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Pancreatic Cancer · Neuroendocrine Tumours (PNET) · Reviewed by CION Oncologists
PNET treatment — how pancreatic neuroendocrine tumours are actually treated
A pancreatic neuroendocrine tumour is not pancreatic cancer as most people mean it, and it is not treated the same way. This page sets out what decides your plan, every main treatment option and what each one is for — and which parts CION delivers in-house versus coordinates with specialist partner centres.
- It is a different disease from adenocarcinoma — different cells, a separate guideline, and generally a better outlook.
- Grade drives almost everything — how fast the cells divide decides the sequence of treatment more than anything else.
- Systemic treatment is in-house — somatostatin-analogue-class, targeted tablets and chemotherapy are delivered by CION.
- Surgery and PRRT are coordinated — partner HPB and nuclear-medicine centres deliver those, and may bill you directly.
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PNET Treatment Follows a Different Rulebook
If you have already searched for pancreatic cancer and found the results frightening, read this before you read anything else. A pancreatic neuroendocrine tumour is not the same disease as pancreatic ductal adenocarcinoma. It starts in different cells, it usually behaves differently, and it is treated on a separate pathway with a separate set of decisions — and the outlook is generally considerably better. What you found online about pancreatic cancer very probably does not describe your situation. Pancreatic neuroendocrine tumours (PNET) explained covers what the tumour itself is; this page covers what happens next.
PNET treatment is built around three questions, asked in this order. How fast is the tumour growing — its grade, judged by the pathologist from how many cells are actively dividing. Is it making a hormone that is causing symptoms, or is it silent. And how far has it spread — confined to the pancreas, involving nearby nodes, or present in the liver. Every option below is chosen from the answers to those three, not from a fixed protocol.
The other thing worth saying plainly at the outset: for most people with a well-differentiated PNET, this is not a same-week emergency. There is usually time to get the pathology right, to complete the scans properly, and to take the case to a tumour board before anything irreversible is decided. The exception is a high-grade, fast-moving tumour, where treatment starts quickly. Your team should tell you clearly which of those two situations you are in, and why.
Did you know? The World Health Organization classification separates pancreatic neuroendocrine neoplasms into well-differentiated neuroendocrine tumours, graded 1, 2 or 3 by how actively the cells are dividing, and poorly differentiated neuroendocrine carcinoma, which is a genuinely different disease with a different treatment pathway. NCCN keeps neuroendocrine tumours of the pancreas in a separate guideline from pancreatic adenocarcinoma altogether. That one distinction is the reason a PNET plan should never be read against what you find online about pancreatic cancer — the two are not being treated by the same rules, and were never meant to be compared.
Before any treatment is chosen
What Actually Decides Your Treatment Plan
These are the findings a neuroendocrine tumour is judged on. If your reports do not mention them, that is the first thing to ask about.
Grade
How fast the cells are dividing
A well-differentiated tumour is graded 1, 2 or 3 by the pathologist. A poorly differentiated neuroendocrine carcinoma is a separate category. Grade drives almost every downstream decision.
Hormone activity
Functioning or non-functioning
A functioning tumour releases a hormone that causes symptoms - low blood sugar, ulcers, flushing or diarrhoea. Controlling that syndrome is treated as urgently as the tumour itself.
Spread
Confined, nodal, or in the liver
Whether the tumour sits only in the pancreas, involves nearby lymph nodes, or has reached the liver changes the whole shape of the plan — and whether an operation is on the table.
Receptor imaging
Whether the tumour lights up
DOTATATE PET shows whether the tumour carries somatostatin receptors. If it does, receptor-directed treatments become available. This scan is coordinated with partner nuclear-medicine centres.
Symptom burden
What the tumour is doing to you now
Pain, jaundice, weight loss or a hormone syndrome can move treatment up the queue even when the imaging looks unhurried. What you feel is part of the evidence, not separate from it.
You
Fitness, other illnesses, and your priorities
A slow tumour treated over years has to fit a life. Age, kidney and liver function, other conditions and what you actually want from treatment all belong in the decision.
