Materiały źródłowe

• #1 Principles of diagnosis and management of neuroendocrine tumours

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5359105/

  Neuroendocrine tumours (NETs) are a unique group of malignant growths, best known for their ability to secrete bioactive peptides, which may cause symptoms such as flushing and diarrhea. […] Because NETs are perceived to be uncommon and may be nonspecific in their presentation, delays in diagnosis are frequent. A recent international survey of 1928 patients with NETs reported a mean delay of 52 months between symptom onset and diagnosis; patients see an average of six different health care providers before receiving the correct diagnosis. […] This review summarizes the classification, presentation, diagnostic workup and treatment of NETs with the aim of helping generalists to facilitate timely diagnosis and referral. Diagnostic recommendations made in this review are based on consensus expert opinion, whereas recommendations for systemic treatment are largely based on phase three randomized controlled trials (RCTs), which compare new treatments with standard treatment.

• #2 Principles of diagnosis and management of neuroendocrine tumours

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5359105/

  The diagnosis of a NET requires a coordinated multidisciplinary effort involving medical oncologists, surgeons, interventional radiologists and pathologists. Results from pathology testing, hormonal testing, and diagnostic and functional imaging are integrated to form a comprehensive diagnostic picture. […] Obtaining tissue for pathology testing is mandatory for the diagnosis of NETs. When surgical resection is not an option, core needle biopsy is preferred over fine needle aspiration to allow full assessment of the tumour architecture. […] For patients presenting with symptoms of a functioning NET, biochemical testing should be targeted to the specific syndrome. […] Chromogranin A is the diagnostic biomarker of choice for NETs. […] There are two general categories of diagnostic imaging modalities that are used in combination for the diagnosis of NETs. […] Standard cross-sectional imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is recommended for all patients with a suspected NET. […] Endoscopic ultrasonography is the most sensitive test for the diagnosis of pancreatic NETs (sensitivity 82%93%).

• #3 How are neuroendocrine tumors diagnosed? | Roswell Park Comprehensive Cancer Center – Buffalo, NY

  https://www.roswellpark.org/cancertalk/202411/how-are-neuroendocrine-tumors-diagnosed

  The diagnosis and treatment of a NET requires a coordinated multidisciplinary approach involving an expert team of specialists including medical oncologists, surgeons, interventional radiologists, pathologists, nutritionists, social workers and other healthcare staff, Dr. Iyer says. […] Results from pathology testing, hormonal testing, and diagnostic and functional imaging are integrated to form a complete diagnostic picture. […] Roswell Park Comprehensive Cancer Center brings together experts in these fields who take a comprehensive approach to NET diagnosis and treatment planning. […] Along with a team of dedicated NET experts, with nearly 20 years of experience in diagnosing and treating NET patients, Roswell Park is a leading center for NET care, committed to giving patient-centered care and holistic approaches to treatment.

• #4 Diagnosis of neuroendocrine tumours (NETs) | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/neuroendocrine-tumours/diagnosis

  Diagnosis is the process of finding out the cause of a health problem. Diagnosing a neuroendocrine tumour (NET) may begin with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for a NET or other health problems. […] The following tests are usually used to rule out or diagnose NETs. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. […] Biochemical markers are substances, including proteins and hormones, measured in the blood or urine that are made and released by the cells of a tumour. An increased amount of certain markers may mean that a person has a neuroendocrine tumour or a hormonal syndrome, such as carcinoid syndrome. Biochemical markers can also be used to check your response to cancer treatment and during follow-up.

• #5 Tests to diagnose neuroendocrine cancer

  https://www.cancerresearchuk.org/about-cancer/neuroendocrine-tumours-nets/getting-diagnosed/tests-diagnose

  You usually have a number of tests to diagnose cancer. If you have neuroendocrine cancer these test results help your doctors find out your type and stage. […] The tests include: blood tests, urine tests, x-rays and scans, tests to look inside your body – such as endoscopy or colonoscopy. […] Your GP might do some tests to help them decide if you need to see a specialist. These tests include: blood tests, a physical examination. […] Blood tests can check your general health. They can also sometimes pick up problems caused by neuroendocrine cancer. […] If they suspect neuroendocrine cancer, they refer you to a neuroendocrine multi disciplinary team (MDT). […] Your specialist usually repeats the blood tests done by your GP. You also have more tests. These might include: further blood tests, scans such as CT scan, MRI scan, PET-CT scan and octreoscan, tests to look inside your body – such as endoscopy, bronchoscopy or colonoscopy, an endoscopic ultrasound scan to look inside your abdomen.

• #6 What are neuroendocrine tumors, and how are they treated? | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/neuroendocrine-tumors–9-things-to-know.h00-159379578.html

  About 12,000 people in the United States will be diagnosed with neuroendocrine tumors sometimes called carcinoid tumors each year. […] Neuroendocrine tumors are cancers that can develop anywhere endocrine cells are present. […] The short answer is that neuroendocrine tumors are almost always cancerous. […] Today, almost all neuroendocrine tumors are considered malignant. […] How are neuroendocrine tumors usually diagnosed? […] Some seek help for symptoms, such as pain due to metastatic cancer. […] For others, the cancer is detected purely by chance. […] We can treat neuroendocrine tumors that have spread, but right now, we cannot cure metastatic neuroendocrine tumors. […] Many patients with neuroendocrine tumors have hormonal symptoms that get progressively worse. […] Where you go first for treatment matters. And the sequencing of that treatment matters. […] We believe that patients benefit most when they get the right treatment at the right time with doctors who specialize in treating these complex diseases.

• #7 Diagnosis of neuroendocrine tumours (NETs) | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/neuroendocrine-tumours/diagnosis

  Diagnosis is the process of finding out the cause of a health problem. Diagnosing a neuroendocrine tumour (NET) may begin with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for a NET or other health problems. […] The following tests are usually used to rule out or diagnose NETs. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. […] Biochemical markers are substances, including proteins and hormones, measured in the blood or urine that are made and released by the cells of a tumour. An increased amount of certain markers may mean that a person has a neuroendocrine tumour or a hormonal syndrome, such as carcinoid syndrome. Biochemical markers can also be used to check your response to cancer treatment and during follow-up.

• #8 Diagnosis – Neuroendocrine tumors – Cancer Institute | Northwell Health

  https://cancer.northwell.edu/cancer-care/neuroendocrine-tumors/diagnosis

  Diagnosing neuroendocrine tumors can be challenging because there are so many types. At Northwell, you have access to leading-edge diagnostic tools and some of the Northeasts top diagnostic specialists. What type of tests you take depends on the type of tumor suspected, and could include: […] Advanced diagnostic tools and some of the most promising therapies available make us a leading provider for the treatment of neuroendocrine tumors. […] Physical exam (all tumor types): A thorough physical examination in which a doctor feels for lumps and looks for other signs of disease. […] Blood and urine tests (carcinoid, pancreatic, pheochromocytoma): These tests measure the amount of hormones and other substances present. Abnormalities in the counts may indicate cancer. […] Molecular testing (all tumor types): These tests help doctors identify genes, proteins and other factors unique to each type of tumor.

• #9 Lab and Imaging Tests for Neuroendocrine Tumors

  https://www.webmd.com/cancer/neuroendocrine-tumors-diagnosis

  Neuroendocrine tumors (NETs) look and act differently than a lot of other tumors. That can make them harder to spot. Your doctor may ask you to take several different tests to help them make a diagnosis. […] Sometimes doctors discover NETs by accident while doing tests to look for other diseases. But if you do have symptoms, like diarrhea, fatigue, or redness and heat in your face, let your doctor know right away. Lab and imaging tests can find the cause — and the right treatment. […] One way your doctor can check whether you have a NET is to take advantage of the fact that some tumors release hormones and proteins. They can do tests that find these substances in your blood and urine. […] Another blood test checks for chromogranin A (CgA), a protein that NETs release. About 60%-80% of NET tumors in the pancreas and digestive system raise CgA levels in your blood.

