Shah's Gastro, Cancer & Robotic Surgery Centre · Ahmedabad & Gandhinagar
Neuroendocrine tumour surgeon in Ahmedabad · Gota OPD, Gota, Ahmedabad · Apollo Hospital, Bhat, Gandhinagar
Last updated: 16-Oct-2026
A neuroendocrine tumour, or NET, is not one disease. Where it sits, how fast it grows and whether it makes hormones decide the plan.
Families hear the word cancer and expect the worst. With a NET, that fear is often wrong. Most of these tumours grow far more slowly than ordinary cancer. Many people live for many years in good health, even after spread to the liver. That changes how a surgeon thinks. Some NETs need a large operation. Some need only a small one through a scope. Some small ones are safer watched. This page explains how that choice is made for you, who makes it, and what to ask before you sign. An ordinary pancreatic cancer follows a different path, set out on the pancreatic cancer treatment page.
Before any operation is planned, four things must be known: where the tumour started, its grade, its type under the microscope, and whether it makes hormones.
| What must be known | Why it changes the plan |
|---|---|
| Where it started: appendix, rectum, stomach, duodenum, small bowel or pancreas. | Each site has its own rules. A small appendix NET may need nothing more. A small bowel NET usually needs an operation. |
| The grade, from the Ki-67 index and the mitotic count. | Grade 1 grows slowly. Grade 2 is in between. Grade 3 grows faster. The report must state both numbers. |
| Well or poorly differentiated. | A poorly differentiated tumour is a neuroendocrine carcinoma. It is a different disease, and medicine leads its treatment. |
| Whether it makes hormones. | A tumour that makes insulin or gastrin, or causes flushing and diarrhoea, needs its own preparation and its own operation. |
| Spread, seen on a scan done the right way. | A CT taken in the arterial phase, or an MRI of the liver. A scan taken only in the later phase can miss liver spots. |
| A Ga-68 DOTATATE PET scan, where it fits. | It finds hidden tumours and shows whether a later radiation treatment, PRRT, could work. |
Other tests depend on the site. An endoscopic ultrasound looks at the pancreas, stomach and duodenum. A colonoscopy looks at the rectum. Blood and urine tests check for hormones. Chromogranin A is read as a trend over time, not as one value, because many things raise it. If flushing and diarrhoea are present, the heart is checked with an echo. A heart valve problem from the tumour is often missed, and it changes the risk of surgery. A young patient, more than one tumour in the pancreas, or a family history leads to a genetics referral for MEN1 and related conditions.
Every NET is discussed at a tumour board before treatment. Dr Harsh Shah examines you, explains the plan and performs the operation himself.
Shah’s Gastro, Cancer & Robotic Surgery Centre. He trained in super-specialty surgical gastroenterology and holds two higher degrees in that field. He has 18 years of experience in GI and cancer surgery, including the pancreas, small bowel and liver. You see the same surgeon from the first visit to the last follow-up.
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
Google rating 4.89 from 216 reviews at the Gota clinic, and 4.94 from 18 reviews at Apollo, Bhat.
NETs are uncommon and each one is different. A decision made by one specialist alone tends to age badly. So the board meets for every case. A surgeon, a cancer physician, a hormone specialist, a nuclear medicine doctor, a radiologist and a pathologist look at the same scans and slides. The board must see every grade 3 tumour, every carcinoma, anyone being considered for liver treatment or PRRT, and anyone with more than one pancreatic tumour. It also reviews every plan to watch a small pancreatic NET instead of removing it. Dr Shah then sits with you and the family and explains the choice. The route, keyhole, robotic or open, is chosen to suit the operation you need. Ask who will be at the operating table or the robotic console on the day, and whether that holds if the date moves.
