analysis to confirm the presence of a NET, determine its type, grade, and location, and rule out other conditions.

Medical History and Physical Examination

The diagnostic process begins with a detailed medical history and physical examination. Our doctors ask about symptoms, family history of endocrine or neuroendocrine conditions, and any previous treatments. During the examination, they assess the body for signs such as abdominal lumps, flushing, or other hormone-related symptoms, helping form a complete clinical picture.

Blood and Urine Tests

To evaluate the tumour’s activity, blood and urine tests are performed. These tests measure hormone levels and specific markers, such as chromogranin A, serotonin, or pancreatic hormones. This helps identify whether the NET is functional (hormone-producing) or non-functional, which guides treatment decisions.

Imaging Studies

Advanced imaging is used to locate the tumour, assess its size, and check for any spread. Common imaging tools include:

• CT or MRI scans: Provide detailed images of the tumour and surrounding organs.
• PET-CT or Gallium-68 DOTATATE scans: Detect NETs that may not be visible on standard scans.
• Endoscopy or colonoscopy: Used when the tumour is suspected in the gastrointestinal tract.

These imaging studies allow our specialists to map the tumour accurately and plan the most effective treatment approach.

Biopsy

In most cases, a biopsy is performed to confirm the diagnosis. A small tissue sample is collected from the tumour and examined under a microscope. This step determines the tumour grade and differentiation, which is essential for understanding its growth rate and selecting the appropriate therapy.

At Max Hospitals, our multidisciplinary team of oncologists, endocrinologists, radiologists, and pathologists work together to ensure an accurate, timely, and precise diagnosis. This careful approach helps us design personalised treatment plans and provide the best possible outcomes for every patient.

Following a diagnosis of a Neuroendocrine Tumour (NET), treatment is tailored to each patient’s individual needs and condition, taking into account the tumour’s location, grade (G1, G2, G3), and whether it is functional (hormone-producing) or non-functional. At Max Hospitals, we adopt a comprehensive, multi-modal approach designed to treat the disease, control its progression, and manage symptoms, ensuring the best possible quality of life.

Surgery

Surgery is often the first-line treatment for NETs that can be safely removed. Our surgeons carefully plan each procedure to remove the tumour while preserving healthy tissue. Surgery may involve removing the tumour from the pancreas, digestive tract, lungs, or other affected areas.

Targeted Therapy

For NETs that cannot be fully removed or have spread, targeted therapies may be used to attack cancer cells specifically without affecting healthy tissue. These therapies help slow tumour growth and control symptoms.

Hormone Therapy

If the NET is functional and produces excess hormones, hormone therapy can help control symptoms such as flushing, diarrhoea, or low blood sugar. This improves quality of life while other treatments address the tumour itself.

Chemotherapy and Immunotherapy

For aggressive or high-grade NETs, chemotherapy or immunotherapy may be recommended. These treatments work to destroy rapidly dividing cancer cells or stimulate the body’s immune system to fight the tumour.

Radiotherapy and PRRT (Peptide Receptor Radionuclide Therapy)

Advanced techniques such as radiotherapy or PRRT are used for NETs that cannot be removed surgically or have metastasised. PRRT delivers targeted radiation directly to tumour cells, minimising damage to healthy tissues.

At Max Hospitals, our team continuously monitors progress and adjusts therapy as needed, ensuring both effective tumour control and a better quality of life.

If not diagnosed and managed promptly, Neuroendocrine Tumours (NETs) can lead to a range of complications. These may include:

• Hormonal imbalances: Functional NETs can produce excess hormones, leading to flushing, diarrhoea, low blood sugar, or high acid levels in the stomach.
• Carcinoid syndrome: A condition caused by hormone secretion from some NETs, resulting in flushing, diarrhoea, wheezing, and heart problems.
• Organ damage: Tumours that grow locally or spread may affect organs such as the liver, lungs, or pancreas.
• Metastasis: NETs can spread to distant organs, complicating treatment and affecting prognosis.
• Reduced quality of life: Persistent symptoms or treatment side effects can impact daily living and wellbeing.

Early detection, regular monitoring, and timely treatment are key to minimising these complications.

