Gastrointestinal neuroendocrine (carcinoid) tumours: current diagnosis and management

• DOI: 10.5694/j.1326-5377.2010.tb03742.x
• Publication Date: 2019-09-24T08:55:38Z
• Authors: Irvin M Modlin; Steven F Moss; Kjell Oberg; Robert Padbury; Rodney J Hicks; Bjorn I Gustafsson; Nicholas A Wright; Mark Kidd
• Keywords: Chromogranin A; Radionuclide therapy; Lanreotide

Neuroendocrine tumours (NETs) are increasing in both incidence and prevalence and, as a group, more prevalent than either gastric, pancreatic, oesophageal or hepatobiliary adenocarcinomas, any two of these cancers combined. Clinical awareness the protean intermittent symptoms NETs (eg, sweating, flushing, diarrhoea, bronchospasm) is critical for timely diagnosis; however, classical carcinoid syndrome relatively uncommon. The most useful diagnostic test gastrointestinal measurement plasma chromogranin A (CgA) levels. Disease extent assessed by anatomical imaging, nuclear imaging with radiolabelled somatostatin analogues. Pathological evaluation comprises tumour–node–metastasis classification, minimum pathological dataset, CgA synaptophysin immunostaining, well mitotic count Ki-67 index (a marker cell proliferation) to define grading. Resection primary lesion much metastatic disease possible increases efficacy medical therapy. Other management strategies include hepatic embolisation peptide receptor radionuclide Patients expressing receptors should be treated Depending on tumour grade, other effective agents cytotoxics, tyrosine kinase inhibitors, antiangiogenics. overarching requirement best patients ensure that they have ready access experienced multidisciplinary clinician groups located within centres appropriate subspecialty expertise.