Pancreatic Neuroendocrine Tumors

Timothy B. Gardner, MD
Director, Pancreatic Disorders
Dartmouth-Hitchcock Medical Center
Assistant Professor of Medicine
Dartmouth Medical School
 

With the death of former Apple, Inc CEO Steve Jobs, who had a pancreatic neuroendocrine tumor and a liver transplant, this type of pancreatic cancer has received a great deal of attention. The NPF felt it was important to highlight this type of tumor and explain the differences between neuroendocrine tumors and the more common pancreatic adenocarcinoma.

What Are Pancreatic Neuroendocrine Tumors

Pancreatic neuroendocrine tumors are less common than the more familiar pancreatic adenocarcinoma, comprising about 5% of pancreas tumors. Pancreatic neuroendocrine tumors arise from cells in the pancreas called islet cells. Islet cells are that part of the pancreas which makes chemicals called hormones that are released into the bloodstream and regulate certain body functions.

Pancreatic adenocarcinoma, which causes over 90% of pancreatic cancers, arise from the cells which line the cells of the drainage tubes of the pancreas – the ductal cells. As a result, pancreatic neuroendocrine tumors and pancreatic adenocarcinoma behave in very different ways.

In general, pancreatic neuroendocrine tumors grow at a much, much slower rate than pancreatic adenocarcinoma. While each type of tumor can spread (metastasize) from the pancreas to other organs, pancreatic neuroendocrine tumors usually spread over a period of years. Pancreatic adenocarcinoma, on the other hand, typically spreads over a period of months.

Treatment

The cure for both types of tumors is surgery. If the tumor cannot be removed, chemotherapy is often given to try and prevent the tumor from growing further. The type of chemotherapy is different for each type of tumor.

In very rare situations, liver transplants are performed in patients who have neuroendocrine tumors which have spread to the liver. The rationale behind this is that because neuroendrocine tumors are so slow growing, removing the entire tumor in the liver with a transplant allows for several more years of life. Again, because pancreatic adenocaricnoma is faster moving, liver transplants are not offered in this disease when it has spread to the liver.

In Summary

While both pancreatic neuroendocrine tumors and adenocarcinoma arise from the pancreas, they are vastly different in terms of prognosis. Adenocarcinomas are unfortunately much more common than neuroendocrine tumors, and typically have a worse overall prognosis.