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Treating Pancreatic Neuroendocrine Tumors (Islet Cell Tumors)

Treatment for pancreatic neuroendocrine tumors (NETs), also called islet cell tumors, depends on what type of pancreatic NET you have and whether it produces hormones. Other factors that affect your treatment plan include:

  • the stage and grade of the tumor
  • how many tumors are found in the pancreas
  • whether the cancer has spread to lymph nodes near the pancreas or to other parts of the body such as the liver, lung, peritoneum, or bone

Learn more about pancreatic NET stages and grades at Pancreatic Neuroendocrine Tumor Diagnosis and Staging.

Types of treatment for pancreatic neuroendocrine tumors

Many treatments are available for people with pancreatic NETs. The type of treatment you receive will depend on the type of pancreatic NET, its stage and grade, how many tumors are found, and whether they have spread to lymph nodes, liver, or other parts of the body.

Types of treatments available for people with pancreatic NETs include:

Active surveillance

Surveillance is closely watching a person’s condition but not giving any treatment unless there are changes in test results that show the condition is getting worse. During active surveillance, certain exams and tests are done on a regular schedule. Surveillance may be used for pancreatic NETs that are small or low grade.

Surgery

Surgery is a common and effective treatment for pancreatic NET. The type of surgery depends on the location and size of the tumor. Surgeries used to treat pancreatic NET include:

  • Enucleation removes the tumor only. This may be done when cancer occurs in one place in the pancreas.
  • Central pancreatectomy is used for tumors in the pancreas neck, the area between the body and the tail.
  • Distal pancreatectomy is used for tumors in the body and tail of the pancreas. It involves removing the body and tail of the pancreas and sometimes the spleen.
  • Whipple procedure, also called pancreaticoduodenectomy, removes tumors in the head of the pancreas. It involves removing the head of the pancreas, the gallbladder, part of the small intestine, part of the bile duct, and part of the stomach. Enough of the pancreas is left to produce digestive juices and insulin.
  • Liver resection removes parts of the liver with cancer. It is used if the tumor has spread to the liver.

Learn more about Surgery to Treat Cancer.

Ablation therapy

Ablation therapy destroys cancerous tissue. It is most often used to treat PNETs that have spread to the liver. Different types of ablation therapy may be used for pancreatic NETs:

  • Radiofrequency ablation uses a probe that emits tiny electrodes to kill pancreatic NET cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital with general anesthesia.
  • Microwave ablation is similar to radiofrequency ablation, but it uses a probe to emit microwaves that heat and kill pancreatic NET cells.
  • Ethanol ablation injects ethanol (alcohol) through the skin directly into a tumor to kill cancer cells. Ultrasound or a CT scan is used to guide the needle into the tumor. It is also called alcohol ablation or  percutaneous ethanol injection (PEI).
  • Cryosurgical ablation freezes tissue to destroy abnormal cells. This is usually done with a special instrument that contains liquid nitrogen or liquid carbon dioxide. The instrument may be used during surgery or laparoscopy or inserted through the skin. This procedure is also called cryoablation. Learn more about Cryosurgery to Treat Cancer.

Somatostatin analogs

Medicines called somatostatin analogs can help slow the growth of some types of pancreatic NETs and control symptoms caused by excess hormones in the body. Lanreotide, octreotide, and pasireotide are somatostatin analogs used to treat pancreatic NETs.

Chemotherapy

Chemotherapy involves using drugs to kill cancer cells. It is often used for pancreatic NETs that cannot be controlled with surgery or other therapies.

Chemo may be combined with other treatments, such as radiation therapy, embolization, or targeted therapy. If chemo and radiation are given at the same time, it’s called chemoradiation. 

Chemotherapy for pancreatic NETs is usually systemic, meaning it is injected into a vein or given by mouth. When given this way, the drugs enter the bloodstream to reach cancer cells throughout the body. 

Chemotherapy used alone or in combination to treat pancreatic NETs may include:

Learn more about how chemotherapy works, how it is given, common side effects, and more at Chemotherapy to Treat Cancer and Chemotherapy and You: Support for People With Cancer.

Radiation therapy

Radiation therapy uses high-energy x-rays to kill cancer cells. It can be used to shrink tumors before surgery or to relieve symptoms caused by tumor growth. The two main types of radiation therapy are external radiation therapy and peptide receptor radionuclide therapy (PRRT).

Learn more about Radiation Therapy to Treat Cancer.

