What are Non-Functioning Pancreatic NETs?

Specialized neuroendocrine cells of the pancreas give rise to non-functioning pancreatic neuroendocrine tumors (NETs). Functional neuroendocrine tumors, such as insulinomas, gastrinomas, and somatostatinoma, exhibit signs of excessive hormone production. In contrast, non-functioning NETs don’t exhibit any signs of hormone overproduction.

Small amounts of hormones such as pancreatic polypeptide, calcitonin, or neurotensin are produced by non-functioning pancreatic NETs, however, these hormones do not cause any symptoms. There are warning signs and symptoms of non-functioning pancreatic NETs. These result from the tumor’s size or from its spread to nearby organs like the liver or lymph nodes. In some cases, radiological exams for other illnesses lead to the discovery of tumors by accident.

Causes of Non-Functioning Pancreatic NETs

 It is unknown what precisely set off their unchecked division. Specialized pancreatic neuroendocrine cells multiply and divide uncontrollably, which results in non-functioning pancreatic NETs. Most of these tumors develop spontaneously, however in around 1 in 10 individuals, a non-functioning pancreatic NET may be linked to a genetic disorder such as von Hippel-Lindau disease or multiple endocrine neoplasia type 1 syndrome.

Signs and Symptoms of Non-Functioning Pancreatic NETs

Depending on how big they are or if they have migrated to nearby organs, non-functioning pancreatic NETs have different indications and symptoms. Some of them are given below:

• Abdominal discomfort,
• A lump in the abdomen
• Nausea
• Weight loss
• Jaundice

These tumors are typically not discovered until a late stage since they are not linked to hormone overproduction. These tumors often have huge sizes (average 3–4 cm). At the time of diagnosis, there is evidence of metastasis to neighboring organs such as the liver or bone in up to 80% of individuals with non-functioning pancreatic NETs.

Diagnosis For Non-Functioning Pancreatic NETs

In a patient who is thought to have non-functioning pancreatic NETs, radiological tests like computerized tomography (CT) or magnetic resonance imaging (MRI) scans are first performed to measure the tumor’s size and check for any potential liver or lymph node metastases.

There are also other, more specialized scans that can be done such as:

Blood Test: In order to rule out a functional pancreatic NET, blood tests are also performed to look for excessive production of hormones like insulin, glucagon, somatostatin, or vasoactive intestinal peptide. Chromogranin A or pancreatic polypeptide levels can be measured to help with the diagnosis. The majority of these studies may be done without an inpatient setting.

Somatostatin Receptor Scintigraphy or an Octreotide Scan: To determine the severity and spread of the condition and the tumor’s receptivity to medical treatment, somatostatin receptor scintigraphy or an octreotide scan may be used. A chemical called octreotide will be administered intravenously during this kind of scan. The scan will be able to determine the location of the cells that may commonly bind octreotide in a neuroendocrine tumor.

Positron emission tomography (PET-CT): Another scan that functions similarly to the Octreoscan is positron emission tomography-CT (PET-CT), in which a substance called Gallium-68 labeled somatostatin analogue is injected into the patient’s body. The substance is injected, and the neuroendocrine tumor cells bind to it. Then, it may be used to pinpoint the location of non-functioning pancreatic NETs and gauge how far they have dispersed throughout the body.

Only a tissue sample from a patient who is suspected of having non-functioning pancreatic NETs can be obtained (via biopsy or post-surgery) and examined under a microscope in order to confirm the diagnosis.

Treatments For Non-Functioning Pancreatic NETs

Rare tumors known as neuroendocrine tumors (NETs) of the pancreas do not produce hormones. or create hormones that don’t produce a particular set of symptoms (a syndrome).Your medical care will rely on a variety of factors. Your course of therapy is determined by: your overall health, the location, and size of the tumor, if it has spread, and whether you have the uncommon genetic disease known as multiple endocrine neoplasias 1. (MEN1)

Surgery – For pancreatic NETs that are not functional, surgery is typically the major therapy. Even if cancer cannot be entirely removed, your doctor may still advise surgery. The symptoms of NET can be managed and controlled for a while by removing as much cancer as feasible. Depending on where the tumor lies, numerous sorts of operations are available. There are hazards involved with several of these huge activities. However, if the goal is to manage the malignancy, you might feel that certain risks are worth it. Discuss the advantages and disadvantages of your procedure with your doctor. Typically, you undergo open surgery. To remove the tumor, the surgeon must make a significant incision in your belly. Additionally, the adjacent lymph nodes could be removed.

Somatostatin analogues – Somatostatin is a protein that the body naturally produces. It slows down the synthesis of hormones among other things. Somatostatin analogues are synthetic forms of the hormone somatostatin. Somatostatin analogues may be prescribed to you to treat your symptoms and reduce the growth of the tumor. The most often-used medications are: Octreotide, Lanreotide, and Sandostatin (Somatuline)

Chemotherapy – Chemotherapy utilizes cytotoxic (anti-cancer) medicines to kill tumor cells. If the NET has spread to your liver or other organs, you could need chemotherapy. The most often used chemotherapeutic medications are: Capecitabine, doxorubicin, temozolomide fluorouracil, or streptozotocin

Targeted Therapy – Cancer cells vary from healthy cells in that they contain mutations to their genes (DNA). They behave differently as a result of these modifications. Drugs that are “targeted” kill cancer cells by ‘targeting’ their unique characteristics.

Other Treatments – If cancer has gone to the liver, you could need further therapies. This comprises:

• Transarterial Embolization or Trans Arterial Embolization (TAE)
• Chemoembolisation (TACE) 
• Radiofrequency ablation (RFA)
• A procedure known as PRRT for internal radiation.

Bottom Line: Patients have a fair chance of survival and should go on to have active, fulfilling lives in cases of non-functioning pancreatic NETs that can be surgically removed and in which there is no sign of bone or liver metastasis. In order to monitor for tumor recurrence via blood tests or radiological studies, patients who have had surgery must regularly visit the hospital.