Neuroendocrine tumors of the small bowels are on the rise: Early aspects and management

Scherübl, Hans; Jensen, Robert T.; Cadiot, Guillaume; Stölzel, Ulrich; Klöppel, Günter

doi:10.4253/wjge.v2.i10.325

Cited by 88 publications

(92 citation statements)

References 75 publications

(187 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is possibly because high-resolution imaging, endoscopic diagnosis, and immunohistochemical evaluation in conjunction with histopathological diagnosis are being more frequently used in regular clinical practice [5,6]. However, the therapeutic approach in D-NETs is not fully standardized [7].…”

Section: Introductionmentioning

confidence: 99%

The Risk Factors for Metastasis in Non-Ampullary Duodenal Neuroendocrine Tumors Measuring 20 mm or Less in Diameter

et al. 2017

View full text Add to dashboard Cite

Background/Aims: The treatment strategy for non-ampullary duodenal neuroendocrine tumors (NAD-NETs) ≤20 mm in diameter has not been established. In this study, we aimed to evaluate the detailed characteristics of NAD-NETs ≤20 mm in diameter to clarify the risk factors of subsequent metastasis. Methods: The patients with NAD-NETs ≤20 mm in diameter who had been treated at 12 institutions between 1992 and 2013 were enrolled. Clinical records were retrieved, and histopathological findings of all cases were centrally reviewed by 2 pathologists. Results: We studied 49 patients with a mean follow-up period of 66.5 months. Thirty-five patients were initially treated with endoscopic resection (ER), and 14 with surgery. A univariate analysis revealed the ORs and 95% CIs of the risk factors for metastasis were lymphovascular invasion (12.5 [2.01-77.9]), multiple tumors (9.75 [1.46-65.4]), a tumor size of 11-20 mm (6.67 [1.21-36.6]), and World Health Organization grade G2 (7.13 [1.16-43.9]). Five-year overall and disease-specific survival rates were 86.1 and 97.2%, respectively. Conclusion: This is the first study to demonstrate the risk factors of metastasis in NAD-NETs ≤20 mm in diameter. These findings may be helpful for determining the appropriate therapeutic approach and the clinical strategy of treatment following ER.

show abstract

Section: Introductionmentioning

confidence: 99%

The Risk Factors for Metastasis in Non-Ampullary Duodenal Neuroendocrine Tumors Measuring 20 mm or Less in Diameter

et al. 2017

View full text Add to dashboard Cite

show abstract

“…In an analysis of the years 1999-2004, Strosberg et al reported a 5-year survival rate of about 75% in patients with metastatic NET/carcinoid disease of the small intestine, receiving multimodal therapy [17] . An earlier detection of all NETs of the small bowel may have led to improved prognosis [15,18] , since the proportion of advanced disease of small intestine NETs (at the time of diagnosis) has decreased from 31.3% in the 1970s and 1980s, to 22.4% in the 1990s and finally to < 18.9% in the years between 2002-2004 [7,16,20,27] . With duodenal NETs/carcinoids, distant metastases are nowadays observed in less than 6%-10% of the cases [19,20,28,29,30] .…”

Section: Prognosis Of Nets/carcinoids Of the Small Bowelmentioning

confidence: 99%

“…7 mm measuring NET/carcinoid of the rectum (D2). Modified from reference [13][14][15] . NETs: neuroendocrine tumors; EUS: Endoscopic ultrasound.…”

Section: Stomach Duodenum and Rectummentioning

confidence: 99%

“…Similar observations have been reported from England [8] and Norway [9] . The most obvious reason for this phenomenon is a better awareness of, and improved diagnostic strategies, for NENs, and an increased and more widespread use of gastrointestinal endoscopy [8][9][10][11][12][13][14][15] . The overall 5-year-survival rate for patients with gastrointestinal NETs/carcinoids has improved by almost 20% in the last 35 years [16][17][18] .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Management of early gastrointestinal neuroendocrine neoplasms

