Neuroendocrine pancreatic tumors: contemporary principles of diagnostics and treatment tactics

Abstract

Noted, that a significant part of the neuroendocrine pancreatic tumors are nonfunctioning, id est. not secreting into blood a variety of gastrointestinal hormones and polypeptides and as a result, not accompanied by typical clinical manifestations. In some cases, with nonfunctioning tumors it occurs randomly and is in fact appears to be incidentaloma. Unfortunately, the scan search often starts in the detection of distant metastases of neuroendocrine tumors and development of cancer cachexia. It is shown that in recent years some authors have noted a positive shift – in the first year from the onset of the disease, the cause of the disease cannot be defined in 45–55% of cases. Diagnostics of neuroendocrine tumors of the pancreas is a highly complex task, the solution of which depends on the choice of treatment and its remote results. Currently, the only radical method of treatment of hormonally functioning tumors of the pancreas is a surgical method. It is shown that symptomatic therapy can be only considered as a stage of preoperative preparation of a patient. The indication for surgical treatment in this situation, along with the ineffectiveness of conservative treatment is the size of detectable formations of 2 cm or more, which is a risk factor of distant metastases. According to modern views, patients with nonfunctioning neuroendocrine tumors of the pancreas are subjects for surgical treatment. Given that in 70–92% of cases they are malignant, most often distal or extensive pancreatoduodenal resection used. Currently, it is noted that the large size of the tumors are not a contraindication to surgery and if the tumor dormant and up to 1 cm size, then a short-term observation is possible. Any tumors found in the pancreas, need to be enucleated or, – if possible – widely excised. There are analyzed the rational and integrated use of modern arsenal of surgical and therapeutic methods, which significantly prolong life, improvement of its quality in patients with metastatic forms of neuroendocrine tumors of the pancreas.

Keywords

pancreas / neuroendocrine tumor / gastrointestinal tract / insulinoma / gastrinoma / Vipoma / clinical picture / diagnosis / differentiation / surgical treatment / conservative methods of treatment

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