Gastro-Intestinal Neuro Endocrine Tumor
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Gastro-Intestinal Neuro Endocrine Tumor
- 1. GI-NET Dr. Rajib Bhattacharjee MBBS, MD, ECMO, PDCR DNB SS PDT (Medical Oncology)
- 6. Most common sites of GI-NET Most common sites percen tage Small intestine 55% Lung 20- 25% Pancreas 17- 20% Rectum/Colon <5% Others Thyroid Adrenal Ovary/cervix <3%
- 11. Immunohistochemical Markers Conventional markers • Chromogranin A • Synaptophysin • CD 56 (N-CAM) • NSE • CD 57/Leu7 • Protein Gene Product (PGP 95) Novel markers • Synaptic Vesicle Protein 2 (SV 2) • Neuroendocrine Secretory Protein 55 (NESP 55)
- 13. Biomarkers Serum Chromogranin A Serum Serotonin Urine 5-HIAA Sn – 75 % Sp - 85 % Sn – 35 % Sp – 100 % False Positives PPI H2 blockers False positives Fruits – banana, sour fruits Medicines – PPI, H2 blockers, cough suppressants, anti hypertensives, Valium, Muscle relaxants
- 14. Imaging Modalities MIBG scan • Sn – 60–85% • Tumor secret catecholamine CT Enteroclysis • Sn – 86% • Sp – 100 % Echocardiography • To evaluate carcinoid heart ds • NT-pro BNP
- 17. Systemic agents used in GEP NET
- 34. P R R T
- 37. Everolimus
- 41. Follow Up • R0/R1-resected NET G1 and NET G2 with low Ki-67(<5%)- CT or MRI every 6 months • NET G2 (Ki-67>5%) every 3 months • NEC G3 every 2-3 months • Small localised NET G1 (<1 cm in size) in appendix or rectum, R0-resected, no adverse histological features – No F/U needed • No validated tumour marker for recurrence
- 42. Thank You