Pancreatic Neuroendocrine Tumors

Healthcare providers do physical examinations, including asking about specific symptoms, how long you’ve had symptoms and if your symptoms are getting worse. They’ll ask about your medical history, including if anyone in your biological family has certain inherited disorders that have an association with pancreatic neuroendocrine tumors.

What tests are done to diagnose pancreatic neuroendocrine tumors?

Healthcare providers do several tests, including:

• Blood tests, including specific tests for hormone levels.
• Abdominal computed tomography (CT) scan.
• Magnetic resonance imaging (MRI).
• Neuroendocrine positron emission tomography (PET) scan, which may detect neuroendocrine tumor cells.
• Endoscopic ultrasound (EUS).
• Endoscopic retrograde cholangiopancreatography (ERCP).
• Angiogram.
• Bone scan.

Often the only way to confirm a diagnosis of pancreatic NET is to do a biopsy or a laparotomy.

What are pancreatic NET stages and grades?

Healthcare providers use test results to establish pancreatic neuroendocrine tumor stages, grades and whether the tumors are functioning or nonfunctioning:

• Stages describe cancerous tumor size and if it’s spread to your lymph nodes or other parts of your body.
• Grades describe how quickly cancerous cells may multiply.
• Functioning versus nonfunctioning, or whether tumors release hormones.

Stages

Healthcare providers use the TNM cancer staging system to classify pancreatic NETs. (In TNM staging, T stands for tumor size and location, N stands for whether tumors affect nearby lymph nodes and M stands for whether tumors have metastasized.) The stages of pancreatic neuroendocrine tumors are:

• Stage I: The tumor measures less than 2 centimeters across and hasn’t spread from your pancreas.
• Stage II: It measures more than 4 centimeters across and/or has spread into your duodenum (the first part of your small intestine) or to your bile ducts.
• Stage III: The tumor has spread to nearby lymph nodes or nearby organs or large blood vessels.
• Stage IV: The tumor is in more distant organs and tissues, such as your liver or bones.

Grades

Pancreatic NET grades describe how quickly a cancerous tumor may grow and spread. Healthcare providers set tumor grades based on what a medical pathologist learns about the tumor’s cells. The tumor grades are:

• Well-differentiated grade 1: Tumor cells aren’t multiplying very fast, and the cells look more like normal cells than abnormal cells.
• Well-differentiated grade 2: Tumor cells have characteristics that fall in between those of low- and high-grade tumors.
• Well-differentiated grade 3: Tumor cells are multiplying more quickly, and cells look more abnormal.
• Poorly differentiated NET: Tumor cells are multiplying very quickly and cells look extremely abnormal. These are the most aggressive and are also called high-grade neuroendocrine carcinoma (NEC) or small cell cancer.