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Carcinoids are generally slow growing but they do vary from case to case, and some are more aggressive. The biological behavior of each tumor to a considerable degree determines the vigor of the treatment. It has been established in general that small tumors respond better to treatment than do big tumors. Therefore, it is undesirable to delay treatment while waiting for symptoms or for positive imaging evidence of progressing growth of known tumor(s). In other words, when known metastases are present even before symptoms are present, with any sign of progressing tumor growth,including rising levels of chemical tumor products (neuroendocrine markers) early treatment is usually the best treatment in the long run. The treatment for small tumors in an individual without symptoms need not necessarily be harsh. The treatment can be customized in each case. It is not a matter of "one treatment fits all cases".
Current evidence indicates that sequential multiple modality treatment most effectively produces significantly prolonged survival.
The choice of treatment in any given case depends on many factors of both clinical and laboratory nature:
A wide variety of treatment modalities exist and include