The same word, NET, can mean no further treatment, a small procedure through a scope, or a cancer operation. The site and size decide which.
| Where the NET is | What is usually advised |
|---|---|
| Appendix, 1 cm or less, base clear, no spread into vessels or the fat around it. | Removing the appendix is enough. No further surgery, and no long follow-up. |
| Appendix, between 1 and 2 cm. | The tumour board decides. A right hemicolectomy is advised if the base is involved, the fat is invaded, vessels are involved, or the grade is 2 or higher. |
| Appendix, more than 2 cm. | Right hemicolectomy. |
| Rectum, stomach or duodenum, under 1 cm, grade 1, in the inner layers only. | Removal through the scope, with no open operation. |
| Rectum, more than 2 cm, or into the muscle wall, or with nodes. | A cancer operation, as for rectal cancer. |
| Stomach, type 1 (with chronic gastritis). | Usually several small tumours that grow slowly. Removal through the scope and regular checks. A part-stomach operation is rarely needed. |
| Stomach, type 2 (with a gastrinoma). | The gastrinoma is treated. |
| Stomach, type 3 (on its own, normal gastrin). | It behaves aggressively. It is treated like stomach cancer, with gastrectomy and lymph node removal. |
Most NETs reach a surgeon after an appendix operation, when the report comes back. That report is read by a named person, and the size, base and grade are checked against these rules. A NET found by chance is common. It does not mean the first operation was wrong. It means the next step needs care. For the right side of the colon, Dr Shah’s page on right hemicolectomy explains the operation itself.
A small bowel NET is usually removed with its lymph nodes, even when the liver is involved. A small pancreatic NET may be safer watched.
| Situation | What is usually advised |
|---|---|
| Small bowel NET. | The tumour is removed with a wide wedge of the mesentery and its lymph nodes. Those nodes cause blockage and loss of blood supply to the bowel if left. |
| Small bowel NET, with liver spread, in a fit patient. | The primary tumour is still removed. It prevents blockage and loss of blood supply, and it helps survival. |
| Small bowel NET, at operation. | The whole small bowel is run by hand, from end to end. A second tumour is common and easy to miss. |
| Pancreas, under 2 cm, grade 1, no hormones, no symptoms. | Watching with regular scans is a proper choice, especially for older patients or those with other illnesses. |
| Pancreas, 2 cm or more, or causing symptoms, grade 2 or higher, or growing. | Removal. The operation depends on where the tumour sits. |
| Pancreas, with MEN1. | There are often several tumours. The aim is control while keeping as much pancreas as possible, not removing every one. |
When the mesentery is tightly scarred around its main vessels, removal may be limited. That is planned from the scans before the operation, not discovered on the table. For more on how a small bowel tumour is confirmed before any bowel is removed, see small bowel resection for tumour.
A Whipple operation carries a real risk to life. Using it on a small, slow tumour that may never cause harm can do more damage than the tumour.
This is the decision where a second look matters most. A small non-functioning NET of grade 1 may stay quiet for years. Removing it from the head of the pancreas means a Whipple operation. That is a long operation with a slow recovery and a real risk of serious complications. So the board weighs your age, your other illnesses, the exact site and what you prefer. Watching is a plan with fixed scan dates. It is not doing nothing. If the tumour grows, starts causing symptoms or shows a higher grade, the advice changes to removal. A pancreatic cyst raises a similar question, explained on the pancreatic cyst surgery decision page.
| What pushes towards an operation | What supports watching |
|---|---|
| Size 2 cm or more. | Size under 2 cm. |
| Grade 2 or higher. | Grade 1. |
| Symptoms, or a hormone syndrome. | No symptoms and no hormones. |
| Growth between scans. | No change on repeat scans. |
| Younger and fit. | Older, or other serious illness. |
A NET that makes insulin, gastrin or other hormones changes the preparation, the search for the tumour and the operation itself.
| Tumour | What you notice | What the operation involves |
|---|---|---|
| Insulinoma. | Low sugar attacks, often with fasting. | Usually single and not cancerous. It is found carefully with EUS and other tests, then shelled out where possible. Sugar runs high for a while after. That is expected. |
| Gastrinoma. | Stubborn ulcers and diarrhoea. | Often in the duodenum, and often more than one. The duodenum is opened and searched. MEN1 is common, so genetics is checked. |
| Carcinoid syndrome. | Flushing, diarrhoea and wheeze. | It usually means liver spread. The heart is checked first. Octreotide is given before and during surgery to prevent a crisis. |
Glucagonoma, VIPoma and somatostatinoma are rarer hormone-making tumours. They follow the same rule. The hormone is controlled first with medicine, and the operation is planned after. For anyone on long-term somatostatin injections, the gallbladder is usually removed at the same operation. These injections cause gallstones, and a later gallbladder operation is harder.
