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home - Pancreas - Pancreatic Cancers - Islet Cell Tumours Written by Dr Sebastian Zeki
Knowledge


Knows the presentation investigation and staging of pancreatic
cancer

Recognises the importance of considering and being able to identify
uncommon pancreatic tumours (such as neuroendocrine or
intrapapillary mucinous tuours)

Knows the range of potential therapies and recognises the factors
that make such tumours potentially operable or inoperable

Knows the prevalence and natural history of benign cysts/serous
cystadenoma and potentially malignant cystic lesions

Knows the options for palliative treatment
Skills
Shows ability to sequence investigations appropriately
Understands value of multi-disciplinary team
Recognises the importance of considering possibility that the tumour
is unusual

Behaviours
Communicates effectively within the multi-disciplinary team and with
the patient and their family

Islet Cell Tumours

Localization of pancreatic endocrine tumors (islet-cell tumors) EUS>(CT and USS = Ocreotide scan) Treatment of Islet cell tumoursOctreotide and lanreotide — Controls diarrhoea.Interferon alfa (IFNa)-improves symptoms of hormonal hypersecretion in 50 % of patients with pancreatic islet cell tumors.Induces tumor stabilization in 30%, and Tumor regression in 15%.Refractory patients - combined therapy with a glucocorticoid plus octreotide. Somatostatin-receptor scintigraphy (Octreoscan)Pancreatic endocrine tumours can have high concentration of somatostatin receptors. Computed tomographyPoor sensitivity esp if tumour <2cm.Cant be seen on non-enhanced CT.Iv contrast CT -primary pancreatic endocrine tumors appear as rounded, enhanc-ing lesions because of their vascularity. Magnetic resonance imagingLow signal intensity on T1-weighted images and high intensity on T2-weighted images. Endoscopic ultrasonographyThe minimum lesion size detectable by EUS is 2-3mm.EUS detected endocrine tumors in the pancreas with high sensitivity (82 %) and specificity (95 %).EUS is better than CT and USS.EUS has a poor sensitivity for tumours <6mm and can’t visualise pancreatic tail.Sensitivity of 96 % Angiography and arterial stimulation venous samplingWell circumscribed blush 4-6s post contrast injection.Sensitivity for primary lesion is 50%.. Intraoperative localization techniquesIntraop USS with palpation- sensitivity up to 100%. Functional PET imaging techniquesTwo PET radiotracers (18-F-dihydroxy-phenyl-alanine and 11-C-5-hydroxytryptophan ). Localisation of metsOctreotide scan sensitivity for lesions metastatic to the liver was 92%, significantly higher than the other studies except MRI.Non-enhanced scan hepatic metastases appear as hypodense lesions and pancreatic endocrine tumours cant be seen and with iv contrast they become isodense with the liver and therefore invisible.Sensitivity much improved with STIR MRI esp for metastatic lesions.Angiography sensitivity for mets =65%.MRI appears to have even greater sensitivity for detection of liver metastases compared with planar or SPECT somatostatin receptor scintigraphy. Chemotherapy and novel treatment approaches-Streptozocin and doxorubicin.Radiologic response rate is probably between 10 and 40 %.Not first line as nasty side effects.-Alternative is alkylating agent temozolomide. Liver-directed therapy for metastatic disease Surgery —Usually palliates symptoms rather than cures.Hepatic artery embolization — Palliative.Symptomatic response rates>50%.RFA and cryoablation.Liver transplantation —Usually an investigational approach for metastatic islet cell tumors, including insulinoma. Written by Dr Sebastian Zeki

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