Skip to main contentShah's Gastro, Cancer & Robotic Surgery Centre · Ahmedabad & Gandhinagar
Last updated: 17-Oct-2026
Gastroenteropancreatic neuroendocrine tumours (GEP-NETs): pancreas, small bowel, stomach, duodenum, appendix, colon and rectum · Gota OPD, Gota, Ahmedabad · Apollo Hospital, Bhat, Gandhinagar
A neuroendocrine tumour can start in the pancreas, small bowel, stomach, appendix or rectum. Each site has its own plan, so the starting point is found first.
Three more facts shape the plan: how fast the cells grow, whether they still look like normal cells, and whether the tumour makes hormones.
The treatment ladder runs from simple watching, through removal by scope, to surgery, injections and targeted radiation. Many patients never need the higher rungs.
Two tumours can both be called NET and share nothing else. A tiny appendix NET and a fast pancreas carcinoma need opposite plans.
Shah’s Gastro, Cancer & Robotic Surgery Centre. Two higher degrees in surgery of the digestive system, and 18 years of experience in pancreas, bowel and cancer surgery. Scans, endoscopy, pathology, hormone tests, the tumour board, surgery and follow-up work in one pathway.
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Gastro & Cancer Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Every NET is discussed at a tumour board with a surgeon, a cancer physician, a hormone specialist, a nuclear medicine doctor, a radiologist and a pathologist. Single-doctor decisions in this rare disease tend to age badly.
| Fact the plan waits for | Where it comes from | Why it matters |
|---|---|---|
| Where the tumour started. | Scans, scopes and the operation report. | Each site has its own size rules and its own operation. |
| How fast the cells divide (the grade). | The pathology report, using two counts on the tissue. | Slow, middle and fast tumours are treated very differently. |
| Whether the cells still look regular (differentiation). | The pathologist’s description. | A poorly differentiated carcinoma is a different disease. |
| Whether it makes hormones. | Symptoms, and blood or urine hormone tests. | Hormone tumours may need medicine to calm symptoms first. |
| Whether it shows on a special scan. | Ga-68 DOTATATE PET scan. | It finds hidden spots and decides who can have targeted radiation. |
So the first job is not to rush into an operation. The first job is to collect these facts. A report that says only NET, with no grade and no word on how regular the cells look, is not enough to plan treatment. We ask the pathologist for both.
More and more NETs are found by chance. They turn up after an appendix operation, at a scope, or on a scan done for something else.
| Where it starts | How it often shows itself |
|---|---|
| Appendix. | Found in the appendix after an operation for appendicitis. This is the most common way a NET reaches a surgeon. |
| Small bowel. | Bouts of blockage, belly pain after food, or a lump in the bowel’s fan of tissue. Flushing and loose motions can mean spread to the liver. |
| Pancreas, without hormones. | A mass seen on a scan, pressure symptoms, or yellow eyes and skin. |
| Pancreas, with hormones. | Low sugar attacks, stubborn ulcers, or long-lasting watery loose motions. |
| Stomach or duodenum. | A small lump under the lining, seen at an upper scope. |
| Rectum or colon. | A small smooth nodule seen at a colonoscopy or a finger examination. |
If a scan has shown a pancreas mass and the type is not yet clear, our page on a body or tail mass and the other things it can be explains that wider pathway. For tumours of the small bowel in general, see small bowel cancer treatment.
Some NETs pour out a hormone and cause clear symptoms. Most make no active hormone and are found by size, pressure or chance.
| Type | The hormone | What the patient notices |
|---|---|---|
| Insulinoma. | Insulin. | Sweating, shaking, confusion or fainting when hungry, which settles with sugar. |
| Gastrinoma. | Gastrin. | Ulcers that keep coming back despite tablets, and loose motions. |
| Glucagonoma, VIPoma, somatostatinoma. | Other gut hormones. | Rare. Skin rash, sugar changes, or heavy watery loose motions. |
| Carcinoid syndrome. | Serotonin and related substances. | Flushing, loose motions and wheeze. It usually means the tumour has reached the liver. |
| Non-functioning NET. | None that causes symptoms. | Nothing, or pressure symptoms from size. |
Hormone tumours change the order of care. Low sugar from an insulinoma or acid from a gastrinoma is controlled first with medicine and feeds. Then the tumour is found exactly and removed. Carcinoid syndrome needs a heart scan before any big operation, because it can damage the valves on the right side of the heart.
The tissue report comes first, because the grade is the single most important fact. Scans then find where the tumour is and where it has gone.
Chromogranin A can be falsely high with acid tablets, weak kidneys or a thin stomach lining. One high value alone does not mean the tumour is growing. When an inherited condition is possible, the family is counselled too. Our page on hereditary GI cancer syndromes explains how family testing works.
