Carcinoid syndrome is the result of advanced neuroendocrine tumours (NETs). The development of somatostatin analogues resulted in a major change in the management of patients with NET resulting in improved control of associated symptoms and ultimately disease control. Most patients do however develop recurrence or progressive symptoms (and disease) and thus alternate treatments are required. Alternatives will include interventions to control disease progression overall and new agents targeting symptoms specifically such as Telotristat ethyl. Novel interventions such as rose Bengal may also have a role in the future. Long term control of symptoms is crucial for quality of life but it is important to also consider prevention of carcinoid flare associated with surgical interventions and also PRRT. As PRRT access has increased clinicians increasingly understand the risk of symptom flare and new guidelines have been suggested and recently published.