• #10 Diagnostic work-up of gastroenteropancreatic neuroendocrine tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3328823/

  Neuroendocrine tumors are a heterogeneous group of malignancies that present a diagnostic challenge. The diagnosis is based on histopathology, imaging, and circulating biomarkers. The histopathology should contain specific neuroendocrine markers such as chromogranin A, synaptophysin, and neuron-specific enolase and also an estimate of the proliferation by Ki-67 (MIB-1). Standard imaging procedures consist of computed tomography or magnetic resonance imaging together with somatostatin receptor scintigraphy. 68Ga-DOTA-octreotate scans will in the future replace somatostatin receptor scintigraphy because they have higher specificity and sensitivity. Neuroendocrine tumors secrete many different peptides and amines that can be used as circulating biomarkers. The most useful general marker is chromogranin A, which is both a diagnostic and prognostic marker in most neuroendocrine tumors. However, there is still a need for improved biomarkers for early detection and follow-up of patients during treatment. The initial diagnostic approach in patients with NETs includes histological examination, which is always required before therapeutic decisions are made. The following investigations are also required: (a) immunohistochemical markers and detailed histological analysis; (b) assessment of the primary tumor and the extent of extrahepatic spread by imaging, including patterns of hepatic metastases; and (c) biochemical assessment of functionality and general tumor markers. Immunohistochemical determination of CgA and synaptophysin as well as proliferation marker Ki-67 (MIB-1) is mandatory. The minimal biochemical work-up for NETs includes circulating chromogranin A and assessment of a specific marker to assess functionality, such as urinary 5-HIAA evaluation in carcinoid syndrome. There has been impressive progress in the field of biomarkers as well as molecular imaging. However, we still need more sensitive markers for early detection and follow-up.

• #11 Gastrointestinal Neuroendocrine Tumors (PDQ®) – NCI

  https://www.cancer.gov/types/gi-neuroendocrine-tumors/hp/gi-neuroendocrine-treatment-pdq

  Diagnostics: Biochemical Markers, Imaging, and Approach […] Biochemical investigations in the diagnosis of gastrointestinal neuroendocrine tumors include the use of 24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA) collection, which has a specificity of approximately 88%, although the sensitivity is reported to be as low as 35%. Measurement of plasma chromogranin A (CgA), first described in a study of adrenal gland secretions in 1967 as one of the soluble protein fractions (also including CgB and CgC) of chromaffin granules, is also useful. Although plasma levels of CgA are very sensitive markers of gastrointestinal neuroendocrine tumors, they are nonspecific because they are also elevated in other types of neuroendocrine tumors, such as pancreatic and small cell lung carcinomas. Plasma CgA appears to be a better biochemical marker of neuroendocrine tumors than urinary 5-HIAA. Numerous investigations have revealed an association between plasma CgA levels and disease severity. However, false-positive plasma levels of CgA may occur in patients on proton pump inhibitors, reported to occur even with short-term, low-dose treatment. Many other biochemical markers are associated with neuroendocrine tumors including substance P, neurotensin, bradykinin, human chorionic gonadotropin, neuropeptide L, and pancreatic polypeptide but none match the specificity or predictive value of 5-HIAA or CgA.

• #12 Gastrointestinal Neuroendocrine Tumors (PDQ®) – NCI

  https://www.cancer.gov/types/gi-neuroendocrine-tumors/hp/gi-neuroendocrine-treatment-pdq

  Diagnostics: Biochemical Markers, Imaging, and Approach […] Biochemical investigations in the diagnosis of gastrointestinal neuroendocrine tumors include the use of 24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA) collection, which has a specificity of approximately 88%, although the sensitivity is reported to be as low as 35%. Measurement of plasma chromogranin A (CgA), first described in a study of adrenal gland secretions in 1967 as one of the soluble protein fractions (also including CgB and CgC) of chromaffin granules, is also useful. Although plasma levels of CgA are very sensitive markers of gastrointestinal neuroendocrine tumors, they are nonspecific because they are also elevated in other types of neuroendocrine tumors, such as pancreatic and small cell lung carcinomas. Plasma CgA appears to be a better biochemical marker of neuroendocrine tumors than urinary 5-HIAA. Numerous investigations have revealed an association between plasma CgA levels and disease severity. However, false-positive plasma levels of CgA may occur in patients on proton pump inhibitors, reported to occur even with short-term, low-dose treatment. Many other biochemical markers are associated with neuroendocrine tumors including substance P, neurotensin, bradykinin, human chorionic gonadotropin, neuropeptide L, and pancreatic polypeptide but none match the specificity or predictive value of 5-HIAA or CgA.

• #13 Tests to diagnose neuroendocrine cancer

  https://www.cancerresearchuk.org/about-cancer/neuroendocrine-tumours-nets/getting-diagnosed/tests-diagnose

  If your doctor suspects a neuroendocrine cancer they might look at the levels of a specific hormone. […] A raised amount of 5-HIAA in your urine can be a sign of a neuroendocrine tumour. […] The test you have depends on where the suspected neuroendocrine cancer is. […] A biopsy means removing a piece of tissue so that a pathologist can look at it under a microscope. This is the only way to be certain if an abnormal area is cancer and what type it is. […] A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body. […] MRI scans can sometimes show up soft tissue more clearly than CT scans. […] PET-CT scans can be useful for some types of neuroendocrine cancer. […] Radioactive scans can help your doctors diagnose some types of neuroendocrine cancer. […] The tests you have help your doctor find out if you have neuroendocrine cancer. And it tells them what type it is, and where it is in your body.

• #14 Principles of diagnosis and management of neuroendocrine tumours

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5359105/

  The diagnosis of a NET requires a coordinated multidisciplinary effort involving medical oncologists, surgeons, interventional radiologists and pathologists. Results from pathology testing, hormonal testing, and diagnostic and functional imaging are integrated to form a comprehensive diagnostic picture. […] Obtaining tissue for pathology testing is mandatory for the diagnosis of NETs. When surgical resection is not an option, core needle biopsy is preferred over fine needle aspiration to allow full assessment of the tumour architecture. […] For patients presenting with symptoms of a functioning NET, biochemical testing should be targeted to the specific syndrome. […] Chromogranin A is the diagnostic biomarker of choice for NETs. […] There are two general categories of diagnostic imaging modalities that are used in combination for the diagnosis of NETs. […] Standard cross-sectional imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is recommended for all patients with a suspected NET. […] Endoscopic ultrasonography is the most sensitive test for the diagnosis of pancreatic NETs (sensitivity 82%93%).

• #15 Pancreatic Neuroendocrine Tumors : Diagnosis and Management with an Emphasis on Endoscopy – Practical Gastro

  https://practicalgastro.com/2023/01/26/pancreatic-neuroendocrine-tumors-diagnosis-and-management-with-an-emphasis-on-endoscopy/

  Pancreatic neuroendocrine neoplasms (pNENs) and carcinoid tumors develop from the islets of Langerhans in the pancreas and enterochromaffin cells in the gastrointestinal tract, respectively. […] The incidence of GEP-NENs has expanded over the past few decades, likely due to increased emphasis on screening and widespread use of cross-sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI). […] Also, recent technological advancements in endoscopy have facilitated the early diagnosis of neuroendocrine neoplasms. […] In this review, we will summarize the clinical presentations and diagnostic criteria of each functional GEP-NEN. […] The most dependable test to diagnose insulinomas is the measurement of serum glucose, proinsulin, and C-peptide levels after an overnight fast and every 4 hours for up to 72 hours.