A NET sits on a scale. At one end it behaves like a harmless lump. At the other end it is a fast cancer needing chemotherapy.
| Finding | How it behaves | What it means for treatment |
|---|---|---|
| Small appendix NET, fully removed, with clear edges. | Behaves like a benign growth. | The appendix operation is enough. No more surgery, no long follow-up. |
| Insulinoma. | Usually benign and single. | Removed, often by shelling it out, once it is found exactly. |
| Slow-growing NET (low grade). | A slow cancer. Many good years are usual, even with spread. | Watching, removal by scope, or surgery, by site and size. |
| Middle-grade NET. | Grows faster. Needs more care. | Surgery more often, and longer, closer follow-up. |
| Fast-growing but well-differentiated NET. | Aggressive, but still a NET. | Plan made at the board. Injections or targeted radiation may still work. |
| Neuroendocrine carcinoma (poorly differentiated). | A different, fast disease. | Chemotherapy is the main treatment, as for small cell cancer. |
The word cancer makes most families fear the worst. For well-differentiated NETs, even after spread to the liver, the outlook is often counted in many good years. Saying this plainly is part of the treatment. Other growths can look like a NET on a scan. Ordinary pancreatic cancer and cysts are the commonest. Those are confirmed or ruled out by the tissue report. For mostly fluid-filled growths, see pancreatic cysts: which need an operation.
Treatment is chosen rung by rung. The lower rungs are often enough. Each step up is taken only when the facts call for it.
Targeted radiation and the special PET scan are not easy to get everywhere. They can be costly. We plan the route to them early, and talk about cost early, rather than looking for them only when the tumour grows.
Over-treatment is a real danger with NETs. A big operation for a small, slow tumour can do more harm than the tumour itself.
| Situation | What is usually done instead |
|---|---|
| Appendix NET of 1 cm or less, fully removed, with clear edges and no spread into vessels. | Nothing more. Reassurance, and no long follow-up. |
| Small, slow rectal or stomach NET under 1 cm, in the inner layers only. | Removal through a scope. |
| Many small stomach NETs from a thin, inflamed stomach lining (type 1). | Removal by scope and regular scopes. An operation is rarely needed. |
| Pancreas NET under 2 cm, slow, making no hormone, causing no symptoms. | Watching with scans is a fair choice, especially in older or less fit patients. |
| Neuroendocrine carcinoma. | Chemotherapy is the main treatment. |
| MEN1 with many small pancreas tumours. | Control while saving pancreas. Not every lump has to come out. |
A Whipple operation for a small, slow pancreas NET would put a patient through a major operation for a tumour that might never have harmed him. That is a harm, not a cautious choice. When watching is proposed, the tumour board reviews it, and the scans are repeated on a fixed plan.
When surgery is needed, the site decides the operation. The aim is to remove the tumour and its lymph glands, and keep healthy organ.
| Site | When surgery is advised | The usual operation |
|---|---|---|
| Appendix, 1 to 2 cm. | Tumour board decision. Surgery if the base is involved, it spreads into the fat or vessels, or the grade is not low. | Right hemicolectomy, or nothing more. |
| Appendix, over 2 cm. | Advised. | Right hemicolectomy, which removes the right colon and its lymph glands. |
| Rectum, over 2 cm, or into the muscle, or with gland spread. | Advised. | An operation as for rectal cancer. |
| Stomach, single tumour with normal gastrin (type 3). | Advised. It behaves aggressively. | A formal stomach removal with lymph glands, as for stomach cancer. |
| Duodenum, gastrinoma. | Advised. | The duodenum is opened and explored, because these are often small and many. |
| Small bowel. | Advised, even when the liver is involved, in fit patients. | Bowel removal with a wide sweep of its fan of lymph glands. The whole small bowel is checked by hand. |
| Pancreas, 2 cm or more, growing, causing symptoms, or not low grade. | Advised. | Shelling out, tail removal with the spleen kept where safe, or a Whipple operation for the head. |
For what a right hemicolectomy involves, see our page on the right hemicolectomy operation. All pancreas tumour services are on the pancreatic cancer treatment page.
In the small bowel, the lymph glands and the scarring around them cause blockage and cut off blood supply. Removing them prevents that.
Small bowel NETs are often more than one. A second tumour is easy to miss, so the surgeon runs the whole small bowel deliberately, by hand. The tumour and a wide wedge of the bowel’s fan of tissue are removed together, because the glands there drive the problems. When the root of that fan is involved, the operation is planned carefully on the scans first. In a fit patient, the first tumour is removed even when the liver already has spots. It prevents blockage and loss of blood supply to the bowel, and helps people live longer.
A patient speaks after a keyhole small bowel resection for a neuroendocrine tumour. Shared with consent. Every patient’s plan is made for that patient.
