Diagnosis and treatment of gastric neuroendocrine tumours

Abstract

Gastric neuroendocrine tumours (NET) are rare. Clinically they are classified in tumours type 1 to 3. The histological classification is according to the WHO 2000 classification for endocrine tumours. NET type 1 occur in coincidence with chronic atrophic gastritis, as single or multiple small tumours. The prognosis of type 1 tumours is excellent, with no tumour related death reported during follow-up. NET type 2 are part of the MEN-1 syndrome. These tumours may be more aggressive and even develop metastasis. However, in most patients with MEN-1 the prognosis is due to other manifestations of the disease as duodenal or pancreatic neuroendocrine tumours. Gastric neuroendocrine tumours type 3 are sporadic tumours without relationship to other gastric pathology. They tend to occur earlier, without sex preference. These tumours may develop an aggressive course, with metastatic disease and an overall poor prognosis. Thus, aggressive surgical therapy is recommended.

Serum chromogranin A level continuously rises with the progression of type 1 diabetes, and indicates the presence of both enterochromaffin‐like cell hyperplasia and autoimmune gastritis

“…AIG is present in 5–10% of type 1 diabetes patients compared with approximately 2% of the non‐type 1 diabetes population, and gastric NETs develop in approximately 4–9% of type 1 diabetes patients with AIG. Furthermore, ECL hyperplasia, AIG and gastric NETs are observed more often in women compared with men.…”

Phase II study of single agent capecitabine in the treatment of metastatic non-pancreatic neuroendocrine tumours

“…For unresectable tumours, the choice of treatment is determined by the anatomical origin, degree of differentiation and endocrine function of the NET (Plockinger, 2007; Modlin et al , 2008; Clark et al , 2009). Therapeutic options include somatostatin analogues, targeted radiotherapy, immunotherapy (interferon- α (IFN- α )), hepatic artery embolisation, radiofrequency ablation, cytotoxic chemotherapy and agents that target mTOR or angiogenesis (Modlin et al , 2008; Basu et al , 2010).…”

Treatment of gastroenteropancreatic neuroendocrine tumors

“…Surgery is rarely indicated in patients with small (<1 cm) gastric neuroendocrine tumors type 1 or type 2, due to the mostly benign course of the disease. In contrast, oncological resection of the tumor is imperative in malignant type 3 gastric neuroendocrine tumors [53,54,58]. Duodenal and pancreatic primaries are both indications for surgical therapy.…”