Spread to the liver does not end the surgical options. In a well-differentiated NET, removing most of the liver disease can still help.
This is where NETs differ most from ordinary cancer. In ordinary cancer, an operation that leaves some disease behind rarely helps. In a well-differentiated NET, removing most of the liver tumours is worthwhile. It controls hormone symptoms and helps survival. The options include liver resection, burning the spots with ablation, blocking their blood supply with embolisation, or a mix. A liver transplant is considered only for a few highly selected young patients at specialist centres. Medicines run alongside. Somatostatin injections slow growth and control symptoms. PRRT, a targeted radiation treatment, is used for progressive tumours that show on the DOTATATE scan. Tablets such as everolimus or sunitinib, or CAPTEM chemotherapy for the pancreas, are other choices. PRRT is costly and hard to reach locally. The referral route is planned early, not when the disease grows.
A poorly differentiated neuroendocrine carcinoma is a different, fast-growing disease. Chemotherapy is the main treatment, and the outlook is quite different.
The name sounds almost the same, but the plan is not. A carcinoma is treated like small cell cancer, with platinum and etoposide chemotherapy. Somatostatin injections and PRRT are not the main treatment here. A grade 3 tumour that is still well differentiated sits in between. It may still respond to injections or PRRT, and the board decides. That is why the pathologist must state the differentiation plainly, not just the grade. If a tumour called a NET grows much faster than expected, the slides are reviewed again, and an FDG-PET scan is done.
Some risks belong only to NETs. A carcinoid crisis under anaesthesia is the main one, and it is prevented with octreotide given before surgery starts.
The operative risks are those of the operation you need. A Whipple carries more risk than most other resections. Your own figures are given at consent.
General risks include bleeding, infection, clots in the legs or lungs, heart or breathing problems, a problem with the anaesthetic, a leak from a join, and the risk of dying. That last risk is higher for a Whipple than for most other bowel or pancreas operations. NET-specific risks are a carcinoid crisis under anaesthesia, high sugar for a while after an insulinoma, and gallstones from long-term injections. In the long run, regular scans and sometimes injections may be needed for years. This is a long relationship, not a single operation, and that is usually good news. Dr Shah talks you through four things in person. They are the good outlook in a well-differentiated tumour, the long follow-up, the crisis prevention, and the fact that the final grade comes only after the tissue is examined. For the general consent steps before pancreatic surgery, see pancreatic surgery consent and second opinion.
NETs can come back late, so five years is not the end of follow-up. Only a small, fully removed appendix NET is discharged early.
| When | What is done |
|---|---|
| Three months after surgery. | A baseline scan, chromogranin A, a symptom review and a board-confirmed plan. |
| Every 6 to 12 months, grade 1 or 2. | CT or MRI, and chromogranin A read as a trend. Urine 5-HIAA if carcinoid syndrome was present. |
| Every 3 to 6 months, grade 3 or carcinoma. | Closer scans, set by the cancer physician. |
| Appendix NET of 1 cm or less, fully removed. | No long-term follow-up. You are reassured and discharged. |
| Carcinoid syndrome. | An echo of the heart from time to time. |
| On long-term injections. | Checks for gallstones, sugar, vitamin B12 and other vitamins. |
| Beyond 5 to 10 years. | Checks continue for grade 2 and higher, and for small bowel NETs. |
| MEN1 or another inherited cause. | Lifelong checks, and testing for family members. |
A second opinion helps most before the first operation. Take one if a key fact is missing, or if the size of the operation seems out of step.
