Oncologist-approved cancer information from the American Society of Clinical Oncology
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Islet Cell Tumor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 4/2013
Treatment Options

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of tumor. To see other pages in this guide, use the colored boxes on the right side of your screen, or click “Next” at the bottom.

This section outlines treatments that are the standard of care (the best proven treatments available) for an islet cell tumor. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Latest Research sections.

Treatment overview

In caring for a person with a tumor, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.

Descriptions of the most common treatment options for an islet cell tumor are listed below. Treatment options and recommendations depend on several factors, including the type and stage of the tumor, possible side effects, and the patient’s preferences and overall health. Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Active surveillance

Sometimes, active surveillance (also called watchful waiting or watch-and-wait) may be recommended. This is because islet cell tumors are often slow growing (called non-aggressive or indolent) and may not grow, spread, or cause problems for many months or years. With this approach, the patient is monitored closely with regular CT scans (see the Diagnosis section) and physical exams to find out if the tumor is growing. Treatment usually only begins if the tumor shows signs of growing and/or spreading.

Surgery

Surgery is the most common treatment for an islet cell tumor that is localized (has not spread outside of the pancreas). Surgery is the removal of the tumor and surrounding healthy tissue during an operation. During surgery, the doctor may need to remove most or part of the pancreas, depending on the location and size of the tumor. A surgical oncologist is a doctor who specializes in treating cancer using surgery.

Common surgical procedures that may be used in treating a person with an islet cell tumor include:

Enucleation. During this surgery, only the tumor is removed.

Whipple procedure. During this procedure, the surgeon removes the head of the pancreas and part of the small intestine, bile duct, and stomach, and then reconnects the digestive tract and biliary system.

Distal pancreatectomy. If the cancer is located in the tail of the pancreas, the most common operation is a distal pancreatectomy, in which the surgeon removes the tail and body of the pancreas, as well as the spleen.

Splenectomy. Spleen removal is called a splenectomy.

Gastrectomy. For a gastrinoma, it may also be necessary to take out the stomach to remove ulcers, a procedure called a gastrectomy.

Side effects of surgery include weakness, fatigue, and pain the first few days following the procedure. The doctor may prescribe medication to help manage these side effects. The patient will need to stay in the hospital for several days and will probably need to rest at home for about one month. Learn more about cancer surgery.

If all or part of the pancreas was removed during surgery, it may be difficult to digest food. A special diet and medicine may help. Also, the doctor can prescribe hormones and enzymes to replace those lost by the removal of the pancreas. Diabetes is another side effect of pancreas removal due to the loss of insulin, which is made by the pancreas. For this, the doctor can prescribe insulin.

Hormone therapy

Hormone therapy may be given to relieve symptoms caused by the tumor. The most common hormone used is octreotide (Sandostatin, OncoLAR), which is similar to one of the hormones normally produced by the body, somatostatin. Many islet cell tumors have receptors for somatostatin on their cell surface. Octreotide can be given either as daily injections under the skin or as monthly intramuscular (into a muscle) injections (called Sandostatin LAR Depot). Common side effects of octreotide include gallstones and/or biliary sludge and gastrointestinal problems, such as diarrhea and abdominal discomfort.

Chemotherapy

Chemotherapy is the use of drugs to kill tumor cells, usually by stopping the cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach tumor cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating tumors with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. Chemotherapy may be given intravenously (through a vein) or orally (by mouth). A patient may receive one drug at a time or combinations of different drugs at the same time.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using these searchable drug databases.

Immunotherapy

Immunotherapy (also called biologic therapy) is designed to boost the body's natural defenses to fight the tumor. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Alpha interferon is a form of immunotherapy given as injections under the skin and is sometimes used to help relieve symptoms caused by an islet cell tumor. However, it can have significant side effects including fatigue, depression, and flu-like symptoms.

Learn more about immunotherapy in this additional article on Cancer.Net.

Targeted therapy

Targeted therapy is a treatment that targets the tumor’s specific genes, proteins, or the tissue environment that contributes to tumor growth and survival. This type of treatment blocks the growth and spread of tumor cells while limiting damage to healthy cells. However, targeted therapies still have a number of side effects, but they are different from those associated with traditional chemotherapy.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them.

Two targeted treatments were approved in 2011 for the treatment of patients with locally advanced or metastatic islet cell tumor. These treatments have been shown to significantly delay the growth of islet cell tumors. Both drugs can be taken orally each day.

Everolimus (Afinitor). This drug, which is taken orally, targets a protein called mTOR that is important for cell growth and survival. Common side effects associated with everolimus include sores in the mouth, fatigue, diarrhea, and rash.

Sunitinib (Sutent). This oral drug’s main target is the receptor of a protein called VEGF. VEGF is important in the process of making new blood vessels, called angiogenesis. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies like sunitinib is to “starve” the tumor. Common side effects associated with this drug include diarrhea, nausea/vomiting, fatigue, and high blood pressure.

Learn more about targeted treatments.

Hepatic artery embolization

Generally used for patients with cancer that has spread to the liver, hepatic artery embolization helps stop cancer growth and spread by temporarily sealing off the blood vessels that supply oxygen and nutrients to the tumor(s) (typically branches of the hepatic artery). Whether this procedure is recommended for a patient depends on the size and number of tumor(s) and the location of the tumor(s) in the liver.

Sometimes this procedure also involves delivering chemotherapy, either as a mixture of drugs together with an oil called lipiodol or as drug(s) loaded into beads/spheres, directly into the tumor before blocking the blood supply to that portion of the liver. This is called chemoembolization or transarterial chemoembolization (TACE). Alternatively, radioactively labeled microbeads, such as TheraSpheres or SIR-Spheres, can be delivered during this procedure. This is known as radioembolization.

These procedures are usually performed by an experienced interventional radiologist and may require an inpatient hospital stay. Side effects include pain around the liver, fever, and temporarily higher levels of liver enzymes as measured by blood tests.

Getting care for symptoms and side effects

A tumor and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the tumor, an important part of care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the tumor and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.   

Recurrent islet cell tumor

A remission is when a tumor cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the tumor will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the tumor returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if it does return. Learn more about coping with the fear of recurrence

If an islet cell tumor does return after the original treatment, it is called a recurrent tumor. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the tumor’s stage has changed. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery, chemotherapy, immunotherapy, and targeted therapy), but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent tumor.

People with a recurrent tumor often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with recurrence.

Progressive islet cell tumor

Progressive disease is when the tumor becomes larger or spreads, usually while the patient is having treatment. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of disease because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Your health care team may recommend a treatment plan that includes a combination of surgery, hormone therapy, chemotherapy, immunotherapy, and targeted therapy. As noted above, hepatic artery occlusion or embolization may be used if cancer has spread to the liver. Supportive care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of progressive disease is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

If treatment fails

Recovery from an islet cell tumor is not always possible. If treatment is not successful, the disease may be called advanced or terminal disease.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and bereavement.

Choose “Next” (below, right) to continue reading to learn more about clinical trials, which are research studies. Or, use the colored boxes located on the right side of your screen to visit any section.

Last Updated: 
Tuesday, April 23, 2013

© 2005-2014 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.

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