Treatment

NET Treatments

There are different types of treatment for patients with NET pancreatic tumors, depending on the type of tumor, if cancer, the stage of the cancer; whether the tumors are functional and the person’s overall health. At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer, including standard therapies and novel therapies only available in clinical trials. That’s why careful diagnosis is so important.

As part of a research medical center, physicians at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis have access to a wide range of clinical trials to test new therapies as they emerge. Many of our doctors are principle investigators in these trials, which cover medical, surgical, and radiation therapies. Discuss with your physician how your cancer might benefit from clinical trials.

The standard treatments for pancreatic NETs include surgery, chemotherapy, hormone therapy, chemoembolization, targeted therapy and supportive care for symptoms. Endocrine tumors make up only 5 percent of pancreatic tumors, have a slightly different approach and may involve different surgical procedures and approaches because many of them are benign. Clinical trials are testing many other approaches, some of which are becoming standard of care.

NET tumors can spread to the liver. In that case, radioembolization and regional therapy is employed.

Surgery and Other Procedures

Enucleation: This surgery removes only the tumor and may be done when cancer occurs in one place in the pancreas.

Whipple procedure: A more extensive surgical procedure removes the head of the pancreas, the gallbladder, nearby lymph nodes and part of the stomach, small intestine, and bile duct. Enough of the pancreas is left to make digestive juices and insulin.

Distal pancreatectomy: This surgery to remove the body and tail of the pancreas and sometimes the spleen.

Total gastrectomy: For some tumors that involve the stomach, surgery is done to remove the whole stomach.

Parietal cell vagotomy: This surgery cuts the nerve that causes stomach cells to make acid.

Liver resection: If the liver is involved, surgery removes part or all of the liver.

Radiofrequency ablation: A special probe with tiny electrodes kills cancer cells.

Cryoablation: A special instrument that contains liquid nitrogen or liquid carbon dioxide freezes tissue to destroy abnormal cells.

After surgery, some patients are given chemotherapy to kill any remaining cancer cells and lessen the chances the cancer will come back.

Chemotherapy

Chemotherapy involves the administration of drugs, either orally or intravenously to kill cancer cells. Over the last five years, several new drugs have increased the options for physicians treating patients with pancreatic cancer. Therapy that falls under medical treatment has a wide range of approaches, including timing of treatment. It can be given before or after surgery, in conjunction with radiation or by itself.

Hormone therapy: This tumor treatment removes hormones or blocks their action and stops cancer cells from growing. If tests show that the cancer cells have receptors where hormones can attach, drugs, surgery, or radiation therapy can be used to reduce the production of hormones or block them from working.

Hepatic arterial occlusion or chemoembolization: Drugs and small particles block or reduce the flow of blood to the liver through the hepatic artery 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.

Targeted therapy: This type of treatment 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.

Different combinations of therapies may be used depending on the stage of the cancer and the health of the patient. New combinations of therapies are always being tested in clinical trials and are available at the Siteman Cancer Center before other places may have access to them.