A review on management discussions of small intestinal neuroendocrine tumors 'midgut carcinoids'. (May 2015)

• Record Type: Journal Article
• Authors: Åkerström, Göran; Norlén, Olov; Edfeldt, Katarina; Crona, Joakim; Björklund, Peyman; Westin, Gunnar; Hellman, Per; Stålberg, Peter
• Is Part Of: International journal of endocrine oncology. Volume 2:Number 2(2015)
• Page Start: 119
• Page End: 128
• Publication Date: 2015-05
• Subjects: carcinoid heart disease -- Ki67 proliferation index -- liver metastases -- mesenteric metastases -- peritoneal carcinomatosis -- small intestinal neuroendocrine tumors (SI-NET) -- surgical treatment -- survival -- TNM classification; Endocrine glands -- Cancer -- Periodicals; 616.9944005
• DOI: 10.2217/ije.15.2
• Languages: English
• ISSNs: 2045-0869

Abstract

European Neuroendocrine Tumor Society staging, together with the Ki67 grading system, has appeared as superior for classification of neuroendocrine tumors (NET). The management of small intestinal NET (SI-NET) has been overall controversial. Mesenteric metastases occur also with the smallest SI-NET, and the majority of patients risk to ultimately progress with liver metastases. 68 Gallium (somatostatin receptor)/PET/CT has appeared as most sensitive for imaging, and fluorodeoxyglucose-PET is recommended to identify lesions with high proliferation. Our treatment policy for SI-NET is to initiate somatostatin analog treatment, and in order to prevent abdominal complications we recommend early intestinal resection for removal of primary tumors and clearance of lymph node metastases. Liver metastases are liberally treated by resection (or ablation), as this can efficiently palliate carcinoid syndrome-associated symptoms.