What is a pancreatic neuroendocrine tumor, and how is it detected?
Pancreatic neuroendocrine tumors hold the small cells (islet cells) in the pancreas that produce hormones.
In some pancreatic neuroendocrine tumors, the tumor cells continue to produce hormones (referred to as functional tumors), and the amount of hormone released can be excessive. In non-functional tumors, hormone production does not occur. Pancreatic neuroendocrine tumors are generally solid in structure.
How is pancreatic cancer different from pancreatic cystic tumors and pancreatic neuroendocrine tumors? (Functional tumor)
The type of cancer commonly referred to as pancreatic cancer is a special type of pancreatic cancer called adenocarcinoma. Some cystic tumors carry the risk of turning into adenocarcinoma after reaching a certain size.
Neuroendocrine tumor is a separate type of cancer and does not turn into adenocarcinoma. In some cases, both can be found in the pancreas. Treatment plans for pancreatic cancer and neuroendocrine tumors are different.
What are the causes of pancreatic neuroendocrine tumor?
The causes that lead to neuroendocrine tumors are not yet known for certain; however, neuroendocrine tumors in the pancreas occur as a result of changes (mutations) in the DNA of hormone-producing cells (islet cells) in the pancreas.
What are the symptoms of pancreatic neuroendocrine tumor?
Pancreatic neuroendocrine tumors usually do not cause symptoms. In advanced stages, symptoms such as ulcers, burning sensation in the chest, diabetes, muscle cramps, indigestion, diarrhea, skin rash, pain in the abdomen or back, weight loss, fatigue and weakness may be indicators of these tumors.
What methods are used for diagnosis?
In the diagnosis of neuroendocrine tumors in the pancreas; Physical examination, tests showing the increase in hormones, imaging methods such as computerized tomography, MRI, PET and biopsy are used.
What are the types of pancreatic neuroendocrine tumors?
i. Nonfunctional neuroendocrine tumors
Nonfunctional ones account for 15-30 percent of pancreatic neuroendocrine tumors. These tumors do not secrete excessive amounts of hormones and are therefore called nonfunctional tumors.
They usually show symptoms such as abdominal pain, nausea-vomiting, gastrointestinal bleeding, weight loss, and jaundice.
Diagnosis may be made later in nonfunctional neuroendocrine tumors.
ii. Insulinoma
Insulinoma occurs in the insulin-secreting beta cells of the pancreas and is more common in women. Insulinoma, a member of the functional pancreatic neuroendocrine tumor (PNET) group, is mostly benign and is the most common hormone-producing tumor of the pancreas. Because the tumor produces insulin irregularly, insulin production becomes continuous.
Insulinoma is determined by ultrasound, CT scan or MRI imaging methods. Additionally, a diet test may be performed on the patient to see if there is an unnatural sugar deficiency before the diagnosis is made. The most appropriate treatment method is to surgically remove the insulinoma tumor in the pancreas. In case of metastasis, chemotherapy may be added to the treatment.
iii. Gastrinoma
Rarely, a gastrinoma tumor can sometimes be found directly within the pancreas; however, it is also seen around the pancreas and in other organs such as the stomach or duodenum. This tumor, which is usually malignant, metastasizes early. Increased gastrin hormone due to the tumor causes complaints of stomach and intestinal ulcers. The treatment method is surgery. The tumor must be removed.
iv. Vipoma
Vipoma is among the rare tumors. The tumor seen in the hormone-secreting Langerhans cells of the pancreas takes its name from the combination of vip (vasoactive intestinal peptide) and oma (unwanted cell proliferation). In vipoma, an uncontrolled increase occurs in the cells that produce vasoactive intestinal peptide hormone. It is usually a benign tumor, but due to diarrhea caused by the intensely secreted vasoactive intestinal polypeptide hormone, patients experience dehydration (fluid loss), hypokalemia (low potassium in the blood), achlorhydria, acidosis, hypotension (low blood pressure), hypercalcemia (increased calcium concentration in the blood) and hyperglycemia (increased calcium concentration in the blood). high blood sugar) is observed.
v. Glucagonoma
Glucagonoma is one of the rare tumors in the pancreas. Approximately 5-10 percent of all pancreatic neuroendocrine tumors are glucagonomas. Glucagon is a hormone produced by the pancreas that works with insulin to control the amount of sugar in the blood. Glucagonoma tumor cells that produce large amounts of glucagon cause painful and life-threatening symptoms such as high blood sugar, extreme thirst and hunger due to high blood sugar, frequent urination at night, diarrhea, weight loss and blood clots in the legs. For treatment, the tumor must be removed surgically. Additionally, methods such as drug therapy are also used to relieve the complaints it causes.
How are neuroendocrine tumors in the pancreas treated?
Treatment of neuroendocrine tumors; it varies depending on the type of tumor, its location, whether it produces hormones, its degree of aggressiveness, and whether it has spread to other parts of the body. Depending on the characteristics of the tumor in treatment; surgical tumor removal, chemotherapy, targeted drug therapy, Peptide receptor radionuclide therapy (PRRT), which is a combination of a drug targeting cancer cells and a small amount of radioactive material, radiotherapy and drugs that regulate increased hormone secretion are used.