The options, plainly
Every Main Treatment, What It Is For, and Where It Happens
A pancreatic neuroendocrine tumour is looked after by more than one team. This is the honest split, so you know who to call and where each part of the bill sits.
| Treatment | What it is for | Where it happens |
|---|---|---|
| Active monitoring | A small, low-grade, non-functioning tumour found by chance on a scan done for something else. Watched on a defined imaging schedule rather than treated straight away. | Ordered, reported and reviewed in-house at CION |
| Surgery — enucleation, distal pancreatectomy or a Whipple | The only route that offers a cure for a tumour still confined to the pancreas, and sometimes worthwhile even when disease has spread, to control a hormone syndrome. | Coordinated with specialist HPB and GI surgical partners, and may be billed there |
| Somatostatin-analogue-class therapy | A regular injection that both calms hormone symptoms and slows growth in receptor-positive, well-differentiated tumours. Often the first systemic treatment used — see somatostatin-analogue therapy for PNETs. | In-house at CION |
| Targeted tablet therapy | Oral treatment from the mTOR-inhibitor class or the tyrosine kinase inhibitor class, used when a well-differentiated tumour progresses despite earlier treatment. | In-house at CION |
| Chemotherapy | Combination chemotherapy, used mainly for higher-grade tumours, poorly differentiated neuroendocrine carcinoma, or bulky disease that needs a faster response. | In-house at CION |
| PRRT — peptide receptor radionuclide therapy | A receptor-targeted radioactive treatment given by drip for progressing, receptor-positive tumours — explained in full on PRRT for PNETs. | Coordinated with partner nuclear-medicine centres, and may be billed there |
| Liver-directed treatment | Ablation or embolisation aimed at deposits in the liver, used when the liver is the main site of disease and systemic treatment alone is not enough. | Coordinated with partner interventional-radiology centres, and may be billed there |
| Symptom, nutrition and supportive care | Hormone-symptom control, pancreatic enzyme replacement, dietary support, pain relief and psycho-oncology — running alongside treatment, not after it. | In-house at CION |
Nobody receives all of these, and the order matters as much as the list. If you are holding a report and cannot tell which row you are in, bring it to us and we will tell you plainly. Book a free consultation or call 1800 202 8726.
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A Slow Tumour Still Deserves a Written Plan
Systemic treatment, imaging, nutrition and follow-up are delivered by CION across 35+ centres.
What actually happens
How Your PNET Plan Is Actually Built
-
Confirm the tumour is really a PNET
Everything downstream depends on the pathology. Tissue is usually obtained with an endoscopic ultrasound and a fine-needle sample, and the report should state the grade, not just the diagnosis.
Biopsy coordinated with specialist endoscopy partners -
Map the disease properly
A pancreatic-protocol contrast CT or MRI shows where the tumour sits and its relationship to the vessels behind the pancreas. Baseline bloods and, where useful, chromogranin A and CA 19-9 are taken at the same time.
Ordered and reported in-house at CION -
Check whether it is receptor-positive
A DOTATATE PET answers whether receptor-directed treatment is an option at all, and often finds deposits the CT could not. We arrange it, sit in on the reporting, and tell you where it happens.
Coordinated with partner nuclear-medicine centres -
Settle the hormone question
If symptoms suggest a functioning tumour, the relevant hormone testing is done before treatment is chosen, because controlling a hormone syndrome sometimes takes priority over shrinking the tumour.
In-house at CION -
Take the case to tumour board
Medical oncology, radiation oncology and the surgical partners look at the scans and pathology together. Whether an operation is worth doing, and when, is decided there rather than by one doctor alone.
Tumour board at CION -
Write the plan down, including what would change it
You should leave with the sequence in writing and the reassessment points agreed in advance — the scan interval, and what finding would move you to the next treatment. Pancreatic cancer treatment in Hyderabad sets out how the wider service is organised.
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What CION Delivers, and What Is Coordinated
Being clear about this at the start saves a difficult conversation later. Your first consultation is free and lasts 45 minutes, and it is a genuine review of your reports rather than a booking appointment. Bring the scan report and the pathology report; those two documents decide more than anything else you will be asked.