• #16 Pancreatic Neuroendocrine Tumors : Diagnosis and Management with an Emphasis on Endoscopy – Practical Gastro

  https://practicalgastro.com/2023/01/26/pancreatic-neuroendocrine-tumors-diagnosis-and-management-with-an-emphasis-on-endoscopy/

  Pancreatic neuroendocrine neoplasms (pNENs) and carcinoid tumors develop from the islets of Langerhans in the pancreas and enterochromaffin cells in the gastrointestinal tract, respectively. […] The incidence of GEP-NENs has expanded over the past few decades, likely due to increased emphasis on screening and widespread use of cross-sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI). […] Also, recent technological advancements in endoscopy have facilitated the early diagnosis of neuroendocrine neoplasms. […] In this review, we will summarize the clinical presentations and diagnostic criteria of each functional GEP-NEN. […] The most dependable test to diagnose insulinomas is the measurement of serum glucose, proinsulin, and C-peptide levels after an overnight fast and every 4 hours for up to 72 hours.

• #17 Pancreatic Neuroendocrine Tumors : Diagnosis and Management with an Emphasis on Endoscopy – Practical Gastro

  https://practicalgastro.com/2023/01/26/pancreatic-neuroendocrine-tumors-diagnosis-and-management-with-an-emphasis-on-endoscopy/

  Gastrinomas can be diagnosed by measuring the gastric pH and fasting serum gastrin (FSG) levels. […] To diagnose a VIPoma, patients must present with secretory diarrhea and plasma VIPs 500 pg/mL. […] Clinical documentation of necrolytic migratory erythema with a fasting plasma glucagon value 500 pg/mL can confirm the diagnosis. […] Somatostatinomas are usually diagnosed after immunohistochemical staining for somatostatin. […] In patients with suspected carcinoid syndrome, measuring urinary 5-Hydroxyindoleacetic acid (5HIAA) for 24 hours is the recommended initial test, with a sensitivity and specificity of 73% and 100%, respectively. […] All patients with MEN-1 syndrome should undergo active surveillance throughout their lives to reduce the risk of malignant transformation of pNENs.

• #18 Principles of diagnosis and management of neuroendocrine tumours

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5359105/

  The diagnosis of a NET requires a coordinated multidisciplinary effort involving medical oncologists, surgeons, interventional radiologists and pathologists. Results from pathology testing, hormonal testing, and diagnostic and functional imaging are integrated to form a comprehensive diagnostic picture. […] Obtaining tissue for pathology testing is mandatory for the diagnosis of NETs. When surgical resection is not an option, core needle biopsy is preferred over fine needle aspiration to allow full assessment of the tumour architecture. […] For patients presenting with symptoms of a functioning NET, biochemical testing should be targeted to the specific syndrome. […] Chromogranin A is the diagnostic biomarker of choice for NETs. […] There are two general categories of diagnostic imaging modalities that are used in combination for the diagnosis of NETs. […] Standard cross-sectional imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is recommended for all patients with a suspected NET. […] Endoscopic ultrasonography is the most sensitive test for the diagnosis of pancreatic NETs (sensitivity 82%93%).

• #19 Lab and Imaging Tests for Neuroendocrine Tumors

  https://www.webmd.com/cancer/neuroendocrine-tumors-diagnosis

  While lab tests check for things your tumor releases, imaging tests let your doctor look inside your body and see the tumor. This way, they can learn more about its location and size. […] Nuclear medicine tests go a step further. They can give your doctor an idea of how the tumor functions. Together, these two types of tests give doctors a complete picture. […] Your doctor removes some cells from the tumor. They may take it out with a needle that they put through your skin. […] After the cells are removed, a specialist checks them under a microscope to see if they’re cancerous. The biopsy also lets the specialist look at their features and predict how your disease may act next. […] If the results show you have a cancerous NET, your doctor will give your disease a grade and stage. These describe the size of your cancer, how it looks under a microscope, and whether it has grown and spread. This information will help your doctor decide on the best treatment for you.

• #20 Principles of diagnosis and management of neuroendocrine tumours

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5359105/

  The diagnosis of a NET requires a coordinated multidisciplinary effort involving medical oncologists, surgeons, interventional radiologists and pathologists. Results from pathology testing, hormonal testing, and diagnostic and functional imaging are integrated to form a comprehensive diagnostic picture. […] Obtaining tissue for pathology testing is mandatory for the diagnosis of NETs. When surgical resection is not an option, core needle biopsy is preferred over fine needle aspiration to allow full assessment of the tumour architecture. […] For patients presenting with symptoms of a functioning NET, biochemical testing should be targeted to the specific syndrome. […] Chromogranin A is the diagnostic biomarker of choice for NETs. […] There are two general categories of diagnostic imaging modalities that are used in combination for the diagnosis of NETs. […] Standard cross-sectional imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is recommended for all patients with a suspected NET. […] Endoscopic ultrasonography is the most sensitive test for the diagnosis of pancreatic NETs (sensitivity 82%93%).

• #21 Tests to diagnose neuroendocrine cancer

  https://www.cancerresearchuk.org/about-cancer/neuroendocrine-tumours-nets/getting-diagnosed/tests-diagnose

  If your doctor suspects a neuroendocrine cancer they might look at the levels of a specific hormone. […] A raised amount of 5-HIAA in your urine can be a sign of a neuroendocrine tumour. […] The test you have depends on where the suspected neuroendocrine cancer is. […] A biopsy means removing a piece of tissue so that a pathologist can look at it under a microscope. This is the only way to be certain if an abnormal area is cancer and what type it is. […] A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body. […] MRI scans can sometimes show up soft tissue more clearly than CT scans. […] PET-CT scans can be useful for some types of neuroendocrine cancer. […] Radioactive scans can help your doctors diagnose some types of neuroendocrine cancer. […] The tests you have help your doctor find out if you have neuroendocrine cancer. And it tells them what type it is, and where it is in your body.

• #22 Diagnosis of Pancreatic Neuroendocrine Tumors

  https://www.e-ce.org/journal/view.php?doi=10.5946/ce.2017.131

  The evaluation of hormones or peptides, including insulin, glucagon, gastric, VIP, and somatostatin, is essential for the diagnosis of functional PNETs when signs or symptoms are present. […] For localization and staging of PNETs, multiphasic contrast-enhanced CT is considered the imaging study of choice. […] MRI has been suggested to be more sensitive in detecting small tumors and liver metastasis than other modalities. […] EUS provides high-resolution ultrasonic images of the pancreas and can detect small tumors less than 2-3 cm. […] Early detection through advanced imaging modalities and proper classification and staging with the recently updated classification system are important in providing prognostic information and decision for the management of PNETs.

• #23 Carcinoid Syndrome Tests – NETRF

  https://netrf.org/old-for-patients/living-with-nets/carcinoid-syndrome/carcinoid-syndrome-tests/

  A variety of tests are used to detect and monitor neuroendocrine tumors and carcinoid syndrome, including laboratory tests, and various imaging tests such as PET/CT, MRI, and increasingly sophisticated nuclear medicine studies. […] Laboratory tests focus on detecting the substances (e.g., serotonin) that a neuroendocrine tumor produces that cause carcinoid syndrome symptoms. […] Imaging tests are used to locate the tumor and evaluate the extent of the disease, for instance, if the cancer has spread. […] Other diagnostic tests include upper and/or lower GI endoscopy, with or without ultrasound, to locate tumors and even remove a small piece for testing (called a biopsy). […] The triple-phase CT scan, which makes a cross-sectional image of the abdomen, is a useful diagnostic test. […] MRI is particularly useful due to its high sensitivity for liver metastases.

• #24 Neuroendocrine tumors | Diagnosis | UK Healthcare

  https://ukhealthcare.uky.edu/markey-cancer-center/cancer-types/neuroendocrine/diagnosis

  Typically, MRI scans are the best test for outlining a bone tumor and are also helpful for looking at the brain and spinal cord. […] This specialized and highly sensitive PET scan looks for neuroendocrine tumors. […] A biopsy removes tissue or cells that are checked by a pathologist under a microscope. Results from a biopsy help determine if abnormal cells are cancerous. […] Patients will be contacted after a biopsy by a Markey team member to review results. Further management will be recommended at that time. […] When you are diagnosed with neuroendocrine cancer, it is common to feel a sense of urgency around starting treatment. However, in most cases, there is time to do the needed research to ensure that your diagnosis is correct. That may include getting a second opinion. […] Our team of experts works together to diagnose, treat and prevent neuroendocrine cancer, with a focus on individualized patient care.

