Treatment for insulinomas

Benign tumours (with no spread beyond the pancreas) - Complete surgical removal of the insulinoma from the pancreas can provide a cure. Most patients have single tumours that can be totally removed - 'enucleated' - without even the need to cut away any part of the healthy pancreas. Often this can be performed via keyhole surgery.

During surgery the specialist may perform an intraoperative ultrasound to ensure there are no other small tumours close by or any affected lymph nodes.

Malignant tumours - There are treatment options if you have a malignant tumour that can lead to an improved quality of life and good control of symptoms.

• Surgical - Surgery may still be considered. It may be possible to resect (surgically remove) part of the pancreas containing the tumour and also surgically remove any tumour which may have spread to the liver, which tends to be the main secondary site site for these tumours.
  
• Medical management - If surgery is not possible you may be prescribed a tablet called diazoxide that can help to elevate and control blood sugar levels.

Other treatments

Yttrium therapy - Or 'magic bullet' treatment is one of the radionuclide therapies and has very good results with insulinomas. This is a new therapy that involves 'piggy backing' a radio active therapy to a chemical that attaches itself to the tumour. The therapeutic agent then works to break down and destroy the tumour. You will be admitted to hospital for this treatment but usually only need to stay overnight. You remain in a lead lined room for 12-24 hours after the therapy is administered - often through a cannula inserted into a vein in the arm - and have a scan the following day so the consultant can see if the active agent has been taken up correctly. You may feel tired in the 1-5 weeks after treatment and will need regular blood tests to check kidney function and the health of your bone marrow. This treatment is currently only available at a small number of centres.

Chemotherapy - Can be helpful for highly aggressive tumours that do not respond to other measures. Your consultant will advise you. The combination usually used is 5-fluorouracil plus cisplatin and streptozotocin.

Chemo-embolisation - Involves targeting a dose of chemotherapy directly into the liver via the femoral artery together with cutting the blood supply to the tumour lesions, in an attempt to reduce the size of the secondary tumours in the liver.

What about octreotide injections? - Some NET patients are helped with regular injections of octreotide or lanreotide. But in the case of people with insulinomas this injection can make symptoms worse by decreasing blood sugar further. You will need to seek specialist advice from a NET consultant to find out whether this treatment would be suitable for you.