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Treatment of pancreatic neuroendocrine tumors (NETs) depends to a large extent on whether they can be resected (removed) 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 they recommend.
Sometimes it can be hard to determine if cancer is resectable – that is, if it can be removed completely – using just imaging tests. A 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 few spots in the liver).
If the tumor is resectable, surgery will be recommended. 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, a somatostatin analog such as octreotide 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.
Unresectable 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.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Chan JA, Kulke M, Clancy TE. Metastatic well-differentiated pancreatic neuroendocrine tumors: Systemic therapy options to control tumor growth and symptoms of hormone hypersecretion. UpToDate website. https://www.uptodate.com/contents/metastatic-well-differentiated-pancreatic-neuroendocrine-tumors-systemic-therapy-options-to-control-tumor-growth-and-symptoms-of-hormone-hypersecretion Updated August 31, 2018. Accessed October 9, 2018.
Lee J, Allendorf J, Chabot J. Surgical resection of sporadic pancreatic neuroendocrine tumors. UpToDate website. https://www.uptodate.com/contents/surgical-resection-of-sporadic-pancreatic-neuroendocrine-tumors. Updated January 09, 2018. Accessed October 10, 2018.
National Cancer Institute. Physician Data Query (PDQ). Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment – Patient Version. 2018. Accessed at https://www.cancer.gov/types/pancreatic/patient/pnet-treatment-pdq on October 8, 2018.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine and Adrenal Tumors. V.3.2018. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf on October 10, 2018.
Pasricha G, Padhi P, Daboul N, Monga DK. Management of Well-differentiated Gastroenteropancreatic Neuroendocrine Tumors (GEPNETs): A Review. Clin Ther. 2017 Nov;39(11):2146-2157. doi: 10.1016/j.clinthera.2017.10.010.
Schneider DF, Mazeh H, Lubner SJ, Jaume JC, Chen H. Chapter 71: Cancer of the endocrine system. In: Niederhuber JE, Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa. Elsevier: 2014.
Yao JC, Evans DB. Chapter 85: Pancreatic neuroendocrine tumors. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.
Last Revised: October 30, 2018
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