While NETs cannot always be prevented, certain steps can help reduce risk or aid early detection:

• Regular health check-ups: Especially for individuals with a family history of endocrine disorders or NETs.
• Genetic counselling and testing: Recommended for those with inherited syndromes like MEN1 or von Hippel–Lindau disease.
• Healthy lifestyle choices: Avoid smoking, maintain a balanced diet, and stay physically active.
• Management of existing conditions: Control autoimmune or endocrine disorders effectively.
• Prompt evaluation of symptoms: Seek medical advice for unexplained flushing, diarrhoea, or other persistent symptoms.

How common are Neuroendocrine Tumours?

NETs are relatively rare compared to other types of cancer, but their detection has increased due to improved imaging and awareness. They can occur at any age, though they are more common in adults over 50.

How often should I be monitored after treatment?

Follow-up schedules depend on the tumour type, grade, and treatment received. Most patients undergo regular imaging, blood tests, and clinical evaluations to monitor for recurrence or progression.

Can NETs recur after treatment?

Some NETs can recur even after successful treatment. The risk of recurrence depends on the tumour grade, size, and whether it had spread at the time of treatment. Regular follow-up is crucial for early detection.

What lifestyle changes that can support NET treatment?

Maintaining a balanced diet, staying physically active, avoiding smoking, and managing stress can help improve overall health during treatment and recovery. Always consult your doctor before making major lifestyle changes.

Is NET treatment painful?

Most treatments, including surgery, targeted therapy, and PRRT, are designed to minimise discomfort. Your care team will provide pain management and supportive care as needed.

Can NETs affect hormone levels long-term?

Functional NETs can temporarily or permanently affect hormone balance. Your endocrinologist will monitor hormone levels and recommend treatments or medications to manage any imbalances.

Can NETs metastasise to the liver or other organs?

Yes, NETs can spread to organs such as the liver, lungs, or bones. Early detection and appropriate treatment can help control spread and manage symptoms effectively.

Do Max Hospitals participate in clinical trials for NETs?

Yes, we do participate in ongoing research and offer patients access to clinical trials, especially for rare or advanced NETs. Your doctor can advise if you are eligible.

How do I know if my NET is functioning or non-functioning?

Your doctor will determine this through a combination of blood and urine tests, imaging, and symptom assessment. Functional NETs produce hormones that cause noticeable symptoms, while non-functional NETs often do not.

My tumour is non-functional. Do I still need treatment right away?

Not always. Because many non-functional NETs are very slow-growing (G1), your specialist may recommend a strategy of Active Surveillance. This involves regular blood tests and scans (like a DOTATATE PET/CT) to monitor the tumour. Treatment is only initiated if the tumour shows signs of significant growth or spread.

How long does the Lutetium-177 PRRT treatment take, and what are the main side effects?

The Peptide Receptor Radionuclide Therapy (PRRT) procedure takes approximately 4 to 5 hours per session. You typically receive 4 total treatments, spaced 8 to 12 weeks apart. The most common side effect is a temporary drop in blood counts (lowering your white blood cells, red blood cells, and platelets). Nausea and fatigue may also occur but are often managed with medication.

Do I need to make major dietary changes while living with a NET?

Dietary adjustments are primarily needed if you experience Carcinoid Syndrome. Foods high in the amino acid Tryptophan (such as red wine, strong cheese, or bananas) can sometimes trigger or worsen flushing and diarrhea. Your care team will connect you with a specialist dietitian to help identify your specific trigger foods and maintain good nutrition.

Who should I see for long-term care—a general oncologist or a specialist?

Due to the rarity and unique nature of NETs, it is strongly recommended that you be followed by a Neuroendocrine Tumour Specialist (an oncologist, endocrinologist, or gastroenterologist who specialises in NETs). These specialists have the expertise to manage the diverse treatment options and long-term surveillance that NETs require.

What is the prognosis for a Neuroendocrine Tumour?

The prognosis is highly variable and depends almost entirely on the tumour's Grade (G1, G2, or G3), the primary location (e.g., intestinal NETs often have a better prognosis than high-grade lung NETs), and whether the disease is localised or metastatic. Because most NETs are indolent (slow-growing), many patients enjoy an excellent quality of life for many years with modern, tailored treatment.

Reviewed by Dr. Sandeep Batra, Senior Director - Medical Oncology, Cancer Care / Oncology, Uro-Oncology, Breast Cancer, Thoracic Oncology, Gynecologic Oncology, Gastrointestinal & Hepatobiliary Oncology, on 03 February 2026.