Sixty to 75 percent of gastrinomas are malignant and metastatic at the time of diagnosis. Gastrinomas usually occur in the head of the pancreas but up to onethird are found in the duodenum.
Standard Treatment The tumor should be removed if it can be precisely located by preoperative imaging studies or during surgery. Usually, small lesions can be shelled out from the pancreas without the need for removing the whole organ. Removal of a localized tumor results in a high chance of cure.
Sometimes, the tumor cannot be found. In this case, the best approach is to block the acid production from the stomach with medicines such as histamine H-2 receptor blockers or Omeprazole. This prevents the two main problems with the tumor: ulcers and diarrhea.
Cutting the acid secretion nerves to the stomach (vagotomy) and removing part of the stomach (partial gastrectomy) are not effective. If medical therapy fails to control acid secretion and ulcerations recur or diarrhea persists, a total gastrectomy is the treatment of choice.
In severe cases, primary management may include continuous stomach suction and intravenous replacement of sodium , potassium and chloride to maintain electrolyte balance. Surgery can then remove a functioning tumor when the patient is stable. Postoperative gastrin levels are used for monitoring.
