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Treatment

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
Your doctor will discuss your treatment, its benefits and the possible side effects with you.

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:

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

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 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
What and where the pancreas is

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. 

Some of these are major operations and there are risks. But if the aim is to try to cure the insulinoma, you might feel it is worth some risks. Talk to your doctor about the risks and benefits of your surgery.

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

Insulinomas make too much insulin, which lowers the level of blood sugar in your body. To help control the blood sugar, you need to have sugary drinks and snacks. And have lots of small meals throughout the day.

Your doctor or dietitian can tell you what types of food you should eat.

It helps to be aware of the symptoms of a low blood sugar level. Symptoms include:

  • headaches
  • double or blurred vision
  • confusion and dizziness
  • tiredness
  • sweating
  • constantly feeling hungry

Some drugs can help to control the blood sugar level by reducing the amount of insulin you make. The most common drug used is diazoxide.

You take diazoxide tablets every day. The possible side effects of diazoxide include:

  • problems with your kidneys
  • weight gain
  • a build up of fluid in your legs or other parts of the body
  • excessive hair growth

Other drugs that can help to control the blood sugar levels are verapamil, diphenylhydantoin and steroids such as prednisolone.

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)
Somatostatin analogues do not help everyone with an insulinoma. In some cases, it can make the symptoms worse. Your doctor can tell you if this treatment is suitable for you.

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. 

Last reviewed: 
15 Jul 2019
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    T Okabayashi and others
    World Journal of Gastroenterology, 2013. Vol 19, Issue 6, Pages 829-837

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