Treatment for gastrinoma
The treatment you have for gastrinoma depends on a number of things such as where the tumour is, its size and whether it has spread (the stage).
Surgery is the main treatment for gastrinoma and it’s usually the only treatment that can cure it. But surgery isn’t always possible. Some gastrinomas may have already started to spread when they are diagnosed. You might have treatment to control your symptoms if you can’t have surgery to try to cure your gastrinoma.
Deciding which treatment you need
A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).
The treatment you have depends on:
- where the gastrinoma is and its size
- whether you have 1 or more tumours
- whether the gastrinoma has spread to other parts of the body
- your general health
- whether you have an inherited syndrome called multiple endocrine neoplasia 1 (MEN1)
You are likely to have a clinical nurse specialist (or CNS). They go to the MDT meetings. They can help answer your questions and support you. They are often your main point of contact throughout your treatment.
Surgery
Surgery is the main treatment for gastrinoma. The type of surgery you have depends on whether the gastrinoma started in the small bowel (duodenum) or the pancreas.
You usually have open surgery. This means having a large cut in your tummy (abdomen). You also have an ultrasound scan during your operation to check for other tumours. Your surgeon might also remove the nearby lymph nodes.
You might have an operation called a duodenectomy. Your surgeon makes a cut (incision) in your tummy to open the small bowel and remove the tumour.
You usually have an operation to remove just the tumour. This is called a tumour enucleation. You have this if the gastrinoma is in the widest part of the pancreas (the head).
If your cancer is near the pancreatic duct, you have an operation to remove:
- the widest part of the pancreas (head), the duodenum, gallbladder and part of the bile duct (pylorus preserving pancreaticoduodenectomy or PPPD for short)
- the narrowest part of the pancreas (tail) and the body of the pancreas called distal pancreatectomy
For certain people, doctors may suggest an operation called Whipple’s procedure. This is the same as a PPPD, but the surgeon also removes part of your stomach. You may have a Whipple’s operation if you have large tumours that can’t be removed by tumour enucleation.
If the gastrinoma has spread to the liver, you might be able to have the liver tumour removed at the same time you have the main surgery. Your surgeon may remove just the tumour, or part of the liver too.
Remember to click back to return to the NET section. The rest of the information in the pancreatic section will not apply to you.
Drugs to control the amount of stomach acid
Gastrinomas make large amounts of the hormone gastrin, which increases the amount of acid in your stomach. So you usually have treatment to stop your stomach from making too much acid.
The main treatment to stop you from making too much acid are drugs called proton pump inhibitors (PPIs). You usually have 1 of the following drugs:
- omeprazole
- lansoprazole
- pantoprazole
- esomeprazole
Treatment for advanced gastrinomas
Gastrinomas can spread to other parts of the body or can come back after surgery. This is advanced cancer. One of the most common places where gastrinoma can spread to is the liver.
For advanced gastrinomas, you might have:
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy tumour cells. You may have chemotherapy if the NET has spread to the liver or to other parts of your body.
The most common chemotherapy drugs used are:
- streptozotocin or temozolomide
- fluorouracil or capecitabine
- doxorubicin
Somatostatin is a protein made naturally in the body. It does several things including slowing down the production of hormones. Somatostatin analogues are man made versions of somatostatin.
You may have somatostatin analogues to try to slow down the tumour and help with symptoms. The most common drugs used are:
- octreotide (Sandostatin)
- lanreotide (Somatuline)
Radiofrequency ablation (RFA) uses heat made by radio waves to kill tumour cells. You might have this if the NET has spread to the liver.
You might have this treatment if the NET has spread to the liver.
Trans arterial embolisation (TAE) means having a substance such as a gel or tiny beads to block the blood supply to the liver NET. It is also called hepatic artery embolisation.
You may also have a chemotherapy drug to the liver at the same time. This is called trans arterial chemoembolisation (TACE). But doctors don't know for sure whether adding chemotherapy is better than having embolisation alone for NETs that have spread to the liver.
Embolisation and chemoembolisation work in two ways:
- it reduces the blood supply to the tumour and so starves it of oxygen and the nutrients it needs to grow
- it gives high doses of chemotherapy to the tumour without affecting the rest of the body
Cancer cells have changes in their genes (DNA) that make them different from normal cells. These changes mean that they behave differently. Targeted drugs work by ‘targeting’ the differences that a cancer cell has and destroying them.
You may have 2 types of targeted drugs called everolimus and sunitinib.
Interferon is also called interferon alfa. You may have it if the gastrinoma has spread to other parts of the body. And other treatments have stopped working.
You may have interferon alone or together with somatostatin analogues.
You may have a type of internal radiotherapy called peptide receptor radionuclide therapy (PRRT). Internal radiotherapy means having radiotherapy from inside the body (as a drip into your bloodstream).
PRRT uses a radioactive substance called lutetium-177 or yttrium-90 attached to a somatostatin analogue.
You may have PRRT if:
- your NET has spread to other parts of the body
- you can’t have surgery
- your NET has receptors on the outside of them called somatostatin receptors (you have special scans called octreotide or gallium PET scans to check for this)
You may have a liver transplant if the NET has only spread to the liver and you’re fit and healthy. But a liver transplant might not be possible even if your doctor thinks you can have it. This is because you need a donor liver that is a close match to yours.
A liver transplant is a major operation and it has many risks. It is rarely used as a treatment for NETs.
Clinical trials
Doctors are always trying to improve treatments and reduce the side effects. As part of your treatment, your doctor might ask you to take part in a clinical trial. This might be to test a new treatment or to look at different combinations of existing treatments.
