Editing Pancreatic neuroendocrine tumours (section)

== '''Specific situations''' ==

* Patient presents with symptoms
** Functional testing and localise the tumour
** Surgical resection
** Approach and extent dictated by tumour type and patient factors
** Mostly perform partial pancreatic resection with lymph node sampling
* Patient presents with lesions found incidentally
** Work up with imaging - local and systemic staging with CT CAP, DOTATATE PET, consider EUS +/- FNA
** If <2cm and G1, observation may be an option - repeat CT/MRI at 6-12 months with surgery if increase in size by 0.5cm or more
** If >2cm or G2 or G3, generally recommend resection in a good operative candidate
* Liver mets
** Liver resection - either curative or palliative
** Resection recommended if >90% of disease can be removed
** 80% recurrence at 5 years, but 85% 5-year survival
** Factors with better prognosis: 
*** G1 or G2 tumours
*** Absence of distant lymph node metastases
*** Absence of extrahepatic or peritoneal metastases
** Palliative: can do HAE/chemoembolisation/RFA, but outcomes appear to be worse, not curative
** Liver transplant has been proposed under certain circumstances (unresectable neuroendocrine metastases) but this is controversial, and not done in Australia
** Debulking is reasonable if >90% of tumour can be removed
* Metastatic PNETs in general
** Somatostatin analogues - effective in controlling both hormone secretion and stabilising tumour growth
*** Can provoke cholelithiasis - if possible, cholecystectomy at initial operation
** Knowing the type of somatostatin receptor expressed by the tumour can help guide therapy - there are 5 different types
** Cytotoxic chemotherapy is also an option, especially for poorly-differentiated PNETs