A Look at Lung NETs

Approximately 20% of all primary lung tumors are neuroendocrine (Hung 2019), including:

  • Typical carcinoid (TC)
  • Atypical carcinoid (AC)
  • Small cell carcinoma (SCC)
  • Large cell carcinoma (LCNC)

Classification of Lung NETs

“When we are classifying lung NETs we want to make one basic distinction,” said Suki Padda, MD, Stanford University, “Is this a well-differentiated lung NET, which includes low-grade typical carcinoid, or intermediate grade atypical carcinoid, or is this a poorly differentiated lung NET and that includes SCC and LCNC?” The outlook for each is different.

Classifications of lung neuroendocrine tumors 


Prevalence (% of all lung tumors)

Associated with smoking

Overall survival at 5 years

Typical  Carciniod


Atypical Carcinoid









Small Cell Carcinoma 


Large Cell









Source: Hung 2019

“Large cell neuroendocrine carcinoma and small cell carcinoma are not well differentiated and are very aggressive; these are the ones that we are going to give systemic therapy, such as chemotherapy,” said Nagla Karim, MD, PhD, University of Cincinnati. “The typical and atypical carcinoid are well differentiated are not very aggressive.”

Diagnosing Lung NETs

As with other NETs, the diagnosis of lung NETs can be challenging. Some patients do not show any signs of illness. Those with symptoms, such as coughing, wheezing, or tightness in the chest, may be diagnosed with more common illnesses, such as asthma. Since lung NETs develop in hormone-producing cells, a few patients experience symptoms unrelated to the lungs, such as diarrhea or flushing in the face.

Lung NET presentations from NET patient and caregiver conferences. 

Treatment for Lung NETs

A lack of consensus among leading treatment guidelines complicates the diagnosis of lung NETs. (Hendifar 2017) There are also different recommendations about the need for chemotherapy and/or radiation in early-stage patients who have undergone surgery. (Hendifar 2017, Ramirez 2017) An individual’s treatment will be based on a range of factors including disease classification, stage, lymph node involvement, and tumor biomarkers. Robert Ramirez, DO, Ochsner Medical Center, stresses the importance of a multidisciplinary treatment team for lung NETs to obtain an accurate diagnosis and avoid unnecessary procedures. NETRF has compiled a list of multidisciplinary team-based programs.

The options commonly considered by a treatment team may include:
(Ramirez 2017; NCCN Guidelines Version 3.2017)

  • Surgery
  • Somatostatin analogs
  • mTOR pathway inhibitors
  • Vascular treatments
  • Chemotherapy (may be a combination of therapies)
  • Radiotherapy, such as PRRT
  • Radiation (radiofrequency ablation, stereotactic body radiation therapy or SBRT)
  • Interventional radiology (embolization)


Learn more about lung NETs 

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1 year ago

My insurance company is denying the treatment that my doctor suggests which is cryoablation for the reason stating that there is insufficient evidence that ablation therapy is successful AND that it is not medically necessary. I have one large tumor in my left lung (about 2″ in size) and then 2 smaller tumors in the right lung. Is there any documentation in your studies on ablation therapy?

1 year ago
Reply to  sanforddee

We have not funded any studies on lung tumor ablation, I am sorry to say. NCCN produces clinical guidelines for care. You have to register to view/download them. https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf These do take into consideration variables like tumor grade/stage. This helpful, informative, and educational talk might also help you figure out next steps. https://www.facebook.com/norcalcarcinet/videos/1150770001739346/ Also, try looking at this article https://norcalcarcinet.org/links/81-appeal
Wishing you the best of luck,

1 year ago

Is there a good resource for doctors specializing in lung NET tumor care

9 months ago
Reply to  Kris

Kris, I live near Little Rock, AR and was diagnosed last February. Dr. David Hays at CARTI fought with my insurance company for 3 months and 5 appeals to get my treatment covered. My Oncologist said he had never seen Dr Hays fight so hard for a patient. The treatment he wanted to do was cryoablation therapy. After 6 weeks, the largest tumor was already dying and then after another 6 weeks, it was completely dead!!!

1 year ago

any idea where i can get mTOR pathway inhibitors,
Vascular treatments, Radiation (radiofrequency ablation, stereotactic body radiation therapy or SBRT),
Interventional radiology (embolization) treating option in India, my Dad has pNET G1 with no SSR and no doctor is suggesting us to go for all these option they are directly suggesting Chemo. I believe we should keep Chemo as a last resort when everything stops working.