Treatment
There are several methods available for treating or managing pancreatic endocrine tumors. These treatments can be used alone or in combination with one another. Keep in mind that the options listed on this page are general guidelines.
Surgery
For tumors that are localized, meaning they have not spread outside of the pancreas, surgery is the most effective treatment option. The doctor may recommend any of the following surgical procedures:
Enucleation
Enucleation is surgery to remove only the tumor, but no surrounding tissue, from the pancreas. This procedure may be used when there is only one tumor in one location in the pancreas, and when that tumor is felt to be benign.
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Pancreatoduodenectomy (Whipple procedure)
Pancreatoduodenectomy is also known as the Whipple procedure. This operation removes the head of the pancreas, sometimes a portion of the stomach, a portion of the small intestine, a portion of the common bile ducts, the lymph nodes near the pancreas, and the gallbladder.
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Distal pancreatectomy
Distal pancreatectomy involves the surgical removal of the tail of the pancreas with or without the spleen.
Ablation
Ablation is a type of local treatment that uses extreme heat or cold to destroy tumor cells. The following types of ablative treatments may be recommended.
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Cryoablation
Cryoablation attacks tumors by freezing them with a very cold metal probe. Using ultrasound, a probe is directed into the tumor whereupon an exceedingly cold substance, such as liquid nitrogen, is inserted to cool the metal probe. The extreme cold from the probe then kills the cancer cells.
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Radiofrequency and microwave ablation
Radiofrequency ablation (RFA) and microwave ablation use high-energy radio waves to attack tumors. A thin, needle-like probe is placed into the tumor and releases radio waves. This current then destroys the tumor with extreme heat. These techniques could be performed for selected patients by an interventional radiologist percutaneously.
Additional Treatments
The doctor may also recommend any of the following treatments:
Hormone therapy
Certain hormones can cause a cancer to grow more aggressively. Hormone therapy changes the levels of these hormones in a person's body in order to stop or slow cancer growth. Hormone therapy may be given to patients with functioning islet cell tumors in order to slow tumor growth and relieve symptoms. The most common hormone given to these patients is octeotride, which is a synthetic form of somatostatin.
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Chemotherapy
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to eliminate cancer cells. Chemotherapy is given intravenously and spreads through the bloodstream. Chemotherapy may be given to patients who do not respond well to hormone therapy, to patients with aggressive forms of islet cell cancers, or to patients whose cancer has metastasized, or spread, to distant parts of the body.
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Targeted Therapy
Targeted therapy is a relatively new type of treatment that works in two ways. Some types of targeted therapy target proteins on the surface of cancer cells that cause the cancer to grow more aggressively. Other types attack the process of angiogenesis, which tumors use to create new blood vessels to support their growth.
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Hepatic arterial embolization (chemoembolization)
Tumor embolization is a procedure that involves injecting small particles into a nearby artery in order to block the blood flow to tumors in the liver, thus killing them. Chemotherapy drugs may also be injected into the artery prior to blockade, using a procedure known as chemoembolization. Doctors may use this procedure when the cancer has spread to the liver.
Palliative Care
Palliative care is any form of treatment given to patients to relieve symptoms and side effects of the disease and improve quality of life. The goal of palliative care is not to cure the disease, but to make the patient as comfortable as possible. For islet cell tumors, the doctor may recommend radiation therapy to shrink the tumors that are causing pain, medication to treat stomach ulcers or diarrhea, and medication to control the levels of hormones in the body.
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Radiation Therapy
External beam radiation therapy, which delivers radiation from a machine outside of the body, is typically only used to treat patients with pancreatic neuroendocrine tumors that are causing symptoms such as pain, particularly when they have metastasized to the bone.
Clinical Trials
Clinical trials are vital aspects of research and development for discovering new methods of treatment. Clinical trials involve carefully supervised testing of therapies that scientists believe may significantly increase the life expectancy and quality of life for people with pancreatic cancer. It is important that you speak with your doctor to determine if you are eligible to participate in a clinical trial. Current research in the field of pancreatic neuroendocrine tumors includes studies of new targeted therapies and combinations of chemotherapy drugs.
