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Treatment for pancreatic NETs
This page discusses treatment for the rarest type of pancreatic tumours: neuroendocrine tumours (NETs). Some pancreatic NETs produce hormones functioning), while most don’t (non-functioning). About 90% of pancreatic NETs are non-functioning. This page focuses on the treatment of non-functioning pancreatic NETs.
Treatment of pancreatic NETs is complex. To ensure the best outcome it is recommended that you are treated by a multidisciplinary team in a specialist centre. 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.
Functioning tumours are very rare and are usually managed by an endocrinologist and surgeon. Types of functioning pancreatic NETs include insulinoma, gastrinoma, glucagonoma, somatostatinoma and VIPoma. The name of the cancer is taken from the type of hormone produced, for example, insulinomas produce too much insulin. Contact Cancer Council 13 11 20 or NeuroEndocrine Cancer Australia for information about treating functioning pancreatic NETs.
Neuroendocrine tumours can also affect other areas of the body, including the bowel, lungs and stomach. For information about these types of tumours, call Cancer Council 13 11 20 or contact NeuroEndocrine Cancer Australia or call 1300 287 363.
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).
Active surveillance might help to avoid the side effects of surgery. It can also be a reasonable option if you are not well enough for surgery and the tumours are small.
You might feel anxious about not treating a cancer in your body right away. However, active surveillance will only be recommended if the doctor thinks it is the best thing to do. If you are worried, discuss your concerns with your specialist, GP or a counsellor.
Surgical removal (resection) of the tumour is the most common treatment for people with early-stage disease who are in good health. The surgeon will aim to remove all of the tumour from the pancreas as well as the surrounding tissue. 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. There are risks and potential complications involved in pancreatic surgery. For small pancreatic NETs, keeping a watchful eye on the tumour’s growth may be preferable to major surgery. Your treatment team will weigh up the benefits and risks of surgery, while taking into account your general health and your preferences.
Types of surgery
As with more common types of pancreatic cancer, surgeries for early-stage pancreatic NETs include:
Whipple procedure – Treats tumours in the head of the pancreas; also called pancreaticoduodenectomy
distal pancreatectomy – Removes tumours in the tail or body of the pancreas and often also removes the spleen
total pancreatectomy – Removes the entire pancreas and spleen. This may be the best option if the cancer is large, or in multiple places in the pancreas
Options for advanced pancreatic NETs
Many pancreatic NETs have spread at the time of diagnosis. This is considered advanced cancer and the main aims of treatment will be to control the disease and relieve symptoms. People with advanced pancreatic NETs can live a long time with the disease.
Surgery to relieve symptoms
Different surgical procedures can be used to treat blockages caused by the tumour and to reduce the size of the tumour.
Stenting – If the tumour has blocked the common bile duct or duodenum (first part of the small bowel), a small tube called a stent can be inserted.
Debulking – If the whole tumour can’t be removed, the surgeon may try to remove some of it. This surgery, called debulking, is not always possible and will depend on the tumour’s position and size.
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. How long you will take the drugs will depend on the aim of the treatment, how the cancer responds and the side effects you have. Ask your doctor what side effects you may experience and discuss any side effects with your treatment team as soon as they appear, so they can be managed appropriately.
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.
You may have a dose of chemotherapy before PRRT to make the cancer cells more sensitive to the radiation. PRRT is available only in certain treatment centres. You will usually see a nuclear medicine specialist and a medical oncologist. 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.
Advanced pancreatic NETs often spread to the liver. The tumours on the liver are called metastases. Treatments to control them include:
Radiofrequency ablation and microwave ablation – Using an ultrasound or CT scan as a guide, the doctor inserts a fine needle through the abdomen into the liver tumour. The needle sends out radio waves or microwaves that produce heat and destroy the cancer cells. The treatment takes about 15 minutes and you can usually go home after a few hours. Side effects, including pain or fever, can be managed with medicines.
Transarterial chemoembolisation – In this procedure, the doctor inserts a catheter into the hepatic artery, which supplies blood to the liver. A chemotherapy drug is released into the artery, along with tiny particles called microspheres, which block the flow of blood into the tumour. This causes the tumour to shrink. The procedure is performed by an interventional radiologist.
Selective internal radiation therapy (SIRT) – Also known as radioembolisation, this is done by an interventional radiologist. The radiologist inserts a catheter into the liver’s main artery and then delivers tiny radioactive beads (SIR-spheres) to the liver through the catheter. The beads give a high dose of radiation to the tumour while causing little damage to normal liver tissue.
This information is reviewed by
This information was last reviewed February 2020 by the following expert content reviewers: Dr Lorraine Chantrill, Head of Department, Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Marion Bamblett, Nurse Unit Manager, Cancer Centre, Fiona Stanley Hospital, WA; Prof Katherine Clark, Clinical Director of Palliative Care, Northern Sydney Local Health District Cancer and Palliative Care Network, and Conjoint Professor, Northern Clinical School, The University of Sydney, NSW; Lynda Dunstone, Consumer; Kate Graham, Accredited Practising Dietitian – Upper GI Dietitian, Peter MacCallum Cancer Centre, VIC; Dr Gina Hesselberg, Radiation Oncologist, St George Hospital Cancer Centre, NSW; Dr Marni Nenke, Endocrinologist and Mary Overton Early Career Research Fellow, Royal Adelaide Hospital, SA; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; A/Prof Nicholas O’Rourke, Head of Hepatobiliary Surgery, Royal Brisbane Hospital and The University of Queensland, QLD; Rose Rocca, Senior Clinical Dietitian – Upper GI, Peter MacCallum Cancer Centre, VIC; Gail Smith, Consumer.