Endocrine pancreatic carcinoma.

Endocrine carcinomas of the pancreas are rare, but they should be treated aggressively because they threaten the patient's life by both malignant growth and hormone excess. Resection for cure should be attempted, but is hardly ever possible. Debulking should be performed primarily in hormone-active tumours so that symptoms can be controlled by subsequent medical treatment; this can be directed against tumour growth and/or hormone production, and it can reduce stomach acid secretion in the gastrinoma syndrome. Surgery should be undertaken whenever possible since the patient's life can be considerably prolonged in most cases. Palliative surgery can reduce the patient's symptoms that may be caused by excessive hormone production and/or obstruction of the bile duct or the duodenum.