Diagnosed with Stage 4 pancreatic neuroendocrine metastasized to liver

Posted by ahilker @ahilker, May 24, 2023

Hi everyone. I am new to the group and wondered what kinds of symptoms others with Pnet go through. I was diagnosed just under a year ago and began the lanreotide infusion shot this past October. I went into my regular doctor last May for what I thought was a gall bladder infection. My doctor sent me in for a full abdomen CT and found a 3 cm mass on the tail of the pancreas. At the time my doctor told me we need to look at the mass first before looking into the gall bladder. After several PT scans and biopsies they can see small tumors covering my entire liver the largest being 1.1 cm. Since surgery was not an option, I started on the infusion. My nausea did not go away so I went back in to see about my gall bladder. Since then I feel 25 times worse. I’m exhausted all the time, very little appetite but no real weight loss, depression from having to rely on my family and pain around the pancreas and liver. I am grade 2 well functioning stage 4. Any suggestions would be greatly appreciated

Interested in more discussions like this? Go to the Neuroendocrine Tumors (NETs) Support Group.

Hello all! New to the group. Diagnosed with PNET that have metastasized to liver, bone, lung. Had symptoms for years but no one could find out what was going on. I had a bout of pancreatitis in December and my gallbladder was removed at that time. Scans revealed something on the pancreas. Long story short, stage 4. Grade 2 well differentiated tumors Started lanreotide two weeks ago. I have been experiencing bloating, low heart rate, wheezing and some swollen tongue issues which my doctor does not feel are related. Has anyone else had these symptoms? I also have experienced some insomnia and tumor area pain. Anyone else?
Thank you!

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@carm1011

Hello all! New to the group. Diagnosed with PNET that have metastasized to liver, bone, lung. Had symptoms for years but no one could find out what was going on. I had a bout of pancreatitis in December and my gallbladder was removed at that time. Scans revealed something on the pancreas. Long story short, stage 4. Grade 2 well differentiated tumors Started lanreotide two weeks ago. I have been experiencing bloating, low heart rate, wheezing and some swollen tongue issues which my doctor does not feel are related. Has anyone else had these symptoms? I also have experienced some insomnia and tumor area pain. Anyone else?
Thank you!

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Hello @carm1011 and welcome to the NETs support group on Mayo Connect. I am glad that you found this forum. Many on this forum have had similar experiences to yours with a late diagnosis of NETs after years of symptoms and many of us have had no symptoms at all, our NETs were found incidentally.

You mentioned swelling. You might find the following discussion helpful. Here is the link:
--Swelling with Liver Metastasis
https://connect.mayoclinic.org/discussion/swelling-with-liver-metastases/

Has there been any mention of surgery and/or liver embolization to treat your NETs? Are you currently seeing a NETs specialist? If not, I would highly recommend at least one consultation with a NETs specialist. Mayo Clinic has NET specialists at all three of their locations. If you would like a consultation with a Mayo NET specialist, here is a link with information to schedule an appointment, http://mayocl.in/1mtmR63

If a Mayo appointment is not possible, here is a world-wide listing of NET specialists, https://www.carcinoid.org/for-patients/treatment/find-a-doctor/

I am sure that others in this pNET discussion will post with you soon and share their experiences. In the meantime, you mentioned tumor-area pain. Is this related to the bone pain or to the liver/pancreas?

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@carm1011

Hello all! New to the group. Diagnosed with PNET that have metastasized to liver, bone, lung. Had symptoms for years but no one could find out what was going on. I had a bout of pancreatitis in December and my gallbladder was removed at that time. Scans revealed something on the pancreas. Long story short, stage 4. Grade 2 well differentiated tumors Started lanreotide two weeks ago. I have been experiencing bloating, low heart rate, wheezing and some swollen tongue issues which my doctor does not feel are related. Has anyone else had these symptoms? I also have experienced some insomnia and tumor area pain. Anyone else?
Thank you!

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Hello carm1011! I have the same diagnosis - pNET well functioning, Grade 2, Stage 4 with liver metastases. I had 4 Lanreotide injections. Similar symptoms - bloating, gas, loose stools, low heart rate. After 2-3 mo on Lan symptoms are not so bad. I get them more severeon day 1-4 after injection. It gets better! I do not have a swollen tongue, but have some sores in my mouth, and my hair started falling off. I had surgery on Feb.1, 2023. ( distal pancreatectomy, with spleen and gall bladder removal as well as hysterectomy). My tumor was very large ( 10×16×22 cm).Be strong! You got this!💜🦓

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@pmberman

Hi all, I’m new to this forum and this condition. Started with GI pain and inconsistent stool about 8 weeks ago (maybe longer in retrospect). Then the flushing, palpitations, loss of appetite, weight loss, and just feeling weak and unwell. After seeing 4 doctors, I ended up going to Cleveland Clinic Weston, FL where they did (at my request) the 5-HIAA urine test and 64 CU Dotatate PET scan. The urine test came back positive and the PET lit up areas of my duodenum and it looks like a 4mm nodule in right lung with possible lymph involvement, although they actually told me the scan was normal!! (It’s not clearly). I have the textbook carcinoid syndrome symptoms as stated above. Unfortunately, because Cleveland Clinic does not have NET specialists, they are flying blind and I am having to tell them to what tests and scans I need so I can get the disease localized and treated somewhere that has a clue. This week I am going back to Cleveland Clinic to have an upper endoscopy with biopsies as well as an upper endoscopic ultrasound to look at pancreas, ducts etc. I am going to also demand MRIs and ultrasounds of the liver, lungs and pancreas. The PET didn’t show anything in the liver, but I don’t trust that because I’ve read a lot on this site about liver metastases being very small and numerous and hard to see on scans. I’ve also learned that you don’t get the carcinoid syndrome symptoms unless it’s in the liver and/or lungs. This has been a long, scary road that’s upended my life and I don’t feel I am dealing with experts which is costing me precious time. I have FL Blue insurance so I’m kind of stuck with what we have here. Any advice, thoughts and prayers would be welcomed. This isn’t what I expected at 56. It’s hard to function. PS - I’ve been thinking about going to Moffitt in Tampa, but they seem to only focus on GI, so if it’s in the liver or lung then not sure they can help? Mayo FL is out of network for my insurance, but I’d go there if it was better. Also even thinking about going to a true specialist like MD Anderson or Mayo MN and paying out of pocket. I’d have to sell our house to cover it but what’s a house with no life? Angry, sad and confused. Sorry to be such a downer.