| What you notice | Why it matters |
|---|---|
| The report gives a grade but not the Ki-67, the mitotic count or the differentiation. | The plan rests on all three. |
| A Whipple is advised for a small grade 1 pancreatic NET with no symptoms. | Watching may be the safer choice for you. |
| A 1 to 2 cm appendix NET was closed with no board review. | Some need a right hemicolectomy, and some do not. |
| The CT was not done in the arterial phase. | Liver spots can be missed. |
| Liver spread was called beyond help, with no board review. | Removing most of it, or other liver treatments, may still help. |
| Several pancreatic NETs, or a young patient, with no genetics referral. | MEN1 changes the whole plan, and the family’s checks. |
| Carcinoid syndrome, but no heart echo before surgery. | A valve problem changes the anaesthetic risk. |
| A tumour called a NET is growing fast. | It may be a carcinoma, which needs a different treatment. |
A second opinion that agrees with your plan is not wasted. You go into the operation with no question left open. Bring the pathology report, the slides or blocks if you can get them, all scans on a disc, the hormone and chromogranin A results, and a list of your medicines.
★★★★★
“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
★★★★★
“My patient was having tumour in abdomen. Dr Harsh Shah did an operation called whipple’s operation. Today after 7 days of operation, we are being discharged from the hospital. We are happy with the services provided by Dr Harsh Shah & Apollo Hospital.”
— piyush aanjna, Google review
★★★★★
“Dr harsh shah is good doctor . Had done surgery for abdominal tumour .thank you so much.”
— narendra bhati, Google review
Reviews are reproduced exactly as written on Google. The first two describe a Whipple operation by Dr Harsh Shah. The third speaks about surgery for an abdominal tumour. None states the type of tumour, so none is presented as a NET case.
A patient speaks after a Whipple operation for a neuroendocrine tumour of the pancreas, performed by Dr Harsh Shah. Recorded and shared with consent. Every patient’s plan and recovery are different.
The cost depends on the operation, the days in hospital and the scans and medicines needed later. A written estimate is given before admission.
Apollo Hospital, Bhat, works with the major insurers and cashless schemes. The insurance desk handles pre-authorisation. PRRT and the DOTATATE scan are costly and are discussed early, so the referral route is ready when needed. On admission, bring all scans on a disc or drive, all reports, your medicines with doses, the insurance card and an identity proof. If you have questions about your report before booking, call +91-63555-64601.
It is a kind of cancer, but most NETs grow far more slowly than ordinary cancer. Many people live for many years in good health, even with spread to the liver.
No. A small appendix NET may need nothing more. Small rectal or stomach NETs can be removed through a scope. Some small pancreatic NETs are safer watched.
The grade shows how fast the tumour grows. With the site and the type under the microscope, it decides the operation, the medicines and the follow-up.
Sudden flushing, low blood pressure and wheeze during anaesthesia. It is prevented with an octreotide drip started before the operation.
Often, yes. In a well-differentiated NET, removing the main tumour and most of the liver disease can control symptoms and help survival.
Usually many years. NETs can come back late. Only a small, fully removed appendix NET is discharged without long follow-up.
Shah’s Gastro, Cancer & Robotic Surgery Centre — Gota, Ahmedabad
Consultations, review of reports and scans, follow-up and surveillance.
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.
Operations, endoscopic procedures and hospital stay.
Google: Dr Harsh Shah – Robotic GI Surgeon · 4.94 · 18 reviews
Directions to Apollo, Bhat · WhatsApp +91-63555-64601
Families come to Ahmedabad from across Gujarat, including Gandhinagar, Mehsana, Banaskantha, Nadiad, Anand, Bhavnagar, Rajkot, Jamnagar and Kutch, and from southern Rajasthan and western Madhya Pradesh.
Holding a biopsy, scan or appendix report that mentions a neuroendocrine tumour? The pathology report, any CT, MRI or PET scan on a disc and recent blood tests can be sent ahead of your appointment, so the consultation starts with them already read. The plan is decided at the consultation, after examination. Call +91-63555-64601 · Send the reports ahead on WhatsApp
Swasth Parivar: twice a month, practical advice on recovery, diet and warning signs. No advertising. Stop any time.
Your number is used for these updates and for the clinic to reach you. It is never sold or passed on. To stop, reply STOP on WhatsApp.
