ON THIS PAGE: You will learn about the different ways doctors use to treat people with a pituitary gland tumor. To see other pages, use the menu on the side of your screen.
This section outlines treatments that are the standard of care, which are the best known treatments available, for this specific type of 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 approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the About Clinical Trials and Latest Research sections.
For a pituitary gland 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. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.
Any patient with a pituitary tumor should be seen by an endocrinologist, a doctor who specializes in problems with glands and the endocrine system, and by a neurosurgeon, a specialist who operates on the head, brain, and central nervous system. Patients with vision problems should also need to visit an ophthalmologist, a doctor who specializes in the treatment and diagnosis of eye problems.
Descriptions of the most common treatment options for a pituitary gland 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. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of 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 is an option for some people with a pituitary gland tumor who have no symptoms from the tumor and whose hormones are working normally. This approach can also be called watchful waiting. During active surveillance, the patient is monitored closely with regular examinations and tests, to watch for signs of tumor growth or progression. Treatment would begin only if the tumor starts causing symptoms or problems. Surveillance is an option that doctors use based on the tumor type, likelihood of recurrence, and by the results of hormone studies. Hormone studies can sometimes find a recurrence before a tumor is visible on an MRI.
Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is the most common treatment for a pituitary gland tumor. Surgery is often successful in removing the entire tumor. Surgery is performed by a surgical oncologist, which is a doctor who specializes in treating cancer using surgery.
About 95% of surgeries to remove a pituitary gland tumor are done by the transsphenoidal route. That means going through the nasal passage, along the septum that separates the two nostrils, then through the sphenoid sinus cavity located deep above the back of the throat to the pituitary gland immediately behind it. The rest of surgeries are done through an opening in the skull called a craniotomy. This can be done using a microscope or an endoscope, which is a long flexible tube, or both, so the surgeon can see the tumor. Both of these methods are equally safe and effective when done by a skilled surgeon. Talk with your surgeon beforehand to learn about possible side effects based on the type of surgery you will have. Learn more about the basics of surgery for a tumor.
Radiation therapy is the use of high-energy x-rays or other particles to destroy tumor cells. A doctor who specializes in giving radiation therapy to treat a tumor is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen, which is your treatment plan, usually consists of a specific number of treatments given over a set period of time.
For some patients, stereotactic radiation therapy is used when any part of the tumor is left after surgery. This kind of radiation therapy delivers a high dose of radiation directly to the tumor. Not all patients with part of a tumor remaining after surgery need radiation therapy because some noncancerous pituitary gland tumors do not grow back even when some of the tumor is left behind after surgery. If the entire tumor is removed, then radiation therapy is not needed.
Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Depending on where the radiation therapy is directed, it may also cause vision problems and short-term memory or cognitive changes, meaning the thought process is affected. However, the risk of developing vision problems or short-term memory or cognitive changes from radiation treatment is small. This is because advances in external-beam radiation therapy allow doctors to aim the radiation more directly at the pituitary gland, sparing more of the surrounding normal tissue from the effects of radiation. Radiation therapy can cause the pituitary gland to gradually lose the ability to make hormones. If this occurs, hormone replacement therapy may be needed. See below for more information. Talk with your doctor about what to expect based on your specific radiation treatment and how those side effects will be managed by your health care team.
Learn more about the basics of radiation therapy.
Hormone replacement therapy (HRT)
HRT is often necessary for patients with a pituitary tumor when the gland is not making enough of a hormone due to the disease or its treatment. This may include replacement of thyroid stimulating hormone, adrenal hormones, growth hormone, and/or testosterone in men or estrogen in women.
If a pituitary tumor is overproducing a hormone, there are medications that can help. The drugs bromocriptine (Parlodel) and cabergoline (Dostinex) are used to treat tumors that secrete prolactin, and octreotide (Sandostatin), lanreotide (Somatuline) or pegvisomant (Somavert) as well as cabergoline (Dostinex) can be used to treat tumors that make growth hormone. Octreotide and lanreotide can also be used to treat pituitary tumors that secrete thyroid-stimulating hormone. Pasireotide (Signafor) can be used to treat patients with Cushing's disease. Other medications are available to block adrenal gland production of steroid hormones in patients with Cushing's disease after treatment.
The medications used to treat pituitary tumors are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you have been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.
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 is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. 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, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the tumor, such as surgery or radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.
Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and pallitative 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 can be addressed as quickly as possible. Learn more about palliative care.
Aggressive pituitary gland tumor
If a tumor grows quickly in the pituitary gland and spreads into nearby structures, it is called a locally invasive tumor. If it has spread to another location in the body, it is called a metastatic tumor. Both locally invasive and metastatic tumors can be aggressive, growing and spreading quickly, and are more likely to need treatment with radiation therapy than a noncancerous pituitary adenoma. However, many pituitary tumors do not grow quickly even when they are invasive, which is different from most other types of tumors.
Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this type of tumor, because there can be different opinions about the best treatment plan. Learn more about getting 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 and radiation therapy. Palliative care will also be important to help relieve symptoms and side effects.
For most patients, a diagnosis of an aggressive pituitary gland tumor 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.
Remission and the chance of recurrence
A remission is when the tumor cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the tumor returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the tumor does return. Learn more about coping with the fear of recurrence.
If the 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), which is rare. If there is a recurrence, the tumor may need to be staged again (called re-staging) using the system described in the Staging section. Because there is a chance that the tumor may come back, lifelong follow-up is required.
When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatment described above, such as surgery and radiation 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. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
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 a recurrence.
If treatment fails
Recovery from a tumor is not always possible. If the first treatment is not successful, there are other types of treatments to try to destroy or slow down the tumor. Some patients require additional surgical procedures, radiotherapy, and medical management. However, recovery from a pituitary gland tumor is not always possible.
A diagnosis of an advanced tumor 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 an advanced tumor 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 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 loss.
The next section in this guide is About Clinical Trials and it offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.