Cancer Health Center

STANDARD TREATMENT OPTIONS:

For watery diarrhea, hypokalemia, achlorhydria (WDHA) syndrome, somatostatinoma, and pancreatic polypeptide:

1. Single lesion in head of pancreas or single lesion less than 1.0 cm in tail of pancreas:
   • Enucleation, if feasible.
2. Single lesion in body/tail greater than 1.0 cm:
   • Distal pancreatectomy.
3. Multiple lesions:
   • Resect body and tail.
4. Metastatic disease-lymph nodes or distant sites:
   • Resect when possible. Consider radiofrequency or cryosurgical ablation if not resectable.
5. Unresectable disease:
   • Combination chemotherapy: doxorubicin + streptozocin or fluorouracil + streptozocin in patients for whom doxorubicin is contraindicated.[1]
   • Somatostatin analogue therapy (SMS 201-995) for WDHA syndrome and pancreatic polypeptide.[2] Necrotizing erythema of glucagonoma is relieved in 24 hours with somatostatin analogue, with nearly complete disappearance within 1 week.

Patients with hepatic-dominant disease and substantial symptoms caused by tumor bulk or hormone-release syndromes may benefit from procedures that reduce hepatic arterial blood flow to metastases (hepatic arterial occlusion with embolization or with chemoembolization). Such treatment may also be combined with systemic chemotherapy in selected patients.[3]

References:

1. Moertel CG, Lefkopoulo M, Lipsitz S, et al.: Streptozocin-doxorubicin, streptozocin-fluorouracil or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med 326 (8): 519-23, 1992.
2. Kvols LK, Buck M, Moertel CG, et al.: Treatment of metastatic islet cell carcinoma with a somatostatin analogue (SMS 201-995). Ann Intern Med 107 (2): 162-8, 1987.
3. Moertel CG, Johnson CM, McKusick MA, et al.: The management of patients with advanced carcinoid tumors and islet cell carcinomas. Ann Intern Med 120 (4): 302-9, 1994.