• #25 Tests for Pancreatic Neuroendocrine Tumor | American Cancer Society

  https://www.cancer.org/cancer/types/pancreatic-neuroendocrine-tumor/detection-diagnosis-staging/how-diagnosed.html

  Certain signs and symptoms might suggest that a person could have a pancreatic neuroendocrine tumor (NET), but they will need tests to confirm the diagnosis. […] In taking your medical history, the doctor will ask questions about your general health, lifestyle habits, symptoms, and risk factors. […] If the exam results are abnormal, your doctor will probably order tests, such as imaging, labs, or other procedures, to help find the problem. […] A CT scan uses x-rays taken from different angles, which are combined by a computer to make detailed pictures of the organs. […] Like CT scans, MRI scans show detailed images of soft tissues in the body. […] Ultrasound tests use sound waves to create images of organs such as the pancreas. […] These imaging tests look at the pancreatic ducts and bile ducts to see if they are blocked, narrowed, or dilated.

• #26 Neuroendocrine tumor – Wikipedia

  https://en.wikipedia.org/wiki/Neuroendocrine_tumor

  Symptoms from secreted hormones may prompt measurement of the corresponding hormones in the blood or their associated urinary products, for initial diagnosis or to assess the interval change in the tumor. […] For morphological imaging, CT-scans, MRIs, sonography (ultrasound), and endoscopy (including endoscopic ultrasound) are commonly used. […] Advances in nuclear medicine imaging, also known as molecular imaging, have improved diagnostic and treatment paradigms in patients with neuroendocrine tumors. […] Neuroendocrine tumors, despite differing embryological origin, have common phenotypic characteristics. NETs show tissue immunoreactivity for markers of neuroendocrine differentiation (pan-neuroendocrine tissue markers) and may secrete various peptides and hormones.

• #27 Neuroendocrine tumours: the role of imaging for diagnosis and therapy | Nature Reviews Endocrinology

  https://www.nature.com/articles/nrendo.2013.246

  PETCT with 18F-dihydroxy-L-phenylalanine and 11C-hydroxy-L-tryptophan might potentially be used in the future for therapy response evaluation. […] 18F-FDG-PET is only recommended in patients with grade 3 neuroendocrine cancers but shows potential for other indications, for example, to predict prognosis and determine treatment schedule. […] In patients with neuroendocrine tumours (NETs), a combination of morphological imaging and nuclear medicine techniques is mandatory for primary tumour visualization, staging and evaluation of somatostatin receptor status. […] Somatostatin receptor imaging, by 111In-pentetreotide scintigraphy or PET with 68Ga-labelled somatostatin analogues, frequently identifies additional lesions that are not visible on CT or MRI scans. […] Currently, somatostatin receptor scintigraphy with 111In-pentetreotide is the more frequently available of the two techniques to determine somatostatin receptor expression and is needed to select patients for peptide receptor radionuclide therapy.

• #28 Diagnostic work-up of gastroenteropancreatic neuroendocrine tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3328823/

  Neuroendocrine tumors are a heterogeneous group of malignancies that present a diagnostic challenge. The diagnosis is based on histopathology, imaging, and circulating biomarkers. The histopathology should contain specific neuroendocrine markers such as chromogranin A, synaptophysin, and neuron-specific enolase and also an estimate of the proliferation by Ki-67 (MIB-1). Standard imaging procedures consist of computed tomography or magnetic resonance imaging together with somatostatin receptor scintigraphy. 68Ga-DOTA-octreotate scans will in the future replace somatostatin receptor scintigraphy because they have higher specificity and sensitivity. Neuroendocrine tumors secrete many different peptides and amines that can be used as circulating biomarkers. The most useful general marker is chromogranin A, which is both a diagnostic and prognostic marker in most neuroendocrine tumors. However, there is still a need for improved biomarkers for early detection and follow-up of patients during treatment. The initial diagnostic approach in patients with NETs includes histological examination, which is always required before therapeutic decisions are made. The following investigations are also required: (a) immunohistochemical markers and detailed histological analysis; (b) assessment of the primary tumor and the extent of extrahepatic spread by imaging, including patterns of hepatic metastases; and (c) biochemical assessment of functionality and general tumor markers. Immunohistochemical determination of CgA and synaptophysin as well as proliferation marker Ki-67 (MIB-1) is mandatory. The minimal biochemical work-up for NETs includes circulating chromogranin A and assessment of a specific marker to assess functionality, such as urinary 5-HIAA evaluation in carcinoid syndrome. There has been impressive progress in the field of biomarkers as well as molecular imaging. However, we still need more sensitive markers for early detection and follow-up.

• #29 How are neuroendocrine tumors diagnosed? | Roswell Park Comprehensive Cancer Center – Buffalo, NY

  https://www.roswellpark.org/cancertalk/202411/how-are-neuroendocrine-tumors-diagnosed

  Roswell Park offers cutting-edge technology for diagnosis and surveillance of NET patients, including the latest PET scans using radiopharmaceuticals, such as gallium-68 dotatate (NetSpot) and copper-64 dotatate scan. […] Multiple clinical trials are available for NET patients, that offer access to treatments unavailable from other providers, such as a treatment vaccine for patients with metastatic neuroendocrine tumors, nanoliposomal irinotecan, various novel agents and immunotherapy trials.

• #30 Neuroendocrine tumours: the role of imaging for diagnosis and therapy | Nature Reviews Endocrinology

  https://www.nature.com/articles/nrendo.2013.246

  In the future, because of its higher sensitivity, PET with 68Ga-labelled somatostatin analogues is expected to replace somatostatin receptor scintigraphy. […] Whereas 18F-FDG-PET is only used in high-grade neuroendocrine cancers, PETCT with 18F-dihydroxy-L-phenylalanine or 11C-5-hydroxy-L-tryptophan is a useful problem-solving tool and could be considered for the evaluation of therapy response in the future.

• #31 Neuroendocrine tumours: the role of imaging for diagnosis and therapy | Nature Reviews Endocrinology

  https://www.nature.com/articles/nrendo.2013.246

  PETCT with 18F-dihydroxy-L-phenylalanine and 11C-hydroxy-L-tryptophan might potentially be used in the future for therapy response evaluation. […] 18F-FDG-PET is only recommended in patients with grade 3 neuroendocrine cancers but shows potential for other indications, for example, to predict prognosis and determine treatment schedule. […] In patients with neuroendocrine tumours (NETs), a combination of morphological imaging and nuclear medicine techniques is mandatory for primary tumour visualization, staging and evaluation of somatostatin receptor status. […] Somatostatin receptor imaging, by 111In-pentetreotide scintigraphy or PET with 68Ga-labelled somatostatin analogues, frequently identifies additional lesions that are not visible on CT or MRI scans. […] Currently, somatostatin receptor scintigraphy with 111In-pentetreotide is the more frequently available of the two techniques to determine somatostatin receptor expression and is needed to select patients for peptide receptor radionuclide therapy.

• #32 Neuroendocrine tumours: the role of imaging for diagnosis and therapy | Nature Reviews Endocrinology

  https://www.nature.com/articles/nrendo.2013.246

  PETCT with 18F-dihydroxy-L-phenylalanine and 11C-hydroxy-L-tryptophan might potentially be used in the future for therapy response evaluation. […] 18F-FDG-PET is only recommended in patients with grade 3 neuroendocrine cancers but shows potential for other indications, for example, to predict prognosis and determine treatment schedule. […] In patients with neuroendocrine tumours (NETs), a combination of morphological imaging and nuclear medicine techniques is mandatory for primary tumour visualization, staging and evaluation of somatostatin receptor status. […] Somatostatin receptor imaging, by 111In-pentetreotide scintigraphy or PET with 68Ga-labelled somatostatin analogues, frequently identifies additional lesions that are not visible on CT or MRI scans. […] Currently, somatostatin receptor scintigraphy with 111In-pentetreotide is the more frequently available of the two techniques to determine somatostatin receptor expression and is needed to select patients for peptide receptor radionuclide therapy.

