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Pancreatic Neuroendocrine Tumor

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Pancreatic Neuroendocrine Tumor

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Neuroendocrine tumors can originate from many places in the body, however pancreatic NET is among the top three site of origin. UM-Sylvester NET program is the only dedicated clinical and research program focused on NETs in South Florida. All NET cases are discussed at our weekly multi-disciplinary NET tumor board. Our patients have access to cutting edge clinical trials including novel combination PRRT (Peptide receptor radionuclide therapy) studies and immunotherapies studies.

These tumors form in hormone-creating cells, or islet cells, of the pancreas. Tumors that form in islet cells are called islet cell tumors, pancreatic endocrine tumors, or pancreatic neuroendocrine tumors, also called pancreatic NETs or PNETs. When pancreatic NETs are malignant, they are called pancreatic endocrine cancer or islet cell carcinoma.

Most pancreatic NETs are functional tumors.

  • Functional tumors make extra quantities of hormones, such as gastrin, insulin, and glucagon, that cause signs and symptoms.
  • Nonfunctional tumors do not make extra hormones. Signs and symptoms are precipitated by the tumor as it spreads and grows. Most nonfunctional tumors are malignant, or cancerous.

Types of functional pancreatic NETs

Gastrinoma
This is a tumor that grows in cells that make gastrin. Gastrin is a hormone that helps digest food by causing the stomach to release an acid.

Insulinoma
This tumor forms in cells that produce insulin. Insulin controls the amount of glucose or sugar in the blood. It moves glucose into the cells to produce energy.

Glucagonoma
This tumor forms in cells that manufacture glucagon. Glucagon is a hormone that boosts the amount of glucose in your blood. It causes the liver to break down glycogen.

VIPomas
VIPoma is a pancreatic neuroendocrine tumor which secretes vasoactive intestinal peptide. It may also be called Verner-Morrison syndrome.

Somatostatinoma
Found in cells that make somatostatin, these are rare neuroendocrine tumors that arise in the pancreas.

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has reaffirmed us as South Florida’s only NCI-designated cancer center. We have been recognized for our scientific leadership, our commitment to training the next generation of cancer researchers and providers, as well as our engagement with the communities that we serve. For patients, this designation translates into greater access to leading-edge treatment options, including clinical trials that prioritize your specific cancer.

Specialized care that improves outcomes. At our center, patients experience survival rates up to 14 percent higher than the national average for early- and late-stage pancreatic cancer. Our multi-disciplinary team of pancreas cancer experts offer innovative treatment approaches, high-tech and modern minimally invasive surgical approaches, ground-breaking clinical trials, and cutting-edge radiation technologies. We are committed to a thorough workup of your cancer to provide an individualized treatment strategy for your unique tumor so you may experience the best potential outcomes and the fewest possible side effects.

One of few Pancreatic Cancer Research Institutes in the United States. You have increased access to leading-edge treatments and additional resources for patients and families.

More cancer clinical trials than any other South Florida hospital. If appropriate for your cancer and stage, our clinical trials provide you with easy access the very newest ways to treat and potentially cure your cancer.

Multidisciplinary care teams. Your care team is made up of experts in all aspects of your exact type of cancer. All of your physicians, nurses and more collaborate to save lives.

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Treatments

  • Surgery

    An operation may be needed to remove the tumor.

    • Enucleation: When the cancer occurs in one place in the pancreas, this surgery may remove the tumor only.
    • Whipple Procedure (Pancreatoduodenectomy): A surgical procedure designed to remove the head of your pancreas, gallbladder, nearby lymph nodes and possibly part of the stomach, small intestine, and bile duct, depending on your condition. The surgeon leaves enough of the pancreas to produce digestive juices and insulin.
    • Distal Pancreatectomy: This is a surgery to remove portions of the pancreas, including the body and tail. The surgeon may also decide to remove your spleen, depending on your condition. 
    • Total Gastrectomy: This surgery is performed to remove the whole stomach.
    • Parietal Cell Vagotomy: This surgery is performed to cut the nerve that causes stomach cells to make acid.
    • Liver resection: This surgery removes part or all of the liver.

