The Neuroendocrine Neoplasms of the Digestive Tract: Diagnosis, Treatment and Nutrition

Abstract

Nuroendocrine neoplasms (NENs) are a group of rare neoplasms originating from dispersed neuroendocrine cells, mainly of the digestive and respiratory tract, showing characteristic histology and immunoprofile contributing to classification of NENs. Some NENs have the ability to produce biogenic amines and peptide hormones, which may be associated with clinical syndromes like, e.g., the carcinoid syndrome caused by unmetabolized overproduced serotonin, hypoglycemic syndrome in case of insulinoma, or Zollinger-Ellison syndrome accompanying gastrinoma. Diagnostics for these include ultrasound with endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI), and positron-emission tomography/computed tomography (PET/CT). Different nuclear medicine procedures can also be used, like somatostatin analogues scintigraphy (SRS) and 68Ga-Dota-Peptide PET/CT, as well as biochemical methods to determine the level of general neuroendocrine markers, such as chromogranin A (CgA), 5-hydroxyindolacetic acid (5-HIAA), synaptopfysin and cell type-specific peptide hormones, and neurotransmitters like gastrin, insulin, serotonin, and histamine. NENs influence the whole organism by modulating metabolism. The treatment options for neuroendocrine neoplasms include surgery, somatostatin analogue therapy, radionuclide therapy, chemotherapy, molecular targeted therapies, alpha-interferon therapy, and inhibitors of serotonin production. In the case of hypersensitivity to biogenic amines, a diet that limits the main sources of amines should be used. The symptoms are usually connected with histamine, tyramine and putrescine. Exogenic sources of histamine are products that take a long time to mature and ferment. Patients with a genetic insufficiency of the diamine oxidase enzyme (DAO), and those that take medicine belonging to the group of monoamine oxidases (MAO), are particularly susceptible to the negative effects of amines. Diet plays an important role in the initiation, promotion, and progression of cancers. As a result of the illness, the consumption of some nutrients can be reduced, leading to nutritional deficiencies and resulting in malnutrition. Changes in metabolism may lead to cachexia in some patients suffering from NENs. The aim of this narrative review was to advance the knowledge in this area, and to determine possibilities related to dietary support. The authors also paid attention to role of biogenic amines in the treatment of patients with NENs. We can use this information to better understand nutritional issues faced by patients with gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs), and to help inform the development of screening tools and clinical practice guidelines.

Comparison of the Clinical Features and Outcomes of Gallbladder Neuroendocrine Carcinoma with Those of Adenocarcinoma: A Propensity Score-Matched Analysis

“…In addition, CgA is a soluble secretory glycoprotein secreted by dense-core secretory of neuroendocrine cells [ 28 , 29 , 30 ], and it has been found that 60% to 80% of NENs in the digestive system contain elevated serum CgA levels [ 31 , 32 , 33 ]. Serum CgA is related to tumor burden, and the serial measurement of CgA may be useful to detect recurrence [ 29 , 34 ]. In a previous study involving 44 patients with NENs, the sensitivity and specificity of CgA for detecting NEN were 86% and 88%, respectively [ 31 ].…”

Assessment and State of Nutrition of Patients with Gastroenteropancreatic Neuroendocrine Neoplasms

“…The recommendations also focus on the limitation of the consumption of fat to 30%, especially in people with a carcinoid and a tendency to have diarrhea [36]. However, it is highlighted that a diet's constituents should be individually adjusted to the needs of the patient [37]. Moreover, NEN patients with hypersensitivity should be wary of certain products that feature biogenic amines [37].…”

“…However, it is highlighted that a diet's constituents should be individually adjusted to the needs of the patient [37]. Moreover, NEN patients with hypersensitivity should be wary of certain products that feature biogenic amines [37]. Products that they should avoid include, e.g., ripe cheese, smoked meat, alcohol-wine/beer, soy products, broad bean, sauerkraut, tomatoes, avocados, bananas, raspberries, pineapples and chocolate [33].…”

“…The introduction of nutritional education among patients with GEP-NENs is the right direction to support their oncological treatment. Due to the variety of symptoms, nutritional status and NEN-associated diseases, nutritional approaches for each patient should be individualized [37].…”

The Change in the Content of Nutrients in Diets Eliminating Products of Animal Origin in Comparison to a Regular Diet from the Area of Middle-Eastern Europe

“…Frequently occurring caloric restrictions in the use of vegetarian diets have an effect on life extension and protection against cancer [ 7 ]. Likewise, eliminating fried, smoked, or grilled foods, red meat, aflatoxin-contaminated foods, preserved salty meals, and alcohol [ 8 ]. Moreover, cancer risk is also reduced by introducing a diet rich in plant foods (e.g., vegetables, beans, fruit, and whole grains) and by reducing consumption of animal fat, meat, and fatty dairy products [ 9 ].…”