Pancreatic endocrine tumours are rare tumours that arise from the hormone-producing cells of the pancreas. They can be either benign (non-cancerous) or malignant (cancerous), and may be functional (actively secreting hormones) or non-functional (do not secrete hormones). Non-functional tumours are more common, while functional tumours tend to be associated with certain genetic syndromes.
Many tumours are non-functional, and are therefore asymptomatic. They may be discovered on imaging performed for other unrelated reasons.
Functional tumours may produce symptoms related to the hormones secreted. They may cause gastric or intestinal ulcers, result in low or high blood sugar levels, or produce flushing and diarrhoea. However, most patients who have these symptoms do NOT have a pancreatic endocrine tumour.
In addition, advanced tumours that are large may produce symptoms such as blockage of the bile duct (jaundice) or intestine (obstruction). These tumours are more likely to be malignant, and should be removed.
These tumours often have a characteristic appearance on imaging. In cases where there is doubt, a biopsy is generally performed to confirm the diagnosis. Occasionally, functioning tumours can be very small despite causing significant symptoms, and specialised imaging techniques may be required to accurately pinpoint their location in order to allow treatment.
In localised endocrine tumours, treatment involves resection. This may involve a Whipples operation for tumours in the head of the pancreas, or a distal pancreatectomy (with or without splenectomy) for tumours in the body and/or tail.
Occasionally, in small, asymptomatic tumours, close observation may be considered. However, before choosing this option, it is important to establish the diagnosis definitively, and ensure that the tumour has non-aggressive features.
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