• #33 Tests to diagnose neuroendocrine cancer

  https://www.cancerresearchuk.org/about-cancer/neuroendocrine-tumours-nets/getting-diagnosed/tests-diagnose

  You usually have a number of tests to diagnose cancer. If you have neuroendocrine cancer these test results help your doctors find out your type and stage. […] The tests include: blood tests, urine tests, x-rays and scans, tests to look inside your body – such as endoscopy or colonoscopy. […] Your GP might do some tests to help them decide if you need to see a specialist. These tests include: blood tests, a physical examination. […] Blood tests can check your general health. They can also sometimes pick up problems caused by neuroendocrine cancer. […] If they suspect neuroendocrine cancer, they refer you to a neuroendocrine multi disciplinary team (MDT). […] Your specialist usually repeats the blood tests done by your GP. You also have more tests. These might include: further blood tests, scans such as CT scan, MRI scan, PET-CT scan and octreoscan, tests to look inside your body – such as endoscopy, bronchoscopy or colonoscopy, an endoscopic ultrasound scan to look inside your abdomen.

• #34

  https://www.cancervic.org.au/cancer-information/types-of-cancer/carcinoid/carcinoid-tumours-overview.html

  NETs can be difficult to diagnose and are sometimes found when doctors are testing for a different condition. […] If your doctor thinks that you may have a NET (or one of the syndromes associated with NETs), they will ask about your medical history, do a physical examination and run some tests. […] If the results suggest that you may have a NET, your doctor will refer you to a specialist, who will usually carry out one or more of the tests listed below. […] Blood tests a full blood count to measure your white blood cells, red blood cells and platelets and a hormone marker called chromogranin A. […] Urine tests these measure the hormone serotonin (which can be produced by NETs). […] Endoscopy a thin, flexible tube with a light and camera (endoscope) is inserted down the throat to examine the digestive tract.

• #35 Diagnosis – Neuroendocrine tumors – Cancer Institute | Northwell Health

  https://cancer.northwell.edu/cancer-care/neuroendocrine-tumors/diagnosis

  Endoscopy (carcinoid): An internal examination in which the doctor threads a thin tube (endoscope) with a camera and a light through the mouth and into the stomach and small intestine to visually identify abnormalities. […] Colonoscopy (carcinoid): Similar to an endoscopy, but the probe is inserted through the anus and travels into the colon for an inspection of the lower digestive tract. […] Biopsy (carcinoid, pheochromocytoma, Merkel cell, neuroendocrine carcinoma): Removes a sample of cells or tissue from the affected area or tumor to be examined under a microscope. […] CT (CAT) scan (all tumor types): This procedure uses a combination of X-rays and computer technology to allow doctors a sliced cross-section view of your body. CT scans create highly detailed imagery of any part of the body, including bones, muscles, fat and internal organs. […] MRI (magnetic resonance imaging) (all tumor types): A magnet, radio waves and a computer all combine to take highly precise imagery of the inside of the body, capturing details that other scans dont.

• #36

  https://www.cancervic.org.au/cancer-information/types-of-cancer/carcinoid/carcinoid-tumours-overview.html

  Gastroscopy an examination of the large bowel with a camera on a flexible tube (colonoscope) which is passed through the anus. […] Bronchoscopy a flexible tube with a light and camera is inserted down the throat to examine the airways and lungs and take tissue samples. […] imaging scans CT (computerised tomography), PET (positron emission tomography) and MRI (magnetic resonance imaging) scans use special machines to create pictures of the inside of your body while you lie still on an examination table. […] Before the scan, you may have an injection of dye (called contrast) or glucose into one of your veins, which makes the pictures clearer. […] The 2 different types of PET scans used for NETs are Gallium-68 Dotatate (also called Gatate scans) and fluorodeoxyglucose (FDG). […] The scan you have will depend on the type and grade of tumour.

• #37 Principles of diagnosis and management of neuroendocrine tumours

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5359105/

  The diagnosis of a NET requires a coordinated multidisciplinary effort involving medical oncologists, surgeons, interventional radiologists and pathologists. Results from pathology testing, hormonal testing, and diagnostic and functional imaging are integrated to form a comprehensive diagnostic picture. […] Obtaining tissue for pathology testing is mandatory for the diagnosis of NETs. When surgical resection is not an option, core needle biopsy is preferred over fine needle aspiration to allow full assessment of the tumour architecture. […] For patients presenting with symptoms of a functioning NET, biochemical testing should be targeted to the specific syndrome. […] Chromogranin A is the diagnostic biomarker of choice for NETs. […] There are two general categories of diagnostic imaging modalities that are used in combination for the diagnosis of NETs. […] Standard cross-sectional imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is recommended for all patients with a suspected NET. […] Endoscopic ultrasonography is the most sensitive test for the diagnosis of pancreatic NETs (sensitivity 82%93%).

• #38 Pancreatic Neuroendocrine Tumors : Diagnosis and Management with an Emphasis on Endoscopy – Practical Gastro

  https://practicalgastro.com/2023/01/26/pancreatic-neuroendocrine-tumors-diagnosis-and-management-with-an-emphasis-on-endoscopy/

  EUS allows a detailed examination of the pNENs, providing information on the location and size of the lesion that will direct treatment and management plans for the patients. […] EUS is an especially powerful diagnostic tool when the size of pNENs is 20 mm. […] A recent systemic review and meta-analysis on 864 patients revealed that the Ki-67 index of EUS-FNA extracted tissue and surgically biopsied tissues matched 80.3%, proving that grading from EUS-FNA extracted pancreatic tissues is dependable. […] One study revealed that the overall sensitivity and specificity of contrast-enhanced EUS in detecting pNENs were 78.9% and 98.7%, respectively, which has similar diagnostic accuracy to CT scans. […] In recent years, EUS-guided radiofrequency and ethanol ablation have emerged as novel techniques for the treatment of patients with pNENs.

• #39 Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs)

  https://www.mdpi.com/2075-4418/11/5/771

  Rectal neuroendocrine tumors (NETs) are rare, with an incidence of 0.17%, but they represent 12% to 27% of all NETs and 20% of gastrointestinal NETs. […] Although rectal NETs are uncommon tumors, their incidence has increased over the past few years, and this is probably due to the improvement in detection rates made by advanced endoscopic procedures. […] According to the current European Neuroendocrine Tumor Society (ENETS) guidelines, tumors that are smaller than 10 mm and well differentiated are thought to have a low risk of lymphovascular invasion, and they should be completely removed endoscopically. […] According to the current European Neuroendocrine Tumor Society (ENETS) consensus, an endoscopic rectal ultrasound (EUS) should be the next and most important diagnostic step after endoscopic exam for a suspected rectal NET.

• #40 Principles of diagnosis and management of neuroendocrine tumours

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5359105/

  The diagnosis of a NET requires a coordinated multidisciplinary effort involving medical oncologists, surgeons, interventional radiologists and pathologists. Results from pathology testing, hormonal testing, and diagnostic and functional imaging are integrated to form a comprehensive diagnostic picture. […] Obtaining tissue for pathology testing is mandatory for the diagnosis of NETs. When surgical resection is not an option, core needle biopsy is preferred over fine needle aspiration to allow full assessment of the tumour architecture. […] For patients presenting with symptoms of a functioning NET, biochemical testing should be targeted to the specific syndrome. […] Chromogranin A is the diagnostic biomarker of choice for NETs. […] There are two general categories of diagnostic imaging modalities that are used in combination for the diagnosis of NETs. […] Standard cross-sectional imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is recommended for all patients with a suspected NET. […] Endoscopic ultrasonography is the most sensitive test for the diagnosis of pancreatic NETs (sensitivity 82%93%).

