20 February, 2025

Pancreatic Neuroendocrine Tumor: What it is, symptoms, treatment and life expectancy

A relatively common consultation is the incidental discovery of a tumor in the pancreas during an imaging test. Upon receiving this diagnosis, the first thing the patient thinks of is pancreatic cancer, but it is classified by the radiologist as a neuroendocrine tumor of the pancreas. What is it? Is it malignant? Do we need to do something?

Origin of the Neuroendocrine Tumor of the Pancreas

The neuroendocrine tumor of the pancreas (TNEp) is part of a group of tumors whose origin is different from pancreatic cancer. The pancreas contains different types of cells, but we can broadly divide them into cells responsible for secreting digestive enzymes and cells responsible for producing various hormones, including insulin and glucagon, which regulate blood sugar levels. When a tumor forms from the first group of cells, it is generally known as pancreatic cancer, and when a tumor forms from the second type of cells, we talk about a neuroendocrine tumor of the pancreas. Therefore, the origin of each type of tumor is very different, and so are the implications.

Types of Neuroendocrine Tumor of the Pancreas

Since the origin of the TNEp is cells capable of producing hormones, there is a possibility that these types of tumors do the same, i.e., produce hormones. However, in most cases, they either do not produce hormones or produce them in small amounts and do not cause any clinical symptoms in the patient. Nevertheless, certain types of neuroendocrine tumor of the pancreas are associated with a secondary clinical condition due to excessive hormone production. The former are called non-functioning TNEps, while the latter are functioning TNEps.

Are They Malignant or Benign Tumors?

When asked whether they are malignant or benign lesions, TNEps cover a spectrum ranging from completely benign lesions that do not require any intervention to extremely aggressive lesions with biological behavior similar to that of a pancreatic tumor. It is essential that the specialist in pancreatic pathology requests the necessary tests to clarify the type of tumor and consequently provide the best treatment.

Benign neuroendocrine tumors of the pancreas, although less common, also exist. These benign pancreatic tumors are not prone to rapid growth or metastasis and can develop from hormone-producing structures, vascular tissue, or nerve tissue. Examples of benign pancreatic tumors include insulinoma, glucagonoma, and serous cystadenoma.

“Most of these tumors will ultimately not require any treatment, just follow-up.”

Dr. Fabio Ausania

When Should a TNEp Be Operated On?

As a general rule, it is necessary to surgically intervene in patients with functioning neuroendocrine tumors of the pancreas. Functioning TNEps produce symptoms that sometimes have a very noticeable impact on quality of life and because –except for insulinoma– they are usually malignant lesions. In the case of non-functioning TNEps, there is a general consensus that it is necessary to remove lesions larger than 2 cm in diameter, as these are lesions with a higher capacity to present metastasis in the lymph nodes. And of course, it is essential that these interventions are carried out in a center with experience in treating these lesions.

“There are others where it is important to have an aggressive approach from a surgical point of view, sometimes even at the level of chemotherapy.”

Dr. Fabio Ausania

Life Expectancy of Neuroendocrine Tumor of the Pancreas

The life expectancy of patients with neuroendocrine tumors of the pancreas varies considerably depending on several factors. In general, neuroendocrine tumors have a higher life expectancy compared to exocrine pancreatic tumors due to their slower growth and lower metastatic potential. The 5-year survival rate can exceed 90% in localized cases, but it decreases significantly if there are liver metastases, with 5-year survival rates around 20-30%. Other factors affecting life expectancy include the patient’s age, overall health, response to treatment, and tumor grade.