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Hello how are you
Did you get a repeat pet scan?
In your other comments you mentioned that pet was negative, so what did it finally turn out to be?

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No second scan. Having biopsies and other tests. Diagnosis tbd. Still have multiple symptoms, but I’ve learned from googling that you can go down the wrong rabbit holes and misinform other readers. So I’ll hold off until I know for sure what is wrong with me. Then I’ll update you. Thanks for checking.

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I have pancreatic neuroendocrine tumor with liver metastasis. It is grade 1. I am scheduled for surgery but often consider canceling. The goal of the surgery would be “ cytoreduction. This would entail a distal pancreatectomy, splenectomy, cholecystectomy, wedge resection and ablations of the liver.” I understand that to mean they would remove the tumor in the tail of the pancreas, remove and ablate some tumors in my liver and also remove my spleen and gall bladder. If I do not do surgery, the other option is to do monthly hormone shots which I was told are effective for 3 to 7 years. Any advice would be greatly appreciated.

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@marct

I have pancreatic neuroendocrine tumor with liver metastasis. It is grade 1. I am scheduled for surgery but often consider canceling. The goal of the surgery would be “ cytoreduction. This would entail a distal pancreatectomy, splenectomy, cholecystectomy, wedge resection and ablations of the liver.” I understand that to mean they would remove the tumor in the tail of the pancreas, remove and ablate some tumors in my liver and also remove my spleen and gall bladder. If I do not do surgery, the other option is to do monthly hormone shots which I was told are effective for 3 to 7 years. Any advice would be greatly appreciated.

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Following.

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@marct

I have pancreatic neuroendocrine tumor with liver metastasis. It is grade 1. I am scheduled for surgery but often consider canceling. The goal of the surgery would be “ cytoreduction. This would entail a distal pancreatectomy, splenectomy, cholecystectomy, wedge resection and ablations of the liver.” I understand that to mean they would remove the tumor in the tail of the pancreas, remove and ablate some tumors in my liver and also remove my spleen and gall bladder. If I do not do surgery, the other option is to do monthly hormone shots which I was told are effective for 3 to 7 years. Any advice would be greatly appreciated.

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I forgot to say I am 67 year old man.

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@marct

I have pancreatic neuroendocrine tumor with liver metastasis. It is grade 1. I am scheduled for surgery but often consider canceling. The goal of the surgery would be “ cytoreduction. This would entail a distal pancreatectomy, splenectomy, cholecystectomy, wedge resection and ablations of the liver.” I understand that to mean they would remove the tumor in the tail of the pancreas, remove and ablate some tumors in my liver and also remove my spleen and gall bladder. If I do not do surgery, the other option is to do monthly hormone shots which I was told are effective for 3 to 7 years. Any advice would be greatly appreciated.

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I’m sorry you’re going through this. My husband had the same surgery except for the liver debulking and treatment 15 years ago. He had a very large liver tumor burden that was later addressed very successfully with radioembolization. In my opinion, with the surgical options they’re giving you this surgery will likely set the clock back for you many many years, as it did for my husband. Sandostatin and lanreotide usually only stall the growth with minimal shrinkage. However, grade 1 is very slow growing so there is that to consider.
Is the surgical approach being suggested by a net specialist? If not (and even if it is) I’d strongly encourage a second opinion from another net specialist. It’s always good to get a consensus on the approach as it is a big surgery. Here’s a link where you can find specialists by state.
Best of luck to you.
https://www.carcinoid.org/for-patients/treatment/find-a-doctor/

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@marct

I have pancreatic neuroendocrine tumor with liver metastasis. It is grade 1. I am scheduled for surgery but often consider canceling. The goal of the surgery would be “ cytoreduction. This would entail a distal pancreatectomy, splenectomy, cholecystectomy, wedge resection and ablations of the liver.” I understand that to mean they would remove the tumor in the tail of the pancreas, remove and ablate some tumors in my liver and also remove my spleen and gall bladder. If I do not do surgery, the other option is to do monthly hormone shots which I was told are effective for 3 to 7 years. Any advice would be greatly appreciated.

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@marct
First of all, I can only tell our story which is very similar. My wife was diagnosed with NET stage 4, with mass on pancreas that spread too many tumors to count on liver. We thought the worse at first, but research and our oncologist calmed us down referred us to a multi disciplinary team including a NET specialist (critical need)to help us. She had to do 9 months of chemo as her mass and tumors were not operable at diagnosis, so I believe you well ahead of us, being able to have surgery right away. After 80% reduction in all tumors from chemo, we had surgery March 23, and had the same surgery your having. We got everything out except all of tumors on liver. Currently, doing PRRT radiation treatments to keep the NET in liver at low amount and our team is considering a liver transplant if PET scan is still clear with the exception of the liver. This will hopefully reset our diagnosis to a decades potential lifespan. I could help with other questions, but be an advocate for your health and ask lots of questions of your team, and do read and research. We in the forum got your back, and will help you through this as we been through this and hopefully can give you ideas to make this a bit easier for you to work through. You got this!🙏

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