• #41 Tests to diagnose neuroendocrine cancer

  https://www.cancerresearchuk.org/about-cancer/neuroendocrine-tumours-nets/getting-diagnosed/tests-diagnose

  If your doctor suspects a neuroendocrine cancer they might look at the levels of a specific hormone. […] A raised amount of 5-HIAA in your urine can be a sign of a neuroendocrine tumour. […] The test you have depends on where the suspected neuroendocrine cancer is. […] A biopsy means removing a piece of tissue so that a pathologist can look at it under a microscope. This is the only way to be certain if an abnormal area is cancer and what type it is. […] A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body. […] MRI scans can sometimes show up soft tissue more clearly than CT scans. […] PET-CT scans can be useful for some types of neuroendocrine cancer. […] Radioactive scans can help your doctors diagnose some types of neuroendocrine cancer. […] The tests you have help your doctor find out if you have neuroendocrine cancer. And it tells them what type it is, and where it is in your body.

• #42 Principles of diagnosis and management of neuroendocrine tumours

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5359105/

  The diagnosis of a NET requires a coordinated multidisciplinary effort involving medical oncologists, surgeons, interventional radiologists and pathologists. Results from pathology testing, hormonal testing, and diagnostic and functional imaging are integrated to form a comprehensive diagnostic picture. […] Obtaining tissue for pathology testing is mandatory for the diagnosis of NETs. When surgical resection is not an option, core needle biopsy is preferred over fine needle aspiration to allow full assessment of the tumour architecture. […] For patients presenting with symptoms of a functioning NET, biochemical testing should be targeted to the specific syndrome. […] Chromogranin A is the diagnostic biomarker of choice for NETs. […] There are two general categories of diagnostic imaging modalities that are used in combination for the diagnosis of NETs. […] Standard cross-sectional imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is recommended for all patients with a suspected NET. […] Endoscopic ultrasonography is the most sensitive test for the diagnosis of pancreatic NETs (sensitivity 82%93%).

• #43 Neuroendocrine Tumors (NETs)

  https://www.dukehealth.org/treatments/cancer/neuroendocrine-tumors

  CT scans and MRI can help identify a tumors location and size. […] PET scans detect neuroendocrine tumors based on how the tumors interact with medically safe radioactive drugs. […] During an upper endoscopy, a gastroenterologist inserts a small tube with a camera at its tip through your mouth to view your stomach and upper GI tract. Your doctor will look for tumor growth and may take a small tissue sample for examination to determine if cancer is present. […] During a colonoscopy, a small tube with a camera at its tip is inserted through your rectum to examine the colon and/or your small intestine. A small tissue sample may be removed and examined to determine if cancer is present. […] If a neuroendocrine tumor is producing hormones that could lead to heart valve damage, an ultrasound of the heart may be performed to look for damage.

• #44

  https://www.cancervic.org.au/cancer-information/types-of-cancer/carcinoid/carcinoid-tumours-overview.html

  Biopsy this removes a sample of tissue from the affected area for examination under a microscope. […] It is done either with a thin needle inserted into the tumour under local anaesthetic, or under general anaesthesia, known as an open biopsy. […] Echocardiogram an ultrasound scan of the heart to check how it is working.

• #45 Diagnostic work-up of gastroenteropancreatic neuroendocrine tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3328823/

  Neuroendocrine tumors are a heterogeneous group of malignancies that present a diagnostic challenge. The diagnosis is based on histopathology, imaging, and circulating biomarkers. The histopathology should contain specific neuroendocrine markers such as chromogranin A, synaptophysin, and neuron-specific enolase and also an estimate of the proliferation by Ki-67 (MIB-1). Standard imaging procedures consist of computed tomography or magnetic resonance imaging together with somatostatin receptor scintigraphy. 68Ga-DOTA-octreotate scans will in the future replace somatostatin receptor scintigraphy because they have higher specificity and sensitivity. Neuroendocrine tumors secrete many different peptides and amines that can be used as circulating biomarkers. The most useful general marker is chromogranin A, which is both a diagnostic and prognostic marker in most neuroendocrine tumors. However, there is still a need for improved biomarkers for early detection and follow-up of patients during treatment. The initial diagnostic approach in patients with NETs includes histological examination, which is always required before therapeutic decisions are made. The following investigations are also required: (a) immunohistochemical markers and detailed histological analysis; (b) assessment of the primary tumor and the extent of extrahepatic spread by imaging, including patterns of hepatic metastases; and (c) biochemical assessment of functionality and general tumor markers. Immunohistochemical determination of CgA and synaptophysin as well as proliferation marker Ki-67 (MIB-1) is mandatory. The minimal biochemical work-up for NETs includes circulating chromogranin A and assessment of a specific marker to assess functionality, such as urinary 5-HIAA evaluation in carcinoid syndrome. There has been impressive progress in the field of biomarkers as well as molecular imaging. However, we still need more sensitive markers for early detection and follow-up.

• #46 Diagnostic work-up of gastroenteropancreatic neuroendocrine tumors | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-diagnostic-work-up-gastroenteropancreatic-neuroendocrine-tumors-S1807593222024048

  Neuroendocrine tumors are a heterogeneous group of malignancies that present a diagnostic challenge. The diagnosis is based on histopathology, imaging, and circulating biomarkers. The histopathology should contain specific neuroendocrine markers such as chromogranin A, synaptophysin, and neuron-specific enolase and also an estimate of the proliferation by Ki-67 (MIB-1). Standard imaging procedures consist of computed tomography or magnetic resonance imaging together with somatostatin receptor scintigraphy. 68Ga-DOTA-octreotate scans will in the future replace somatostatin receptor scintigraphy because they have higher specificity and sensitivity. Other positron imaging tomographic scanning tracers that will come into clinical use are 18F-DOPA and 11C-5HTP. […] The initial diagnostic approach in patients with NETs includes histological examination, which is always required before therapeutic decisions are made. Clinicians should also consider performing repetitive biopsies to reassess the prognosis if the disease course changes significantly. The following investigations are also required: (a) immunohistochemical markers and detailed histological analysis; (b) assessment of the primary tumor and the extent of extrahepatic spread by imaging, including patterns of hepatic metastases; and (c) biochemical assessment of functionality and general tumor markers.

• #47 Neuroendocrine tumor – Wikipedia

  https://en.wikipedia.org/wiki/Neuroendocrine_tumor

  Placing a given tumor into one of these categories depends on well-defined histological features: size, lymphovascular invasion, mitotic count, Ki-67 labelling index, invasion of adjacent organs, presence of metastases and whether they produce hormones. […] Neuroendocrine lesions are graded histologically according to markers of cellular proliferation, rather than cellular polymorphism. The following grading scheme is currently recommended for all gastroenteropancreatic neuroendocrine neoplasms by the World Health Organization: G1 2 3% G2 2 to 20 320% G3 20 20%. […] Currently there is no one staging system for all neuroendocrine neoplasms. Well-differentiated lesions generally have their own staging system based on anatomical location, whereas poorly differentiated and mixed lesions are staged as carcinomas of that location.

• #48 Neuroendocrine tumor – Wikipedia

  https://en.wikipedia.org/wiki/Neuroendocrine_tumor

  Placing a given tumor into one of these categories depends on well-defined histological features: size, lymphovascular invasion, mitotic count, Ki-67 labelling index, invasion of adjacent organs, presence of metastases and whether they produce hormones. […] Neuroendocrine lesions are graded histologically according to markers of cellular proliferation, rather than cellular polymorphism. The following grading scheme is currently recommended for all gastroenteropancreatic neuroendocrine neoplasms by the World Health Organization: G1 2 3% G2 2 to 20 320% G3 20 20%. […] Currently there is no one staging system for all neuroendocrine neoplasms. Well-differentiated lesions generally have their own staging system based on anatomical location, whereas poorly differentiated and mixed lesions are staged as carcinomas of that location.

