Treatment

Non functioning neuroendocrine tumours (NETs) of the pancreas are rare cancers that don’t make hormones. Or make hormones that do not cause a set of symptoms (a syndrome).

The treatment you have depends on a number of things. This includes where the tumour is, its size and whether it has spread (the stage).

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 tumour is and its size
• whether it has spread
• your general health
• whether you have a rare inherited syndrome called multiple endocrine neoplasia 1 (MEN1)

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

Surgery

Surgery is usually the main treatment for non functioning NETs of the pancreas. Your doctor might suggest you have surgery even if the cancer can’t be completely removed. Taking away as much of the cancer as possible can control the NET for some time and help with symptoms.

There are different types of operation depending on where the tumour is.

You usually have open surgery. This means your surgeon makes a large cut in your tummy (abdomen) to remove the tumour. They might also remove the lymph nodes nearby.

You might have surgery to remove:

• just the tumour (enucleation)
• the narrowest part of the pancreas and the body of the pancreas (distal pancreatectomy)
• the whole of the pancreas (total pancreatectomy)
• the widest part of the pancreas, the duodenum, gallbladder and part of the bile duct (pylorus preserving pancreaticoduodenectomy or PPPD for short)
• the widest part of the pancreas, duodenum, gallbladder, part of the bile duct and part of the stomach (Whipple’s operation)

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. 

If the cancer has spread to the liver, you might have the liver tumours removed at the same time as the main surgery. Your surgeon may remove just the tumour or part of the liver.

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. 

You may have somatostatin analogues to try to slow down the tumour and help with symptoms. The most common drugs used are:

• octreotide (Sandostatin)
• lanreotide (Somatuline)

Targeted drugs

Cancer cells have changes in their genes (DNA) that make them different from normal cells. These changes mean that they behave differently. Targeted drugs work by ‘targeting’ the differences that a cancer cell has and destroying them. 

You may have different types of targeted drugs such as:

• everolimus

• sunitinib

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy tumour cells. You may have chemotherapy if the NET has spread to the liver or to other parts of your body. 

The most common chemotherapy drugs used are:

• streptozotocin or temozolomide
• fluorouracil or capecitabine
• doxorubicin

Other treatments

You might have other treatments if the cancer has spread to the liver. This includes:

• trans arterial embolisation (TAE) or trans arterial chemoembolisation (TACE)

• radiofrequency ablation (RFA)

• a type of internal radiotherapy called PRRT

Clinical trials

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

This page is due for review. We will update this as soon as possible.