Embolization

Embolization blocks or reduces blood flow to tumors, especially those that have spread to the liver. Types of embolization used to treat pancreatic NETs include:

  • Transarterial embolization (TAE) uses drugs, small particles, or other agents to block or reduce blood flow to a tumor or an abnormal area of tissue. For pancreatic NETs, TAE is used to block blood flow to the liver through the hepatic artery (the major arterial blood vessel that carries blood to the liver). This is done to kill cancer cells growing in the liver.
  • Transarterial chemoembolization (TACE) combines TAE and chemotherapy. Often, chemo drugs are attached to small beads that are injected into the hepatic artery. The beads block blood flow to the tumor as they release the drug. This allows a higher amount of drug to reach the tumor for a longer period, which may kill more cancer cells. It also causes fewer side effects because very little of the drug reaches other parts of the body.
  • Radioembolization uses a thin, flexible tube to inject tiny beads that hold the radioactive substance yttrium Y 90 into the hepatic artery. The beads collect in the tumor and in blood vessels near the tumor, and the yttrium Y 90 gives off radiation. This blocks the blood vessels that the tumor needs to grow and kills the cancer cells.

Targeted therapy

Targeted therapy uses drugs or other substances to block the action of specific enzymes, proteins, or other molecules involved in the growth and spread of cancer cells.

Targeted therapies used to treat pancreatic NETs include:

Learn more about Targeted Therapy to Treat Cancer.

Palliative care

Palliative care is an important part of pancreatic NET treatment and can be given at any stage of disease. It aims to improve quality of life by managing symptoms and providing support to patients and their families. Palliative care can be provided alongside curative treatments, such as chemotherapy, or as the focus of care.

Some people living with pancreatic NETs will experience conditions or symptoms related to the tumor. These conditions or symptoms can often be treated or controlled with palliative care:

  • Stomach ulcers may be treated with drugs that lower your levels of stomach acid or drugs that treat heartburn and acid reflux. These drugs include cimetidine, famotidine, lansoprazole, omeprazole, pantoprazole, and ranitidine. 
  • Dehydration and electrolyte imbalances caused by diarrhea can be relieved with IV fluids that replace electrolytes such as potassium or chloride.
  • Low blood sugar may be treated with drugs that help maintain normal blood sugar levels Eating small frequent meals can also help.
  • High blood sugar can be treated with insulin or drugs that help maintain normal blood sugar levels.

Clinical trials

New treatments for pancreatic NETs are being studied in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for people with cancer. For some people, taking part in a clinical trial may be an option. 

You can find clinical trials for people with pancreatic NETs at Treatment Clinical Trials for Pancreatic Islet Cell Tumors or use the clinical trial search to find NCI-supported cancer clinical trials that are accepting participants. The search allows you to filter trials based on the type of cancer, your age, and where the trials are being done. Clinical trials supported by other organizations can be found at ClinicalTrials.gov.

Learn more about clinical trials, including how to find and join one, at Cancer Clinical Trial Information for Patients and Caregivers.

Treatment of nonfunctioning pancreatic neuroendocrine tumors

Treatment of nonfunctioning pancreatic NETs may begin with active surveillance if the tumor is small, slow-growing, and not causing other problems. For larger tumors or tumors that may grow quickly, your doctor will likely recommend surgery. The type of surgery used depends on the location of the pancreas tumor and how many tumors are found:

  • enucleation is used if only one tumor is found in the head of the pancreas
  • distal pancreatectomy is used if one or more tumors are found in the body or tail of the pancreas
  • Whipple procedure is used if one or more tumors are found in the duodenum (first part of the small intestine)

If the tumor has spread to the liver, other treatments may include surgery to remove the affected part of the liver and embolization.

If surgery is not an option for you or if the tumor continues to cause problems after surgery or has spread to other parts of the body, your doctor may recommend other treatments, such as:

Learn more about these treatments in the section, Types of treatment for pancreatic neuroendocrine tumors.

Treatment of functioning pancreatic neuroendocrine tumors

Treatment of gastrinoma

Surgery is the main treatment for gastrinoma. Gastrinomas that can be completely removed by surgery are often cured. The type of surgery used depends on the location of the pancreas tumor and how many tumors are found:

  • enucleation is used if only one tumor is found in the head of the pancreas
  • distal pancreatectomy is used if one or more tumors are found in the body or tail of the pancreas
  • Whipple procedure is used if one or more tumors are found in the duodenum (first part of the small intestine)

Your doctor may also prescribe medicines that help reduce stomach acid, such as omeprazole or pantoprazole. 
If the tumor has spread to the liver, other treatments may include surgery to remove the affected part of the liver and embolization.

If surgery is not an option for you or if the tumor continues to cause problems after surgery or has spread to other parts of the body, your doctor may recommend other treatments, such as:

Learn more about these treatments in the section, Types of treatment for pancreatic neuroendocrine tumors. 

Treatment of insulinoma

Most insulinomas are benign (not cancer), but they need to be treated to avoid problems related to low blood sugar caused by extra insulin produced by the tumor. Insulinomas can often be completely removed with surgery. The type of surgery used depends on the location of the tumor and how many tumors are found.

If one tumor is found, surgery may include:

  • enucleation for tumors on the surface of the pancreas or in the head
  • central or distal pancreatectomy for tumors in the neck, body, or tail of the pancreas

If multiple tumors are found, you may need a more extensive surgery called a Whipple procedure.