• #49 Diagnostic work-up of gastroenteropancreatic neuroendocrine tumors | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-diagnostic-work-up-gastroenteropancreatic-neuroendocrine-tumors-S1807593222024048

  Immunohistochemical determination of CgA and synaptophysin as well as proliferation marker Ki-67 (MIB-1) is mandatory. […] Staging is performed with the familiar tumor node metastasis (TNM) approach according to the anatomical location of the tumors, and this approach is recommended by the WHO, the American Joint Committee on Cancer and the International Union Against Cancer. […] A standard computed tomographic (CT) scan of the chest, abdomen, and pelvis or magnetic resonance image is mandatory, and should be complemented by somatostatin receptor scintigraphy including single photon emission computer tomography (SPECT)-SRS and triphasic CT. […] The minimal biochemical work-up for NETs includes circulating chromogranin A and assessment of a specific marker to assess functionality, such as urinary 5-HIAA evaluation in carcinoid syndrome. Additional assessment of insulin, C-peptide, (proinsulin), gastrin, pancreatic polypeptide, vasoactive intestinal peptide, glucagon, and calcitonin should be useful, depending on the functional status of the tumor, clinical symptoms, and histological features. […] However, we still need more sensitive markers for early detection and follow-up. Furthermore, new markers delineating sensitivity to various therapies are warranted. Molecular imaging is in its early stages and has the potential to be a significant tool in the management of patients with NETs.

• #50 Delays and routes to diagnosis of neuroendocrine tumours | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-018-5057-3

  The mean duration of the first symptom prior to diagnosis for respondents was 53.8 months overall, 60.1 months for small bowel NETs (sbNETs), 39.1 months for pancreatic NETs (pNETs) and 67.7 months for lung NETs. […] 80% of respondents reported that they had symptoms prior to diagnosis. […] The time from first symptom to diagnosis was 53.8 months, which is a very long time especially when considering the number of respondents that regarded their primary symptom as being severe or very severe in nature. A significant delay is likely to be occurring due to incorrect initial diagnosis. […] The survey has clearly demonstrated that the majority of respondents with NETs do not present with typical symptoms. […] The primary symptoms from respondents appear linked to the primary site of the tumour and associated weight loss is a common finding. Respondents are seeking healthcare but are often misdiagnosed with functional gastrointestinal disorders. Further education regarding investigation of malignancy in patients over 50 and greater use of cross sectional imaging for patients with alarm symptoms over 50 may help shorten the time to diagnosis of NETs.

• #51 How are neuroendocrine tumors diagnosed? | Roswell Park Comprehensive Cancer Center – Buffalo, NY

  https://www.roswellpark.org/cancertalk/202411/how-are-neuroendocrine-tumors-diagnosed

  Neuroendocrine tumors (NETs) are uncommon cancers that are commonly misdiagnosed as another condition causing delays in diagnosis and care. […] In fact, about half are not properly diagnosed until later stages, when the cancer has spread to other areas and is far more difficult to treat, says Renuka Iyer, MD, a medical oncologist, NET expert and the Section Chief for Gastrointestinal Oncology at Roswell Park Comprehensive Cancer Center. […] Due to the lack of a screening test to detect NETs, it is very important to tell your doctor about the specific symptoms that you are experiencing. The key to accurate diagnosis of NETs is having a complete picture of the patients symptoms, Dr. Iyer says. […] If your doctor suspects a NET, further evaluation including blood tests, urine tests, imaging tests and biopsy can be performed to confirm the diagnosis.

• #52 Delays and routes to diagnosis of neuroendocrine tumours | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-018-5057-3

  The mean duration of the first symptom prior to diagnosis for respondents was 53.8 months overall, 60.1 months for small bowel NETs (sbNETs), 39.1 months for pancreatic NETs (pNETs) and 67.7 months for lung NETs. […] 80% of respondents reported that they had symptoms prior to diagnosis. […] The time from first symptom to diagnosis was 53.8 months, which is a very long time especially when considering the number of respondents that regarded their primary symptom as being severe or very severe in nature. A significant delay is likely to be occurring due to incorrect initial diagnosis. […] The survey has clearly demonstrated that the majority of respondents with NETs do not present with typical symptoms. […] The primary symptoms from respondents appear linked to the primary site of the tumour and associated weight loss is a common finding. Respondents are seeking healthcare but are often misdiagnosed with functional gastrointestinal disorders. Further education regarding investigation of malignancy in patients over 50 and greater use of cross sectional imaging for patients with alarm symptoms over 50 may help shorten the time to diagnosis of NETs.

• #53 Can Pancreatic Neuroendocrine Tumor Be Found Early? | American Cancer Society

  https://www.cancer.org/cancer/types/pancreatic-neuroendocrine-tumor/detection-diagnosis-staging/detection.html

  Pancreatic neuroendocrine tumors (pNETs) are hard to find early. The pancreas is deep inside the body, so health care providers can’t see or feel the tumors during routine physical exams. People usually have no symptoms until the cancer has already spread to other organs. […] At this time, no major professional groups recommend routine screening for pNET in people who are at average risk. This is because no screening test has been shown to lower the risk of dying from this cancer. […] Knowing if you are at increased risk can help you and your doctor decide if you should have tests to look for pNET early when treatment might be more successful. […] For people in families at high risk of pNET, such as those with MEN1 syndrome (increases the risk of pancreas, pituitary, and parathyroid tumors), tests for detecting cancer early may help. […] Although definitive screening guidelines for people with the MEN1 gene or their family members are not available, doctors have been able to find early, treatable pNETs in some members of high-risk families with these tests.

• #54 Diagnosis – INCA

  https://incalliance.org/diagnosis-and-misdiagnosis/

  People react in all kinds of ways when they are told they have cancer. […] The situation with neuroendocrine cancer can be even more complicated because these types of tumors are often misdiagnosed initially or can take a long time to be correctly identified. […] As soon as you’re diagnosed with a neuroendocrine cancer, it’s vital to get the best possible advice and treatment from the right team of people. […] If you’re diagnosed with a neuroendocrine cancer, a specialist NET specific multidisciplinary team (NET MDT) should review your case on an ongoing basis. […] Diagnosis isn’t straightforward. The NET/NEC is often small, starting out the size of a grain of sand and often not visible to the most accurate scans until it gets to about half a centimeter across or the size of a pea.

• #55 Understanding the Diagnosis and Prognosis of Neuroendocrine Tumors

  https://www.onclive.com/view/understanding-the-diagnosis-and-prognosis-of-neuroendocrine-tumors

  Neuroendocrine cancers are a little bit tricky because theyre uncommon cancers, though not as rare as people think. […] For the diagnosis of neuroendocrine cancers, it really demands a multidisciplinary approach. The most important member of that team is the pathologist because what they look and confirm for neuroendocrine cancer is obviously critically important. […] When we find the classifications and the pathology of NETs [neuroendocrine tumors], they can be very helpful for us to understand prognosis and treatment recommendations that were going to have. We know that the grading is the most important prognostic feature that we have in neuroendocrine cancer, so we cant trump the biology. […] Tumors that are low grade, which is a Ki-67 [index] less than 3%, tend to portend the best prognosis. Intermediate-grade cancers, which are Ki-67 between 3% and 20%, tend to behave like low grade potentially, and sometimes unfortunately more like high grade. Then those high-grade tumors, which are Ki-67 greater than 20%, are the tumors that we worry about the most because they can portend a more aggressive course.

