Treating Pancreatic Neuroendocrine Tumors, Based on Extent of the Tumor

Treatment of pancreatic neuroendocrine tumors (NETs) depends to a large extent on whether they can be removed (resected) completely or not. But other factors, such as your overall health, can also affect treatment options. Talk to your doctor if you have any questions about the treatment plan he or she recommends.

Sometimes it can be hard to determine if cancer is resectable – that is, if it can be removed completely – using just imaging tests. A staging laparoscopy might be done before surgery to help determine if the tumor can be removed. But even then, cancers sometimes turn out to have spread farther than was first thought.

Pancreatic NETs are more likely to be resectable than exocrine pancreas cancers (the most common type of pancreatic cancer). Most NETs that have not spread to distant parts of the body are resectable. Even some NETs that have spread might be resectable if they have not spread too far (such as only to a small extent in the liver).

Treating resectable tumors

If the tumor is resectable, surgery will be done. The procedure used depends on the type of tumor, its size, and its location in the pancreas. Surgery can range from as little as enucleation (removing just the tumor) to as much as a Whipple procedure (pancreaticoduodenectomy). Lymph nodes are often removed to check for tumor spread.

Before any surgery, medicines are often given to control any symptoms caused by the tumor. For example, drugs to block stomach acid (like proton pump inhibitors) are used for gastrinomas. Often, people with insulinomas are treated with diazoxide to keep blood sugar from getting too low. If the tumor was visible on somatostatin receptor scintigraphy (OctreoScan), a somatostatin analog such as octreotide (Somatostatin) may be used to control any symptoms.

Surgery alone is all that is needed for many pancreatic NETs, but after surgery, close monitoring is important to look for signs that the cancer may have come back or spread.

Treating unresectable tumors

These tumors can’t be removed completely with surgery. Pancreatic NETs are often slow growing, so lab and imaging tests are used to monitor the tumor(s) and look for signs of growth.

People with NETs that have spread outside the pancreas often have symptoms like diarrhea or hormone problems. These can often be helped with medicines like octreotide, lanreotide, diazoxide, and proton pump inhibitors. Some of these might also slow the growth of the tumor.

If further treatment is needed, chemotherapy or targeted drugs (such as sunitinib or everolimus) might be used, but this is usually delayed until a person is having symptoms that can’t be controlled with other drugs or has signs of tumor growth on scans. Surgery or ablative techniques might also be used to treat cancer spread to the liver.

For people with poorly differentiated tumors (neuroendocrine carcinomas), chemotherapy is typically the first treatment.

For adults with somatostatin (a type of hormone) receptor-positive pancreatic neuroendocrine tumors, a radiopharmaceutical drug, called Lutathera (lutetium Lu 177 dotatate), is also an option for treatment.

If treatment is no longer working at some point, you might want to think about taking part in a clinical trial testing a newer treatment. While these are not always the best option for every person, they may benefit you as well as future patients.

The treatment information in this document is not official policy of the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: March 14, 2016 Last Revised: May 31, 2016

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