Overview
Diagnosis
Tests and procedures to diagnose pancreatic neuroendocrine tumors help determine whether a tumor is present, how it behaves and whether it produces excess hormones. Blood tests may reveal hormone imbalances or DNA changes linked to a higher risk of these tumors. Urine tests can show hormone byproducts that suggest the body is processing unusually high hormone levels.
Imaging tests are an important part of diagnosis because they show where the tumor is located and how large it is. These may include X-ray, MRI, CT and PET scans. Nuclear medicine scans also may be used. For these tests, a small amount of radioactive tracer is injected into the bloodstream. The tracer attaches to pancreatic neuroendocrine tumor cells so they show clearly on imaging, often with PET combined with CT or MRI.
Endoscopic ultrasound creates detailed images from inside the digestive tract. A thin, flexible tube with a camera is passed down the throat into the stomach and small intestine. The device includes an ultrasound tool that creates pictures of the pancreas. Additional tools can be passed through the tube to collect tissue samples.
A biopsy removes a piece of tissue for laboratory testing. This may be done during endoscopic ultrasound or during surgery. The tissue is examined to confirm whether it is cancer and to understand its characteristics. This information helps guide treatment planning. If the cancer has spread, cells may be collected from areas such as the liver or lymph nodes using a needle.
Treatment
Treatment for pancreatic neuroendocrine tumors depends on the tumor type, how far the cancer has spread, the tumor’s specific characteristics and your overall health. Treatment plans may involve surgery, radiation, targeted therapy or other specialized options.
Surgery is often recommended when the tumor is limited to the pancreas. Tumors in the tail of the pancreas may be removed with a distal pancreatectomy, which preserves the head of the pancreas. Tumors affecting the head of the pancreas may require the Whipple procedure. When cancer has spread, surgery may also be used to remove cancer from other areas when possible.
Peptide receptor radionuclide therapy, known as PRRT, delivers targeted radiation to tumor cells. A cancer-targeting medicine combined with a small amount of radioactive material is injected into a vein. The medicine binds to tumor cells throughout the body and gradually delivers radiation to kill them. One form of PRRT, lutetium Lu 177 dotatate, is used to treat advanced pancreatic neuroendocrine tumors.
Targeted therapy uses medicines that block specific chemicals in cancer cells. By interfering with these signals, targeted therapy can slow cancer growth or cause cancer cells to die. This treatment is often used for advanced or recurrent tumors.
Radiofrequency ablation destroys cancer cells by heating them with energy waves. A special probe with tiny electrodes is inserted through the skin or through a small incision in the abdomen. The tissue around the probe heats up, causing the cancer cells to die.
Radiation therapy uses focused beams of energy, such as X-rays or protons, to destroy cancer cells. It may be used alone or combined with other treatments. Chemotherapy uses strong medicines to kill cancer cells and may be recommended in certain situations.
Pancreatic neuroendocrine tumors often spread to the liver, and several treatment options exist for liver involvement. A surgeon may remove the affected portion of the liver. In rare situations, a liver transplant might be considered. Slowing blood flow to the liver through the hepatic artery can also help limit tumor growth. Some approaches use chemotherapy medicines or radioactive beads to block the artery and deliver treatment directly to liver tumors. Radiofrequency ablation may also be used to destroy liver tumors by heating and killing cancer cells.
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