• #56 How are neuroendocrine tumors diagnosed? | Roswell Park Comprehensive Cancer Center – Buffalo, NY

  https://www.roswellpark.org/cancertalk/202411/how-are-neuroendocrine-tumors-diagnosed

  The diagnosis and treatment of a NET requires a coordinated multidisciplinary approach involving an expert team of specialists including medical oncologists, surgeons, interventional radiologists, pathologists, nutritionists, social workers and other healthcare staff, Dr. Iyer says. […] Results from pathology testing, hormonal testing, and diagnostic and functional imaging are integrated to form a complete diagnostic picture. […] Roswell Park Comprehensive Cancer Center brings together experts in these fields who take a comprehensive approach to NET diagnosis and treatment planning. […] Along with a team of dedicated NET experts, with nearly 20 years of experience in diagnosing and treating NET patients, Roswell Park is a leading center for NET care, committed to giving patient-centered care and holistic approaches to treatment.

• #57 Neuroendocrine Tumor Diagnosis | Fox Chase Cancer Center – Philadelphia PA

  https://www.foxchase.org/clinical-care/conditions/neuroendocrine-tumors/gastrointestinal-neuroendocrine-tumor-diagnosis

  Neuroendocrine tumors are often found accidentally before they cause any symptoms, often when a patient is being evaluated for another condition, such as iron deficiency anemia. […] Conventional imaging techniques such as CT, FDG PET, ultrasound, or MRI are often not able to detect NETs early because of the small size of the tumor, low metabolic rate and irregular location in the body. […] But, Fox Chase Cancer Center was the first hospital in the greater Philadelphia and tri-state region to introduce a new FDA-approved imaging method called Gallium68 DOTATATE PET/CT that allows for much greater precision than ever before with a much higher rate of detection. […] The Gallium68 PET scan is PET and CT used simultaneously, with PET capturing images of organ and tissue function and CT capturing body structure. […] In addition to providing excellent image quality, the Gallium68 PET scan takes much less time than routine nuclear medicine imaging (such as the OctreoScan). […] Along with being used for diagnosis, the scan is also useful for follow up on treatment response.

• #58 Neuroendocrine Tumor Diagnosis | Fox Chase Cancer Center – Philadelphia PA

  https://www.foxchase.org/clinical-care/conditions/neuroendocrine-tumors/gastrointestinal-neuroendocrine-tumor-diagnosis

  Neuroendocrine tumors are often found accidentally before they cause any symptoms, often when a patient is being evaluated for another condition, such as iron deficiency anemia. […] Conventional imaging techniques such as CT, FDG PET, ultrasound, or MRI are often not able to detect NETs early because of the small size of the tumor, low metabolic rate and irregular location in the body. […] But, Fox Chase Cancer Center was the first hospital in the greater Philadelphia and tri-state region to introduce a new FDA-approved imaging method called Gallium68 DOTATATE PET/CT that allows for much greater precision than ever before with a much higher rate of detection. […] The Gallium68 PET scan is PET and CT used simultaneously, with PET capturing images of organ and tissue function and CT capturing body structure. […] In addition to providing excellent image quality, the Gallium68 PET scan takes much less time than routine nuclear medicine imaging (such as the OctreoScan). […] Along with being used for diagnosis, the scan is also useful for follow up on treatment response.

• #59 Neuroendocrine Tumor Diagnosis: Tests, Scans & Biopsies

  https://www.cancercenter.com/cancer-types/neuroendocrine-tumors/diagnosis-and-detection

  Testing tumor cells for specific genes may help in identifying a targeted treatment option. But genetic testing and counseling are generally less helpful for neuroendocrine tumors than other types of cancer. […] The care team may review the patient’s test results with him or her, likely using several test results to put together a comprehensive picture of the neuroendocrine tumor and any metastases (or cancer spread). These test results help lay the foundation for the treatment options the patient and his or her care team may discuss.

• #60 Survey Details Access, Diagnostic Challenges Faced by Patients With Neuroendocrine Tumors

  https://www.ajmc.com/view/survey-details-access-diagnostic-challenges-faced-by-patients-with-neuroendocrine-tumors-gianna-6-15-asap-

  Misdiagnosis was common in these patients, and mean time to diagnosis was around 5 years. […] New survey results highlight challenges patients with neuroendocrine tumors (NETs) face when it comes to access to diagnostics and treatment, according to the study published in Journal of Neuroendocrinology. […] Delayed diagnosis remains a major issue, the authors wrote. Although these results showed improved access to specialized diagnostics, time from first symptoms to correct diagnosis was still poor, they added. […] They found this unmet need has not improved over time, when they compared results with findings of previous surveys from 2014 and 2018. […] In addition, despite some improvements, SCAN highlighted that global availability and affordability of specialized tools remains poor and a critical area to advance, the researchers said. […] Raising awareness among general practitioners and other HCPs that NETs tend to present late with nonspecific symptoms that may be attributed to an alternative diagnosis is also imperative to further improve NET care.

• #61

  https://link.springer.com/article/10.1007/s10555-011-9292-1

  Neuroendocrine tumors (NETs) consist of a heterogeneous group of malignancies with various clinical presentations and growth rates. […] The diagnosis of a NET is based on histopathology on tumor specimens, circulating biomarkers as well as imaging. Traditional radiology, such as computerized tomography and magnetic resonance imaging, is still the basis but is complemented with somatostatin receptor scintigraphy and positron emission tomography with specific isotopes such 68Ga-DOTA-octreotate, F18-dopamine, or C11-5 hydroxytryptamine. […] There is still an unmet need for more sensitive biomarkers for diagnosis and follow-up.

• #62 Diagnostic work-up of gastroenteropancreatic neuroendocrine tumors | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-diagnostic-work-up-gastroenteropancreatic-neuroendocrine-tumors-S1807593222024048

  Immunohistochemical determination of CgA and synaptophysin as well as proliferation marker Ki-67 (MIB-1) is mandatory. […] Staging is performed with the familiar tumor node metastasis (TNM) approach according to the anatomical location of the tumors, and this approach is recommended by the WHO, the American Joint Committee on Cancer and the International Union Against Cancer. […] A standard computed tomographic (CT) scan of the chest, abdomen, and pelvis or magnetic resonance image is mandatory, and should be complemented by somatostatin receptor scintigraphy including single photon emission computer tomography (SPECT)-SRS and triphasic CT. […] The minimal biochemical work-up for NETs includes circulating chromogranin A and assessment of a specific marker to assess functionality, such as urinary 5-HIAA evaluation in carcinoid syndrome. Additional assessment of insulin, C-peptide, (proinsulin), gastrin, pancreatic polypeptide, vasoactive intestinal peptide, glucagon, and calcitonin should be useful, depending on the functional status of the tumor, clinical symptoms, and histological features. […] However, we still need more sensitive markers for early detection and follow-up. Furthermore, new markers delineating sensitivity to various therapies are warranted. Molecular imaging is in its early stages and has the potential to be a significant tool in the management of patients with NETs.

• #63 Neuroendocrine Tumors Diagnosis and Treatment – Baltimore, MD – Mercy

  https://mdmercy.com/mercy-services/conditions/neuroendocrine-tumors

  The Neuroendocrine Tumor Center at Mercy in Baltimore offers medical oncologists, surgical oncologists, gastroenterologists and other specialists to diagnose and treat neuroendocrine tumors, also be referred to as NETs or carcinoid tumors. […] Neuroendocrine tumors are rare (often referred to as an orphan disease), hard to find and difficult to diagnose. It is important to seek a doctor who is knowledgeable about neuroendocrine tumors to ensure a proper and timely diagnosis. […] Your doctor may order a number of tests to support the diagnosis including: Blood Test, Urine Test, Computed tomography (CT), Magnetic Resonance Imaging (MRI), Gallium 68 PET scan (a PET scan that uses a tracer, injected into the bloodstream, to identify tumors). […] Possible treatment options for neuroendocrine tumors may include: Surgery, Chemotherapy, Chemoembolization, Radiofrequency ablation, Radiotherapy, Targeted radionuclide therapy, including PRRT – Peptide Receptor Radionuclide Therapy, Medications, Clinical Study.

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