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Treatment for pancreatic NETs
Treatment of pancreatic NETs is complex. Some pancreatic NETs produce hormones (functioning), while most don’t (non-functioning). About 90% of pancreatic NETs are non-functioning. Types of functioning pancreatic NETs include insulinoma, gastrinoma, glucagonoma, somatostatinoma and VIPoma.
Your treatment team will discuss the best treatment for you based on the stage and grade of the tumour; whether the tumour is functioning or non-functioning; whether the tumour is associated with an inherited condition; your general health; and your preferences.
If you are diagnosed with a small, low-grade pancreatic NET that is not causing any symptoms or releasing hormones, your doctor might recommend active surveillance. This involves regular imaging and blood tests. If these tests suggest that the tumour has grown, you will be offered treatment (usually surgery).
Surgical removal (resection) of the tumour is the most common treatment for people with early-stage disease who are in good health. The type of surgery will depend on the size of the tumour and where it is located. Surgery for early pancreatic NETs is often done with the aim of cure.
Different surgical procedures can be used to treat blockages caused by the tumour and to reduce the size of the tumour, associated with advanced pancreatic NETs.
The body produces a hormone called somatostatin, which controls how organs such as the pancreas release other hormones. Somatostatin analogues (SSAs) are medicines that are similar to somatostatin. An SSA may be used for a functioning pancreatic NET to slow down the release of hormones and control symptoms, such as diarrhoea. In both functioning and non-functioning NETs, SSAs are also used to slow down a tumour’s growth. The main SSAs used in Australia are octreotide and lanreotide. These are given as monthly injections into the thigh or bottom, and have very few side effects.
Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. It is rarely used for lower-grade pancreatic NETs, but may be used for advanced, high-grade pancreatic NETs. It may be given on its own, with SSAs or before peptide receptor radionuclide therapy (PRRT).
This is a type of drug treatment that attacks specific features of cancer cells to stop the cancer growing and spreading. People with advanced pancreatic NETs may be offered targeted therapy drugs such as sunitinib and everolimus to slow the growth of the tumour. These are given as capsules that you swallow. Some may be taken daily for many months or even years.
PRRT is a type of internal radiation therapy used to treat advanced pancreatic NETs that have large numbers of somatostatin receptors. These are proteins found on the surface of the tumour. If you have PRRT, you will be injected with a somatostatin analogue (SSA) that has been combined with a small amount of a radioactive substance (radionuclide). This mixture targets the somatostatin receptors and delivers a high dose of radiation that kills or damages the cancer cells.
PRRT is available only in certain treatment centres. PRRT is given as an outpatient treatment, with a session lasting around 4–5 hours. Depending on the grade of the tumour, you may have four sessions about 6–12 weeks apart. Your doctor will talk to you about possible side effects and safety precautions you may need to follow.