1. Assemble a Team of Specialists
Patients with gastrinoma should consult with various medical professionals when attempting to identify an individually appropriate treatment protocol. The family physician is the first member of this vital team. Other team members may include a gastroenterologist, radiologist, endocrinologist, oncologist and surgeon. Assembling an appropriate medical team allows the patient the best chance for successful treatment of gastrinoma.
2. Locate the Tumor
The first step in treatment is to locate the tumor and determine the extent of metastasis. Imaging studies help localize the tumor and allow doctors to determine whether surgery is a viable option. One superior type of imaging study used is somatostatin receptor scintigraphy. This particular study allows medical professionals to determine the location of the tumor and the degree of metastases to the liver or bone. Another imaging study, which shows the location of the tumor, is the endoscopic ultrasound. Doctors may opt to use an upper endoscopy depending on the location of the tumor. Other imaging studies include the CT scan and MRI.
3. Medicate and Wait
Doctors approach gastrinoma using two types of medications. The first approach involves daily use of medications known as proton pump inhibitors. Examples of this type of medicine include omeprazole or lansoprazole. These drugs function by reducing the amount of gastric acid secreted, which subsequently reduces the number of resulting ulcers. Ulcers begin to heal approximately two weeks after commencing with proton pump inhibitor treatment. Other medications used include H-2 receptor antagonists, such as cimetidine, famotidine, nizatidine and ranitidine. These types of drugs also reduce acid secretion; however, there is a 50 percent failure rate. Consequently, proton pump inhibitors are the preferred medication of many doctors. If the tumor has metastasized, then a combination of chemotherapy drugs, such as streptozocin, 5-fluorouracil, and doxorubicin, helps shrink the tumor.
4. Surgical Removal of Gastrinoma
When the gastrinoma is localized and hasn't metastasized, surgical removal of the tumor may result in a complete cure of the disease. Typically, these types of tumors are evident on pre-surgical imaging studies. If the exact location of the tumor isn't evident from pre-surgical imaging studies, then a surgeon may perform a laparotomy. During this procedure, the surgeon locates the tumor and then removes it. Some cases of gastrinoma respond best to a Whipple procedure or Whipple pancreaticoduodenectomy, which involves removal of the gall bladder, part of the stomach, a portion of the common bile duct, the head of the pancreas, the duodenum, the proximal jejunum, and surrounding lymph nodes. Generally, patients notice a reduction in acid production following surgery to treat gastrinoma.