Delivered in-house at CION, across 35+ centres in Telangana and Andhra Pradesh: systemic treatment for neuroendocrine tumours — somatostatin-analogue-class injections, mTOR-inhibitor-class and tyrosine kinase inhibitor tablets, and chemotherapy for high-grade disease; radiation where it is indicated; the ordering and reporting of pancreatic-protocol CT, MRI/MRCP, chromogranin A, CA 19-9 and routine bloods; genetic counselling where an inherited syndrome such as MEN1 or von Hippel-Lindau is suspected; nutrition and pancreatic enzyme replacement; pain relief, psycho-oncology and supportive care; and long-term follow-up.
Coordinated with specialist partner centres, and may be billed there: all pancreatic surgery for a neuroendocrine tumour, whether that is an enucleation, a distal pancreatectomy or a Whipple; endoscopic ultrasound with biopsy; ERCP and biliary or duodenal stenting; staging laparoscopy; coeliac plexus block for pain; PET-CT and DOTATATE PET; peptide receptor radionuclide therapy; and liver-directed ablation or embolisation. We arrange each of these, we sit in on the decisions, and we tell you in advance where it happens and who invoices you. We do not describe them as our own theatre, endoscopy or nuclear-medicine lists, because they are not.
The reason this matters practically is continuity. A neuroendocrine tumour is often managed over years, across several treatment lines, with more than one hospital involved. Someone has to hold the whole plan, keep the imaging comparable and know what was tried and when. That is the part we do, whichever building a given treatment happens in.
Take this list with you
What to Ask at Your First Appointment
- Is this a well-differentiated neuroendocrine tumour or a neuroendocrine carcinoma? They are treated as different diseases, and the answer should be in the pathology report already.
- What is the grade, and who assigned it? If the grade is missing, ask whether the sample can be reviewed rather than proceeding without it.
- Is my tumour functioning? If a hormone syndrome is causing your symptoms, controlling it may come before anything aimed at the tumour.
- Has a DOTATATE PET been done, and did the tumour light up? That answer decides whether receptor-directed options, including PRRT, are open to you.
- Is surgery on the table now, later, or not at all? Ask for the reason, not just the answer — and ask which partner unit would operate.
- What is the first systemic treatment, and why that one first? For many receptor-positive tumours the answer is somatostatin-analogue-class therapy, but it should be explained, not assumed.
- How often will I be scanned, and what finding would change the plan? A plan without a written reassessment point is not really a plan.
- Which parts of my care happen here, and which are billed elsewhere? Ask this before treatment starts, not when the invoice arrives.
If you are early in this and simply want the reports read by someone who treats these tumours regularly, that is exactly what the first appointment is for. Book a free consultation or call 1800 202 8726. Start with the wider picture on our complete pancreatic cancer guide if it helps.
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Common questions
PNET treatment - your questions answered
Is PNET treatment the same as pancreatic cancer treatment?
No, and this is the single most useful thing to understand early. A pancreatic neuroendocrine tumour starts in hormone-producing cells rather than in the ducts, usually grows more slowly, and is treated on a completely separate pathway from pancreatic ductal adenocarcinoma. NCCN keeps the two in different guidelines. The options used for a well-differentiated neuroendocrine tumour - active monitoring, surgery, somatostatin-analogue-class injections, targeted tablets, receptor-directed radionuclide therapy - are largely not the options used for adenocarcinoma. The outlook is generally considerably better as well. If you have been reading about pancreatic cancer and applying it to yourself, most of what you have read does not describe your tumour.
What does the grade of my tumour mean for treatment?
Grade describes how actively the tumour cells are dividing, judged by the pathologist on your biopsy or surgical specimen. Well-differentiated tumours are graded 1, 2 or 3, and a poorly differentiated neuroendocrine carcinoma sits in a separate category altogether. In broad terms, a lower grade means a slower tumour, more scope for monitoring or a receptor-directed approach, and a longer runway to plan. A higher grade or a poorly differentiated carcinoma means treatment usually starts sooner and chemotherapy comes into the picture earlier. Grade is not a prediction about you personally, but it is the finding that shapes the sequence of treatment more than any other, which is why the report should always state it.
Can a pancreatic neuroendocrine tumour be cured?