For the pancreas, size, grade, hormones and site decide between watching, shelling out the tumour, a tail operation, or a Whipple.
A small non-hormone NET under 2 cm with a low grade can often be watched, as long as it stays the same. If it is 2 cm or more, grows, causes symptoms, or is not low grade, it is removed. A small tumour near the surface can be shelled out, keeping almost the whole gland. A tumour in the tail is removed with the tail, and the spleen is kept when it is safe for the cancer. A tumour in the head needs a Whipple operation. An insulinoma is usually single and benign, so it is shelled out once it is found. Finding it can need endoscopic ultrasound or a special blood test through an artery. A gastrinoma is often in the duodenum, so the duodenum is opened and searched. In MEN1 there are many tumours. The aim is control while saving pancreas, not clearing every one.
| Pancreas NET | Usual step |
|---|---|
| Under 2 cm, slow, no hormone, no symptoms. | Watch with scans on a fixed plan. |
| Small, near the surface, away from the main duct. | Shell it out (enucleation). |
| In the body or tail. | Tail removal (distal pancreatectomy), keeping the spleen where safe. |
| In the head. | Whipple operation (pancreatoduodenectomy). |
| Insulinoma. | Find it exactly, then shell it out where possible. |
| Gastrinoma. | Explore the duodenum and remove the tumours. |
Liver spread from a well-differentiated NET is not the end of the road. Treating the liver controls symptoms and helps people live longer.
| Option | When it is used |
|---|---|
| Removing liver spots (debulking). | Worth doing in well-differentiated NETs, even when not every spot can be removed. |
| Burning spots (ablation). | For smaller spots, alone or with surgery. |
| Blocking the blood supply (embolisation), with or without chemotherapy or internal radiation. | When many spots are present, mainly in the liver. |
| Somatostatin injections or targeted radiation. | To slow the tumour and calm hormone symptoms. |
| Liver transplant. | Only for very carefully chosen young patients, at specialist centres. |
This is very different from ordinary bowel or pancreas cancer. Removing part of a NET’s liver spread is useful. In adenocarcinoma it usually is not. The tumour board decides which mix suits you.
Some steps are special to NET surgery. They protect against a sudden hormone surge during anaesthesia, and against later gallstones.
| Step | Why it is done |
|---|---|
| An octreotide drip before anaesthesia starts, kept going during surgery. | In carcinoid syndrome or a large tumour load, handling the tumour can release hormones. This causes flushing, a fall in blood pressure and wheeze. The drip prevents it. |
| A heart scan before a major operation. | Carcinoid heart valve disease changes the anaesthesia risk. |
| Removing the gallbladder during the same operation. | Long-term injections cause gallstones. A later gallbladder operation is harder. |
| Nutrition support and exercise before surgery. | A fitter body recovers faster after pancreas or bowel surgery. |
| Writing down the grade, glands removed and whether removal was complete. | These decide the follow-up plan. |
Recovery follows the plan for that operation, with a few NET-specific checks. A high sugar after an insulinoma is removed is expected.
| Time | What happens |
|---|---|
| Day of surgery. | Octreotide is continued in carcinoid syndrome. The team watches for a hormone surge. |
| Days one and two. | Sugar is checked often after an insulinoma. It runs high for a while, and usually settles. |
| Days two to five. | Diet and walking are built up. Enzyme capsules are started after pancreas surgery if needed. |
| Before going home. | The grade and stage are explained. The injection or follow-up plan starts. A baseline DOTATATE scan is booked if not done. |
The main risks are those of the operation you need. Your own figures are explained in person before you sign consent.
| Risk | What it means |
|---|---|
| Risks of the operation itself. | A pancreas operation can cause a juice leak, slow stomach emptying or bleeding. Bowel surgery can cause a leak at the join or an infection. |
| A hormone surge (carcinoid crisis) during anaesthesia. | Severe flushing, low blood pressure and wheeze. Prevented by the octreotide drip, and treated with more octreotide at once. |
| Gallstones from long-term injections. | This is why the gallbladder may be removed during the operation. |
| High sugar after insulinoma removal. | Expected for a period. Insulin is rarely needed. |
| A long relationship with follow-up. | Scans and injections may be needed for years. That is usually good news, not bad. |
| The report shows a carcinoma. | Then chemotherapy becomes the main treatment, and the outlook is different. |
These signs, before or after treatment, need the team that day. Some need a hospital at once.
| Sign | What it may mean |
|---|---|
| Fainting, confusion or sweating when hungry. | A low sugar attack from an insulinoma. Take sugar and come in. |
| Belly pain with vomiting, or pain after meals with a known small bowel NET. | Blockage or poor blood supply to the bowel. |
| Breathlessness or swelling of the legs and belly. | Possible carcinoid heart disease. A heart scan is needed. |
| Pain under the right ribs while on injections. | Gallstones from the injections. |
| Bleeding, or sudden severe belly pain. | Bleeding or a tear in the bowel. An emergency. |
| Fast weight loss and feeling much worse. | The diagnosis is reviewed, because it may be a carcinoma. |
NETs can come back late. Five years is not the end of follow-up, except for the smallest appendix NETs.
