Neuroendocrine tumours

The incidence of neuroendocrine tumours has been reported to have increased 5-fold over the past 30 years. Enteropancreatic neuroendocrine tumours can produce hormonal syndromes attributed to abnormal hormonal production as well as local symptoms including bleeding, obstruction and pain in similarity to other cancer. Diagnosis relies on high index of suspicion and special investigations including measurement of tumour marker such as chromogranin A, endoscopic ultrasound imaging and octreotide scintigraphy.

Pancreatic neuroendocrine tumours

Insulinoma is the most common pancreatic endocrine disease. Localization studies including a CT scan, MRI and endoscopic ultrasound are employed preoperatively. Intra-arterial calcium injections with hepatic venous sampling is performed by radiologists to regionalize tumours that have failed to be located by conventional imaging. For patients with negative localization, a combination of intraoperative localization by palpation and intraoperative ultrasound has achieved high surgical success. Minimally invasive or laparoscopic pancreatectomy has been shown to be safe and feasible for selected tumours.

Other nonfunctioning pancreatic neuroendocrine tumours have variable malignant potential. Surgical treatment is potentially curative before the occurrence of distant metastases. Spread to the liver is common and in the presence of distant metastases, surgical resection, radiofrequency ablation and chemoembolization of hepatic artery can provide effective palliation of hormonal symptoms with potential in improving survival.