Cure is genuinely possible when the tumour is still confined to the pancreas and can be removed completely by surgery, and that is a real and reasonably common situation with these tumours - far more so than with pancreatic adenocarcinoma. Where the disease has already spread, particularly to the liver, the aim usually shifts from cure to long-term control, and that control can last a long time with treatment given in sequence over years. Nobody can promise you an outcome, and you should be wary of anyone who does. What your own team can do is tell you which of those two situations your scans and pathology actually describe, and what the realistic aim of the first treatment is.
Do all PNETs need treating straight away?
Not always. A small, low-grade, non-functioning tumour found by chance on a scan done for something else is sometimes watched on a defined imaging schedule rather than treated immediately, because the risks of an operation on the pancreas can outweigh the risk from a tumour that is behaving quietly. That decision belongs to a specialist team, not to a rule of thumb, and monitoring should mean scheduled scans with a written plan, not being sent away. A functioning tumour causing symptoms, a higher-grade tumour, or one that is clearly growing is a different situation and is treated. Ask which category you are in and what would move you out of it.
What is PRRT, and would I have to go somewhere else for it?
Peptide receptor radionuclide therapy attaches a radioactive particle to a molecule that seeks out somatostatin receptors, so the radiation is delivered to receptor-positive tumour deposits from the inside. It is given as a course of infusions and is generally considered for well-differentiated tumours that are progressing and that light up on a DOTATATE PET. It is not delivered in-house at CION. Both the DOTATATE PET and the treatment itself are coordinated with partner nuclear-medicine centres and may be billed there. We arrange the referral, take part in the decision about whether it is the right next step, and manage everything around it, but we tell you plainly that the treatment happens elsewhere.
My tumour is making a hormone. Does that change the plan?
Yes, and often it changes the order rather than the list. A functioning tumour releases a hormone that produces its own syndrome - low blood sugar, stubborn ulcers, flushing or persistent diarrhoea depending on which hormone is involved - and that syndrome can be more dangerous in the short term than the tumour itself. So the first job is usually to bring the symptoms under control, with somatostatin-analogue-class therapy and specific supportive measures, while the wider plan is worked out. Surgery is sometimes worth doing in a functioning tumour even when disease has spread, purely to reduce the hormone output. Tell your team exactly what symptoms you get and when, because that history genuinely guides treatment.
What does CION actually do for a PNET, and what happens at the first visit?
The first consultation is free and lasts 45 minutes. We read your scans and pathology, tell you whether the grade and receptor status are established or still missing, and set out the realistic sequence of treatment rather than a menu of everything that exists. Delivered in-house across 35+ centres: somatostatin-analogue-class therapy, targeted tablet treatment, chemotherapy for high-grade disease, radiation where indicated, imaging and blood-test ordering and reporting, genetic counselling, nutrition and enzyme support, pain and psycho-oncology care and long-term follow-up. Coordinated with specialist partner centres and possibly billed there: all pancreatic surgery, endoscopic ultrasound and biopsy, stenting, DOTATATE PET, peptide receptor radionuclide therapy and liver-directed treatment. You will be told which is which before anything begins.
Medical disclaimer: This page explains how treatment for a pancreatic neuroendocrine tumour is chosen and how the pathway is organised, and is reviewed by a CION medical oncologist with reference to NCCN guidance on neuroendocrine tumours of the pancreas and the WHO classification of pancreatic neuroendocrine neoplasms. It is general information and not a treatment recommendation for any individual; your own plan depends on your grade, receptor status, hormone activity, extent of disease and general health, and must be decided with your treating team. Systemic therapy for neuroendocrine tumours including somatostatin-analogue-class treatment, targeted tablet therapy and chemotherapy, radiation where indicated, the ordering and reporting of pancreatic-protocol CT, MRI/MRCP, chromogranin A, CA 19-9 and bloods, genetic counselling, nutrition and pancreatic enzyme (PERT) support, pain relief, psycho-oncology and survivorship follow-up are delivered by CION. All pancreatic surgery, endoscopic ultrasound and biopsy, ERCP and biliary or duodenal stenting, staging laparoscopy, coeliac plexus block, PET-CT and DOTATATE PET, peptide receptor radionuclide therapy and liver-directed treatment are coordinated with specialist hepatobiliary, gastroenterology, endoscopy, nuclear-medicine and interventional-radiology partner centres and may be billed there.