Pancreatic Neuroendocrine Tumors

Treatment for a pancreatic neuroendocrine tumor depends on the types of cells involved in your cancer, the extent and characteristics of your cancer, your preferences, and your overall health.

Options may include:

• Surgery. If the pancreatic neuroendocrine tumor is only in the pancreas, treatment usually includes surgery. For cancers in the tail of the pancreas, surgery may involve removing the tail of the pancreas, called a distal pancreatectomy. This surgery leaves the head of the pancreas intact.

  Cancers that affect the head of the pancreas may require the Whipple procedure, also called pancreaticoduodenectomy. This surgery involves removing the cancer and part or most of the pancreas.

  If the cancer spreads to other parts of the body, surgery might be an option to remove it from those locations.

• Peptide receptor radionuclide therapy, also called PRRT. PRRT combines a medicine that targets cancer cells with a small amount of a radioactive substance that’s injected into a vein. The medicine sticks to the pancreatic neuroendocrine tumor cells wherever they are in the body. Over days to weeks, the medicine delivers radiation directly to the cancer cells, causing them to die.

  One PRRT, lutetium Lu 177 dotatate (Lutathera), is used to treat advanced cancers.

• Targeted therapy. Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Targeted therapy is used to treat certain advanced or recurrent pancreatic neuroendocrine tumors.
• Radiofrequency ablation. Radiofrequency ablation involves applying energy waves to cancer cells using a special probe with tiny electrodes. Radiofrequency ablation causes the cancer cells to heat up and die. The probe may be inserted directly in the skin or through a cut in the abdomen.
• Radiation therapy. Radiation therapy uses powerful energy beams to kill cancer cells. The energy comes from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.
• Chemotherapy. Chemotherapy uses strong medicines to kill cancer cells. It’s used in certain situations to treat pancreatic neuroendocrine tumors.

Treatment for cancer that spreads to the liver

Pancreatic neuroendocrine tumors most often spread to the liver. Several treatments exist for this, including:

• Removing part of the liver. A surgeon might remove the part of the liver that has cancer. The rest of the liver can take over for the part that’s removed. In certain situations, it might be possible to remove the entire liver and replace it with a liver from a donor. This procedure is called a liver transplant.
• Slowing blood flow to the liver. Slowing blood flow through the liver’s main artery, called the hepatic artery, can slow or stop cancer growth. Other blood vessels in the liver provide enough blood for the rest of the liver to keep working. Often, chemotherapy medicines or radioactive beads are used to block the artery. These methods slow the blood flow and deliver treatment directly to the cancer cells in the liver.
• Destroying cancer cells with heat. Radiofrequency ablation is a procedure that uses energy waves to heat up cancer cells and cause them to die. It’s done using a special probe with tiny electrodes that’s inserted through the skin and into the liver. Energy waves pass through the probe and cause the tissue around it to heat up.