Nutritional support and treatment of vitamin deficiencies particularly of vitamin B3 (niacin) and of deficient minerals such as calcium, magnesium, iron and zinc are often needed. Chronic diarrhea often goes in line with such deficiencies. Diarrhea can be symptomatically controlled with drugs such as loperamide. Some patients achieve an effective control of diarrhea by consuming freshly ground nutmeg (3 x 1 teaspoon daily) or by taking serotonin antagonists (e.g. ondansetron, tropisetron, ganisetron etc.). When either the last 100 cm of the small bowels or when even longer portions of the small bowels have been resected surgically, a so-called bile-loss-syndrome or even a short-bowel-syndrome can occur; in the case of a bile-loss-syndrome the drug cholestyramin should be administered. The rare short-bowel-syndrome needs special attention and care by an expert. Patients with the carcinoid syndrome should avoid alcohol and adrenalin-like drugs as those can trigger a carcinoid crisis.

Pain treatment

Pain which can considerably impair quality of life is a priority for the patient with advanced neuroendocrine tumor disease. Nowadays, tumor pain can be treated effectively. Pain is first treated with pain killers such as nonsteroidal anti-inflammatory drugs; in the case of severe pain morphium derivatives are added on. Pain treatment is individualized for each patient. Outpatient pain clinics and spezialized pain wards in hospitals have specialized on optimal pain control of their patients.

Prof. Dr. med. Hans Scherübl


Center of Neuroendocrine Tumors
Prof. Dr. med. Hans Scherübl
Vivantes Klinikum Am Urban
Academic Teaching Hospital of Charité-University Medicine, Berlin
Dieffenbachstraße 1
10967 Berlin, Germany
Tel: + 49 30 130 225201
Fax: + 49 30 130 225205
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