  • Chemotherapy

    With chemotherapy, drugs are used to stop the growth of cancer cells, either by killing off the cells or by keeping them from dividing. Taken by mouth or injected into a vein or muscle (systemic chemotherapy), the chemo drugs enter the bloodstream and reach any cancer cells located throughout the body. When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen (regional chemotherapy), the drugs affect tumor cells in those areas.

    • If you need intravenous (infusion) chemotherapy, you can have it at the Comprehensive Treatment Unit (CTU) at Sylvester’s main location in Miami, a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. If you prefer, you may have your infusion treatments at the Kendall, Plantation, Hollywood, Coral Springs, Coral Gables, and Deerfield Beach locations.
    • Cold cap therapy to minimize hair loss: Sylvester offers FDA-cleared cold cap therapy to minimize hair loss during chemotherapy. Cold cap therapy works by cooling your scalp during treatment.

  • Hormone Therapy

    Some hormones can cause certain cancers to grow. This treatment removes or blocks hormones and stops cancer cells from growing. If the tests show that cancer cells have places where hormones may attach, known as receptors, drugs, surgery, or radiation therapy is used to lessen the production of hormones.

  • Hepatic Arterial Occlusion or Chemoembolization

    Hepatic arterial occlusion uses drugs, small particles, or other agents to block or reduce the flow of blood to the liver through the hepatic artery (the major blood vessel that carries blood to the liver). This is done to kill cancer cells growing in the liver. The tumor is prevented from getting the oxygen and nutrients it needs to grow. The liver continues to receive blood from the hepatic portal vein, which carries blood from the stomach and intestine.

    • Chemotherapy delivered during hepatic arterial occlusion is called chemoembolization. The anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug is mixed with the substance that blocks the artery and cuts off blood flow to the tumor. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body.

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  • Targeted Therapy

    Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Certain types of targeted therapies are being studied in the treatment of pancreatic NETs.

  • Supportive Care

    Supportive care is given to lessen the problems caused by the disease or its treatment.

Tests


Along with a physical exam and medical history, the following tests and procedures may be used:

  • Blood Chemistry Studies

    A procedure in which a blood sample is checked to measure the amounts of certain substances, such as glucose (sugar), released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.

  • Chromogranin A Test

    A test in which a blood sample is checked to measure the amount of chromogranin A in the blood. A higher than normal amount of chromogranin A and normal amounts of hormones such as gastrin, insulin, and glucagon can be a sign of a non-functional pancreatic NET.

  • Abdominal Computed Tomography Scan (CT or CAT Scan)

    A procedure that makes a series of detailed pictures of the abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

  • Magnetic Resonance Imaging (MRI)

    A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

  • Somatostatin Receptor Scintigraphy

    A type of radionuclide scan that may be used to find small pancreatic NETs. A small amount of radioactive octreotide (a hormone that attaches to tumors) is injected into a vein and travels through the blood. The radioactive octreotide attaches to the tumor and a special camera that detects radioactivity is used to show where the tumors are in the body. This procedure is also called octreotide scan and SRS.

  • Endoscopic Ultrasound (EUS)

    A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.

  • Endoscopic Retrograde Cholangiopancreatography (ERCP)

    A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope is passed through the mouth, esophagus, and stomach into the first part of the small intestine. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken and checked under a microscope for signs of cancer.

  • Laparotomy

    A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease.

  • Intraoperative Ultrasound

    A procedure that uses high-energy sound waves (ultrasound) to create images of internal organs or tissues during surgery. A transducer placed directly on the organ or tissue is used to make the sound waves, which create echoes. The transducer receives the echoes and sends them to a computer, which uses the echoes to make pictures called sonograms.

  • Biopsy

    The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. There are several ways to do a biopsy for pancreatic NETs. Cells may be removed using a fine or wide needle inserted into the pancreas during an x-ray or ultrasound. Tissue may also be removed during a laparoscopy (a surgical incision made in the wall of the abdomen).

  • Bone scan

    A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the blood. The radioactive material collects in bones where cancer cells have spread and is detected by a scanner. Other kinds of lab tests are used to check for the specific type of pancreatic NETs.

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