Scherübl

Jensen²,

Cadiot³

et al. 2011

WJG

Self Cite

View full text Add to dashboard Cite

Neuroendocrine neoplasms (NENs) of the stomach, duodenum, appendix or rectum that are small (≤ 1 cm) and well differentiated can be considered "early" tumors, since they generally have a (very) good prognosis. In the new WHO classification of 2010, these neoplasms are called neuroendocrine tumors/ carcinoids (NETs), grade (G) 1 or 2, and distinguished from poorly differentiated neuroendocrine carcinomas (NECs), G3. NETs are increasing, with a rise in the age-adjusted incidence in the U.S.A. by about 700 % in the last 35 years. Improved early detection seems to be the main reason for these epidemiological changes. Both the better general availability of endoscopy, and imaging techniques, have led to a shift in the discovery of smaller-sized (≤ 10-20 mm) intestinal NETs/carcinoids and earlier tumor stages at diagnosis. Endoscopic screening is therefore effective in the early diagnosis, not only of colorectal adenocarcinomas, but also of NETs/carcinoids. Endoscopic removal, followed up with endoscopic surveillance is the treatment of choice in NETs/carcinoids of the stomach, duodenum and rectum that are ≤ 10 mm in size, have a low proliferative activity (G1), do not infiltrate the muscular layer and show no angioinvasion. In all the other intestinal NENs, optimal treatment generally needs surgery and/or medical therapy depending on type, biology and stage of the tumor, as well as the individual situation of the patient.

show abstract

“…Gastrointestinal NETs are increasing (7); in the USA, the prevalence and the incidence of gastrointestinal NETs have been calculated to be 35/100,000 and 5/100,000, respectively (4), revealing a 7-fold increase in the last 35 years. This phenomenon may partly reflect the increased number of diagnoses of benign and incidentally-identified lesions due to the increased availability of advanced endoscopic and radiological imaging (8)(9)(10). The overall 5-year survival rate for patients with gastrointestinal NETs has improved by almost 20% in the past 35 years (1,11,12).…”

Section: Introductionmentioning

confidence: 99%

Early diagnosis and treatment of gastrointestinal neuroendocrine tumors

Shen

Zhao

et al. 2016

Oncology Letters

View full text Add to dashboard Cite

Abstract. The aim of the present retrospective analysis on the macroscopic appearance and pathological characteristics of gastrointestinal neuroendocrine tumors (NETs) was to investigate methods for their early diagnosis and treatment. A total of 78 patients were divided into submucosal NET and deeper invasion NET groups, according to the depth of tumor invasion exhibited by the patients. The clinicopathological characteristics and survival time of the NET patients were analyzed and compared. The pathological characteristics of the submucosal NETs group were investigated according to the diameter of the tumor (≤5.0 mm, 5.1-10.0 mm or >10.0 mm). The depth of invasion at diagnosis was observed to significantly correlate with histopathological classification, diameter of the tumor, macroscopic appearance, growth pattern, lymphatic-vascular involvement, lymph node (LN) metastasis and distant metastasis. In the submucosal NETs group, high-grade tumors with lymphatic or venule invasion and distant metastasis were associated with an increased risk of nodal metastases. In patients with minute tumors (≤5.0 mm), no lymphatic-vascular involvement, LN or distant metastasis was observed. By contrast, patients with tumors measuring 5.1-10.0 mm in diameter exhibited high lymphatic-vascular involvement and LN metastasis rates (46.2 and 30.8%, respectively). Survival time was significantly longer in patients with submucosal NETs compared with deeper invasion NETs and in patients with NET G1 and NET G2 compared with NEC. The results of the present study indicate that gastrointestinal submucosal NETs are closely associated with a slightly elevated macroscopic type, low-grade tumors and a small diameter. These features may contribute to early diagnosis of gastrointestinal NETs. Therefore, a tumor diameter of <5.0 mm, with slightly elevated macroscopic appearance may indicate an absolute requirement for endoscopic resection, while tumors measuring 5.1-10.0 mm in diameter must be considered carefully.

show abstract

Neuroendocrine tumors of the small bowels are on the rise: Early aspects and management

Cited by 88 publications

References 75 publications

The Risk Factors for Metastasis in Non-Ampullary Duodenal Neuroendocrine Tumors Measuring 20 mm or Less in Diameter

The Risk Factors for Metastasis in Non-Ampullary Duodenal Neuroendocrine Tumors Measuring 20 mm or Less in Diameter

Management of early gastrointestinal neuroendocrine neoplasms

Early diagnosis and treatment of gastrointestinal neuroendocrine tumors

Contact Info

Product

Resources

About