Islet Cell Cancer

Treatment

Teams of Mayo Clinic physicians diagnose the type and stage of islet cell cancer and collaborate to plan the most effective treatment for each patient. The treatment plan may include surgery, chemotherapy, radiation therapy, hormone therapy, hepatic arterial embolization, and/or radiofrequency ablation. Depending on the stage of the cancer, the team may perform treatments in combination or one after another. In select situations, the treatment team may consider liver transplantation.

Treatment options for patients with islet cell cancer depend upon:

• The size of tumor and whether it has spread outside the pancreas to nearby tissues or lymph nodes or to other parts of the body
• Whether the tumor can be removed by surgery
• The patient's general health
• Whether the cancer has recurred or is newly diagnosed
• The type of tumor and any symptoms related to excessive hormone production

Surgery

When the cancer has not spread beyond the pancreas to other organs, the treatment team generally performs surgery. Surgery may be considered solely to alleviate symptoms and prolong life. This is most commonly considered for patients with liver involvement when more than 90 percent of the cancer can be removed. For other patients, surgery may involve:

• Distal pancreatectomy, in which the tail of the pancreas is removed and the main portion of the organ is left intact. This procedure eliminates the need for surgical reconstruction. Lymph nodes in the area may also be removed for examination under a microscope to determine if they contain cancer.
• Pancreatoduodenectomy, which involves removing the cancer and part or most of the pancreas. This may also require removing some intestinal tissue. Sometimes the stomach is removed (gastrectomy) because of ulcers. Lymph nodes in the area may also be removed for examination under a microscope to determine if they contain cancer.

Liver transplantation may be considered for patients in excellent health whose cancerous areas are limited to the liver. Liver transplantation is appropriate for only a minority of patients with islet cell cancer.

Chemotherapy

Chemotherapy involves the use of medication to kill cancer cells. Patients may take the drug orally or have it injected through a vein into the bloodstream. Chemotherapy is a systemic treatment; the drug travels through the bloodstream and can kill cancer cells throughout the body. The treatment team may recommend chemotherapy when islet cell cancer has spread to other parts of the body. It can be combined with other therapies and is usually recommended for patients who receive radiation therapy.

Radiation Therapy

Radiation therapy is usually recommended for patients with localized pancreatic cancers that cannot be surgically removed. High-dose radiation is directed toward the pancreas to destroy cancer cells and reduce a tumor's size. Radiation is generally delivered from a source outside of the body, but it is sometimes delivered during surgery. Mayo Clinic radiation oncologists have developed techniques that protect important organs such as the kidneys and liver from radiation.

Radioembolization

Radioembolization is another treatment option for some patients with islet cell cancer. Specialists inject radioactive glass microbeads through branches of the hepatic artery, the major artery supplying blood to the liver. The microscopic beads lodge in small blood capillaries in the cancer and deliver radiation internally. Because the beads do not completely block the hepatic artery, patients can still subsequently be treated with chemoembolization, if necessary. Radioembolization is available in Jacksonville and Rochester.

Hormone Therapy

Hormone therapy involves the use of hormone-related medications to stop cancer cells from growing or to relieve symptoms caused by excessive hormone production. Octreotide is most commonly used for this purpose. Scientists are continuing to investigate the benefits of other types of hormones.

Hepatic Arterial Occlusion

Hepatic arterial occlusion or embolization works by using agents to reduce or block the blood flow to the liver to kill islet cell tumors there. Specialists sometimes combine this treatment in combination with chemotherapy.

Radiofrequency Ablation

Radiofrequency ablation involves the use of radiofrequency energy to treat islet cell tumors with heat. Using ultrasound or computed axial tomography scans, a radiologist guides a probe through the skin and directly into the tumor. The probe is connected to equipment that delivers radio waves to heat the tissue around the tip of the probe. This heat kills the cells in a small area around the probe tip. The killed islet cell tumors are not removed, but are gradually replaced by fibrosis and scar tissue. When appropriate, radiofrequency ablation can also be performed during surgery.