| When | What is checked |
|---|---|
| Three months after surgery. | Baseline scan, chromogranin A, symptoms, and the board-confirmed plan. |
| Every six to twelve months, slow and middle grades. | CT or MRI, and chromogranin A read as a trend. Urine 5-HIAA in carcinoid syndrome. |
| Every three to six months, fast grades and carcinomas. | More frequent scans, led by the cancer physician. |
| DOTATATE PET scan. | At the start, and again if the tumour grows. |
| Appendix NET of 1 cm or less, fully removed. | No long follow-up. You are reassured and discharged. |
| On long-term injections. | Checks for gallstones, sugar, vitamin B12 and fat-soluble vitamins. |
| Beyond five to ten years. | Continued for middle grade and above, and for small bowel NETs. |
| MEN1 or other inherited conditions. | Lifelong checks, and testing of the family. |
★★★★★
“We are very thankful to Dr. Harsh Shah for successfully performing the Whipple’s procedure. From the beginning, he explained everything clearly and gave us great confidence throughout the treatment. Today, we are happy to share that we received the discharge and are going home with a positive feeling. Thank you, Dr. Harsh Shah, for your expertise, care, and support. Highly recommended for GI surgery.”
— Desai Sonal, Google review
★★★★★
“I am writing to express my sincere gratitude for the exceptional care provided by Dr. Harsh Shah and his team. Dr. Harsh Shah is an outstanding expert in intestinal surgery, executing complex procedures with remarkable calm and precision. Dealing with gastrointestinal diseases is incredibly stressful for both patients and their families. In my experience, what sets Dr. Harsh Shah apart is his incredible patience; he takes the time to listen to every question and provides clear, reassuring answers to every concern. As a grateful patient, I highly commend Dr. Harsh Shah and the entire team at Apollo Hospital. They did not just treat our physical condition—they truly cared for our mental and emotional well-being”
— Dipen Shah, Google review
★★★★★
“Dr harsh shah is good doctor . Had done surgery for abdominal tumour .thank you so much.”
— narendra bhati, Google review
Reviews are shown exactly as written on Google. None names a neuroendocrine tumour. The first is about a Whipple operation, the second about intestinal surgery, and the third about surgery for an abdominal tumour.
The cost depends on which step of the ladder you need. You get a written estimate before any admission or special scan.
Apollo Hospital, Bhat works with the major insurers and cashless options, and its office handles pre-authorisation. The DOTATATE PET scan and targeted radiation can be costly, so we discuss them at the first visit. Please bring every scan on a CD or link, the biopsy slides and blocks if you have them, your medicine list, your insurance card and an ID.
Most are slow-growing cancers. Many patients live for many years in good health, even after spread to the liver. A small appendix NET that is fully removed behaves like a benign growth.
No. Small appendix NETs need nothing more, small rectal and stomach NETs can be removed by scope, and some small pancreas NETs can be watched.
It tells how fast the cells divide. Slow, middle and fast NETs are treated differently, and a carcinoma is treated with chemotherapy.
Long-term somatostatin injections cause gallstones. Removing the gallbladder during the operation avoids a harder operation later.
Yes. Removing or treating liver spots is worthwhile in well-differentiated NETs, along with injections or targeted radiation.
Usually for many years, often beyond ten, because NETs can return late. The smallest fully removed appendix NETs are the exception.
Shah’s Gastro, Cancer & Robotic Surgery Centre — Gota, Ahmedabad
Consultations, review of reports and scans, second opinions, follow-up.
Google: Dr Harsh Shah · 4.89 · 216 reviews
Directions to the Gota clinic · +91-63555-64601
Apollo Hospital — Bhat, Gandhinagar
Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar.
Endoscopy, endoscopic ultrasound, pancreas and bowel surgery, intensive care and inpatient care.
Google: Dr Harsh Shah – Robotic GI Surgeon · 4.94 · 18 reviews
Directions to Apollo, Bhat · WhatsApp +91-63555-64601
Patients come to Ahmedabad from across Gujarat, southern Rajasthan and western Madhya Pradesh. You can call us on +91-63555-64601.
Told the word neuroendocrine, NET or carcinoid after a scan, a scope or an appendix operation? Your biopsy or operation report, scan films and reports, and any blood or urine hormone tests can be sent ahead, so the consultation starts with them already read. Treatment is decided at the consultation, after examination and at the tumour board. Call +91-63555-64601 · Send the reports ahead on WhatsApp
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