Endocrine tumour treatment

Monday 30 April, 2012

Download PDF Order FREE booklet

On this page: Surgery | After an operation | Non-surgical treatment | Other types of treatment | Reviewers


This section has information about treatment for the rarest type of pancreatic tumours: pancreatic neuroendocrine tumours (PNETs). For information about treatment of exocrine tumours such as adenocarcinoma, which are more common, see the Treating exocrine tumours section.

PNET treatment will depend on:

  • the type of tumour it is
  • its stage
  • if it's spread to other parts of the body, such as the liver
  • if it's functioning (hormone producing) or non-functioning.

It can be difficult to make decisions about treatment. For more information, see the Deciding on treatments section.

Surgery

Your doctor may do an operation to remove as much of the tumour as possible from the pancreas and its surrounding tissue. The type of operation you have will depend on the size of the tumour and where it's located. The surgeon may remove:

  • part of the pancreas
  • the whole pancreas
  • the pancreas and other organs.

Some people have a Whipple's procedure.

If the whole tumour can't be removed, the surgeon may remove as much of it as possible. This is called debulking. Debulking surgery isn't always possible, as it depends on the tumour position and size. If you have this operation, it may relieve some of your symptoms and, for functioning PNETs, reduce your hormone levels. If your hormone levels can be regulated, you'll experience fewer side effects and feel better.

Ask your medical team for more detailed information about the type of operation you'll have.

After an operation

As with all major operations, you'll be given pain relief. When you're in hospital, you'll also have a drip (intravenous infusion) to replace your body's fluids. If you can't eat or drink within a few days, the doctor may insert a temporary feeding tube.

Most people go home within a fortnight of surgery, but if you have complications after surgery, you may need to stay in hospital longer. If you're in pain when you return home, talk to your medical team. They may prescribe pain-killers to make you more comfortable.

Some people who have surgery will need to take tablets known as pancreatic enzymes, which will help to digest fat and proteins. A small amount of people also develop diabetes and may need insulin therapy. See the Nutrition and dietary probelms section for information on dietary issues that may be caused by pancreatic cancer and its treatment.

If the surgeon is able to remove the whole tumour, you may not require any other treatment.

Lesley's story

"My symptoms started with itchy skin. After a few days I was jaundiced and had dark coloured urine and back pain. I thought I had a problem with my gall bladder so I went to Emergency. The doctors did several tests and scans and couldn't figure out what was wrong, so they put a stent into my gall bladder to prevent it from becoming blocked.
The stent was changed four times over the course of a year. I had regular scans but no cancer was detected.
I wasn't feeling well and I had a bout of pancreatitis, so my surgeon removed my gall bladder and did a biliary bypass. They were then able to see that I had a carcinoid pancreatic neuroendocrine tumour on the head of my pancreas.
One good thing for me was that I didn't have to have chemotherapy or radiotherapy. I had a Whipple's procedure. It was a serious operation and I was in hospital for five weeks.
During recovery in hospital, I didn't have a feeding tube – I drank water and built up to other fluids. Over the next six months, I lost a lot of weight because I didn't eat a great deal.
I now eat a mostly vegetarian diet with meat 1 to 2 times per week. I take a digestive enzyme supplement called Creon®  with food and increase the dose with a larger meal. I try to eat well most of the time. I rarely eat sugary, fatty or dairy foods. I'm able to maintain my weight at about 64 kg.
Since I've learned to manage my diet, I was able to go overseas this year on a European river cruise. I was careful with what I ate and I rested a few days when I needed to, but I didn't have any serious problems."

Non-surgical treatment

The following treatments can be combined with surgery or used by themselves. Some of these treatments are used to shrink (debulk) the tumour, especially if it's spread to the liver. If the cancer can't be cured, these treatments may be used to reduce your symptoms (palliative treatment).

Chemotherapy

Chemotherapy is the use of anti-cancer drugs, which kill or slow the growth of cancer cells.

Treatment is usually given by injecting the drugs into a vein (intravenously). You'll probably have several courses of treatment. Your doctor will determine how long treatment will last.

Some drugs can cause temporary side effects, which may include nausea and vomiting, mouth sores, diarrhoea and fatigue. You may have some or none of these side effects. Steps can be taken to prevent or manage any side effects you experience.

For more information about chemotherapy and its side effects, call Cancer Council on 13 11 20 for a free copy of Understanding Chemotherapy.

Chemotherapy is not commonly used to treat PNETs. If you do have chemotherapy, there are a few types of drugs that may be used. Your doctor will talk to you about the drugs you're given.

Peptide receptor radionuclide therapy

This treatment is available at only a few centres in Australia. It's used for PNETs that have receptors for the hormone somatostatin.

You'll be given a drug to protect your kidneys and a radioactive drug. Most people receive the drugs through an IV drip. The tumour cells with somatostatin receptors act like a target for the radioactive drug.

Most people have a few treatment sessions over several weeks. Your body will be slightly radioactive after the treatment, so your doctor will advise you if you need to take any safety measures when you return home.

Other types of treatment

If the PNET has spread, you may have other types of treatment. This may include:

  • radiofrequency ablation: uses radio waves to heat and destroy cancer cells
  • embolisation: blocks the blood flow into the tumour
  • radiotherapy: uses high-energy x-rays to kill or destroy cancer cells.

Radiotherapy is often used as palliative treatment. A machine will direct radiotherapy beams at the cancer. Most patients have treatment daily, Monday to Friday, for several weeks.

For more information about radiotherapy and other types of treatment, call 13 11 20 or talk to your medical team.


Reviewed by: Dr David Chang, Pancreatic and Upper Gastrointestinal Surgeon, Sydney South West Area Health Service and Research Fellow, Pancreatic Cancer Research Group, Garvan Institute of Medical Research, NSW; Professor Andrew Biankin, Head, Pancreatic Cancer Research Group, Garvan Institute of Medical Research, Consultant Hepato-Pancreato-Biliary, Upper GI Surgeon, Sydney South West Area Health Service, NSW, and Clinical Lead, Australian Pancreatic Cancer Genome Initiative; Annie Angle, Oncology Nurse, Cancer Council Victoria; Dr Lorraine Chantrill, Medical Oncologist, Macarthur Cancer Therapy Centre, Campbelltown Hospital, NSW; Leslye Dunn, Consumer; Helen Gooden, Manager, Multimedia Cancer Support Grants, Cancer Council NSW; Barbara Hunter, Consumer; A/Prof Lara Lipton, Medical Oncologist, Cabrini and Royal Melbourne Hospital, VIC; Barry Ranson, Consumer; Meg Rogers, Cancer Nurse Coordinator, Upper Gastrointestinal Service, Advance Practice Nurse, Peter MacCallum Cancer Centre, VIC; Karen Tokutake, Medical Oncology and Haemotology Dietitian, Prince of Wales Hospital, NSW; and Belinda Vangelov, Senior Oncology Dietitian and Clinical Educator, Prince of Wales Hospital, NSW.
Updated: 30 Apr, 2012