Non-Functioning Pancreatic Neuroendocrine Tumours
Approximately 85% of pancreatic neuroendocrine tumours are non-functioning. They are usually sporadic and their cause unknown but can be associated with Multiple Endocrine Neoplasia 1 (MEN1) and Von Hippel-Lindau syndrome.
Non-functioning Pancreatic Endocrine Tumours are often found at a later stage than functioning PNETs because they tend not cause any symptoms. Smaller non-functioning PNETs are frequently found when a scan has been performed for another reason. As tumours get bigger they can cause symptoms such as abdominal pain, disturbance to intestinal function or weight loss.
When a non-functioning PNET is discovered, it is important to get further information to plan treatment. Usually a CT scan plus octreotide/gallium PET scan as well as a series of blood tests are performed. This information is used to create a treatment plan for the disease which is formulated by a multidisciplinary team (MDT) with expertise in management of neuroendocrine tumours.
If a non-functioning PNET is found only in the pancreas and it is feasible to remove with an operation this would be the recommended course of action.
If the tumour has spread (metastasised) to the liver, bones or other organs it is usual for a biopsy to be taken to get more information about the tumour to guide the treatment. This is often done by radiologist who will take a sample of a tumour using a needle – a biopsy.
The tumour tissue obtained from a biopsy gives the MDT useful information about how your pancreatic neuroendocrine tumours are likely to behave. Pathologists analyse the sample and determine the number of cells within the tumour that are actively dividing. This is known as the proliferation index. Tumours are then graded.
- Grade 1 = proliferation index 1% to 2%,
- Grade 2 = proliferation index at 3% to 20%
- Grade 3 = proliferation index greater than 20%
Usually the higher the proliferation index the more aggressively a tumour will behave. Once the grade of the PNET has been established it is possible to plan further treatment.
There are many types of treatment that can be used to fight PNETS. The team looking after you may recommend surgery, chemotherapy, radiotherapy, long-acting octreotide, peptide receptor radiotherapy (PRRT), liver-directed therapy (TACE, radioembolisation, microwave ablation) or other newer biological agent. Treatment is tailored by the MDT to each individual patient depending on the nature of their disease and depending on their general health.
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Information Product No. PCA0011v1 | Published: 15/08/2016 | Last Updated: 20/10/2016 | Next Review Due: 15/08/2019