If the tumor has spread to the liver, treatment may also include surgery to remove the affected part of the liver and embolization.

If surgery is not an option for you or if the tumor continues to cause problems after surgery or has spread to other parts of the body, your doctor may recommend other treatments, such as:

  • ablation therapies
  • chemotherapy
  • somatostatin analogs
  • peptide receptor radionuclide therapy (PRRT)
  • targeted therapy
  • external radiation therapy to relieve pain and other symptoms related to tumor growth

Learn more about these treatments in the section, Types of treatment for pancreatic neuroendocrine tumors.

Treatment of glucagonoma

Most glucagonomas are cancerous. Treatment will depend on whether glucagonoma has spread beyond the pancreas. Often, the first step in treating glucagonoma is managing symptoms and conditions, such as diabetes and skin rash, caused by extra glucagon made by the tumor. These treatments may include:

  • somatostatin analogs
  • diabetes medications or insulin injections
  • antibiotics or steroids to treat the skin rash caused by excess glucagon

If the tumor has not spread beyond the pancreas, your doctor may recommend surgery. The type of surgery used will depend on where the tumor is found in the pancreas and may include enucleation or central or distal pancreatectomy, depending on the tumor’s location. Even if the tumor is completely removed, glucagonoma may recur (come back).

If the tumor has spread to the liver, treatment may also include surgery to remove the affected part of the liver and embolization.

If surgery is not an option for you or if the tumor continues to cause problems after surgery or has spread to other parts of the body, your doctor may recommend other treatments, such as:

  • ablation therapies
  • chemotherapy
  • targeted therapy
  • peptide receptor radionuclide therapy (PRRT)
  • palliative surgery
  • external radiation therapy to relieve pain and other symptoms related to tumor growth

Learn more about these treatments in the section, Types of treatment for pancreatic neuroendocrine tumors.

Treatment of VIPoma

VIPoma is a very rare pancreatic NET that is often cancerous. Treatment will depend on whether VIPoma has spread beyond the pancreas. Often, the first step in treating VIPoma is managing symptoms, such as diarrhea and dehydration, cased by extra vasoactive intestinal polypeptide (VIP) made by the tumor. These treatments may include:

  • IV fluids to replace electrolytes such as potassium or chloride
  • somatostatin analogs

If the tumor has not spread beyond the pancreas, your doctor may recommend surgery. The type of surgery used will depend on where the tumor is found in the pancreas and may include enucleation or central or distal pancreatectomy. Even if the tumor is completely removed, VIPoma may recur (come back).

If the tumor has spread to the liver, treatment may also include surgery to remove the affected part of the liver and embolization.

If surgery is not an option for you or if the tumor continues to cause problems after surgery or has spread to other parts of the body, your doctor may recommend other treatments, such as:

  • ablation therapies
  • chemotherapy
  • targeted therapy
  • peptide receptor radionuclide therapy (PRRT)
  • palliative surgery
  • external radiation therapy to relieve pain and other symptoms related to tumor growth

Learn more about these treatments in the section, Types of treatment for pancreatic neuroendocrine tumors.

Treatment of somatostatinoma

Somatostatinoma is a very rare pancreatic NET that is often cancerous. Surgery is the main treatment for somatostatinoma. Most somatostatinomas are advanced when diagnosed, so they often cannot be completely removed by surgery. If surgery is recommended, Whipple procedure may be used to remove as much of the tumor as possible from the pancreas.

If the tumor has spread to the liver, treatment may also include surgery to remove the affected part of the liver and embolization.

If surgery is not an option for you or if the tumor continues to cause problems after surgery or has spread to other parts of the body, your doctor may recommend other treatments, such as:

  • ablation therapies
  • somatostatin analogs
  • chemotherapy
  • targeted therapy
  • peptide receptor radionuclide therapy (PRRT)
  • external radiation therapy to relieve pain and other symptoms related to tumor growth

Learn more about these treatments in the section, Types of treatment for pancreatic neuroendocrine tumors.

Treatment of recurrent or progressive pancreatic neuroendocrine tumors

Sometimes pancreatic NETs come back (recur) after treatment or continue to grow while you’re receiving treatment. If this happens, treatment depends on the type of pancreatic NET, what therapies you’ve already received, and where the tumor is located. Talk with your doctor to develop a treatment plan that is right for you.

Follow-up care

Some tests that were done to diagnose pancreatic NETs may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. These tests are sometimes called follow-up tests or check-ups.

Planning and scheduling these appointments can be stressful and time-consuming, but making regular visits with your health care team can help you feel supported. Learn more about Follow-Up Medical Care.

Getting support

Whether you’ve just been diagnosed with pancreatic NET or have finished treatment, you or your caregivers may need help coping. Know that you are not alone. Seek support from family and friends, your health care team, and support groups.

Get advice on how to ask for help in Adjusting to Cancer or learn more about Cancer Support Groups.

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