Treatment for insulinoma

Insulinoma is a type of neuroendocrine tumour (NET) that starts in the insulin making cells of the pancreas. The treatment you have depends on a number of things such as where the tumour is, its size and whether it has spread (the stage).

Surgery is the main treatment for insulinomas. This cures most people with insulinoma that hasn’t spread to other parts of the body. But surgery is not always possible. Some insulinomas might have already started to spread or you may not be well enough to have an operation. 

You might have other treatments if surgery isn’t an option, such as:

• drugs and diet to control your blood sugar levels
• chemotherapy
• somatostatin analogues such as octreotide and lanreotide
• radiofrequency ablation (RFA)
• trans arterial embolisation (TAE)

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT). 

The treatment you have depends on:

• where the insulinoma is
• whether you have 1 or more tumours
• whether it has spread to other parts of the body
• your general health
• the symptoms you might have

You are likely to have a clinical nurse specialist (CNS). They go to the MDT meetings. They can answer your questions and support you. The CNS is often your main point of contact throughout your treatment.

Surgery

Surgery is the main treatment for insulinoma. You might have:

Surgery to remove just the tumour (tumour enucleation)

Your surgeon removes the tumour and leaves the healthy pancreatic tissue behind. You might have this if the tumour is less than 2cm across. 

You usually have a tumour enucleation during keyhole surgery (laparoscopic surgery). This is a small operation where the surgeon puts a flexible tube (a laparoscope) into the body through a small cut. The surgeon looks through the laparoscope to find and remove the tumour. 

Removing the body and tail of the pancreas (distal pancreatectomy)

You have a distal pancreatectomy if the tumour is in the body or tail of the pancreas, and you can’t have a tumour enucleation. You may also have it if the tumour is near or touching the pancreatic duct.

Your surgeon removes the body and tail of the pancreas, and leaves the head of the pancreas behind.

Removing the head of the pancreas (PPPD)

Removing the head of the pancreas is called pylorus preserving pancreaticoduodenectomy (PPPD). Your surgeon removes:

• the widest part of the pancreas (the head)
• the first part of the small bowel (duodenum)
• the gallbladder
• part of the bile duct

Whipple’s operation

A Whipple’s operation is the same as a PPPD, but you also have the stomach removed.

Remember to click back to return to the NET section. The rest of the information in the pancreatic cancer section will not apply to you. 

Your surgeon might suggest that you have all of your pancreas removed if you have a rare family syndrome called multiple endocrine neoplasia 1 (MEN1) or von Hippel-Landau syndrome. This is because people who have these syndromes are likely to develop more NETs in the rest of the pancreas.

Drugs and diet to control blood sugar levels

Symptoms of insulinoma can be difficult to cope with. To help control your blood sugar levels, you might have:

• a high sugar (glucose) diet
• drugs to reduce the amount of insulin you make

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. You may have it if you have an insulinoma that has spread to other parts of the body (metastatic) and you can’t have surgery. 

The most common chemotherapy drugs used are:

• doxorubicin
• streptozotocin
• fluorouracil (5FU)
• temozolomide
• platinum drugs such as carboplatin and cisplatin
• etoposide

Somatostatin analogues

Somatostatin is a protein made naturally in the body. It does several things including slowing down the production of hormones. Somatostatin analogues are man made versions of somatostatin. They can reduce the amount of hormones made by the tumour and help with symptoms.

You may have somatostatin analogues if your insulinoma is sensitive to somatostatin analogues. These include:

• octreotide (Sandostatin)
• lanreotide (Somatuline)

Radiofrequency ablation (RFA)

Radiofrequency ablation uses heat made by radio waves to kill cancer cells. You might have this if you are too unwell to have surgery and the insulinoma is only in the pancreas. 

Trans arterial embolisation (TAE)

You might have this treatment if the insulinoma has spread to the liver. 

Trans arterial embolisation (TAE) means having a substance such as a gel or tiny beads to block the blood supply to the liver NET. It is also called hepatic artery embolisation.

You may also have a chemotherapy drug to the liver at the same time. This is called trans arterial chemoembolisation (TACE). But doctors don't know for sure whether adding chemotherapy is better than having embolisation alone for NETs that have spread to the liver. 

Embolisation and chemoembolisation work in two ways:

• it reduces the blood supply to the tumour and so starves it of oxygen and the nutrients it needs to grow
• it gives high doses of chemotherapy to the tumour without affecting the rest of the body

Clinical trials

Doctors are always trying to improve treatments and reduce the side effects. Your doctor might ask you to take part in a clinical trial as part of your treatment. This might be to test a new treatment or to look at different combinations of existing treatments.