Carcinoid tumors are rare, slow-growing neuroendocrine tumors that usually originate in the digestive tract. They can be asymptomatic or cause symptoms depending on whether they produce hormones. Diagnosis involves imaging, endoscopy, biopsy, and hormone level testing. Treatment depends on the tumor size, location, extent of spread, and hormone production, and may include surgery, somatostatin analogs, chemotherapy, or targeted therapy. Prognosis depends on tumor stage, with 5-year survival rates over 90% for localized disease but lower for metastatic disease.
Pancreatic carcinoma is the most dreaded cancer with very dismal prognosis. It is characterized by obstructive jaundice, high colored urine and clay colored stool.
Pancreatic carcinoma is the most dreaded cancer with very dismal prognosis. It is characterized by obstructive jaundice, high colored urine and clay colored stool.
Testicular tumors are rare.
1 – 2 % of all malignant tumors.
Most common malignancy in men in the 15 to 35 year age group.
Benign lesions represent a greater percentage of cases in children than in adults.
Most curable solid neoplasm
Revised Atlanta classification of Acute PancreatitisDr M Venkatesh
The most important change in Atlanta classification is the categorization of the various pancreatic collections.
In acute IEP, collections that do not have an enhancing capsule are called APFCs; after development of a capsule, they are referred to as
pseudocysts
In necrotizing pancreatitis,a collection without an enhancing capsule is called an ANC (usually in the first 4 weeks) and thereafter a WON, which has an enhancing capsule.
The most important distinction between collections in necrotizing pancreatitis and those associated with acute IEP is the presence of nonliquefied material in collections due to necrotizing pancreatitis.
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
Testicular tumors are rare.
1 – 2 % of all malignant tumors.
Most common malignancy in men in the 15 to 35 year age group.
Benign lesions represent a greater percentage of cases in children than in adults.
Most curable solid neoplasm
Revised Atlanta classification of Acute PancreatitisDr M Venkatesh
The most important change in Atlanta classification is the categorization of the various pancreatic collections.
In acute IEP, collections that do not have an enhancing capsule are called APFCs; after development of a capsule, they are referred to as
pseudocysts
In necrotizing pancreatitis,a collection without an enhancing capsule is called an ANC (usually in the first 4 weeks) and thereafter a WON, which has an enhancing capsule.
The most important distinction between collections in necrotizing pancreatitis and those associated with acute IEP is the presence of nonliquefied material in collections due to necrotizing pancreatitis.
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
esophageal carcinoma is one of the common gastrointestinal malignancy. Its usually present at advanced stage. Its management requires diagnosis as early as possible and staging followed by proper planning of treatment. Its treatment include endoscopic, surgical, adjuvant chemotherapy and palliative management.
Pancreatic neoplasm of the endocrine cells of the pancreas.arunabhasinha2
clinical presentation, diagnosis and treatment neoplasms of pancreas arising from different types of endocrine cells, both benign and malignant. exocrine tumours are not included in the presentation.
Renal angiomyolipoma (AML) is a common benign tumor of the kidney.
AML can occur sporadically or may be associated with tuberous sclerosis complex (TSC).
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
5. Symptoms
Endocrinologically inactive(50-70%)
Bronchial carcinoids produce cough, hemoptysis, frequent pulmonary infection.
Appendicitis, bowel obstruction, painful hepatomegaly.
Endocrinologically active(30-50%)
Carcinoid syndrome- Attacks of flushing, diarrhea, hypotension
light-headedness, bronchospasm either spontaneous or precipitated by emotional
or physical stress, alcohol, vigorous liver
6.
7. Symptoms of Pancreatic Neuroendocrine Tumor:
Gastrinoma- PUD with Diarrhea.
Insulinoma- Recurrent hypoglycemia episode
Glucagonoma- dermatosis, diarrhea, depression and deep vein thrombosis.
VIPoma- Watery diarrhea, hypokalemia, achlorhydria.
8. PATHOLOGY
• A histological biopsy or surgical specimen should be used for diagnosis
• A fine needle aspirate is insufficient for specific diagnosis and calculation of Ki-67
proliferation index
• The NEN diagnosis is based on the growth pattern, the uniformity of tumour cells, and
confirmed by immunohistochemical (IHC) staining with the general neuroendocrine markers
synaptophysin and chromogranin A (CgA).
9. • Calculation of Ki-67 index is mandatory and should be assessed in hot spots.
• The index is counted with 500 tumour cells as a reference.
• Other IHC markers (e.g., thyroid transcription factor-1 (TTF-1), serotonin, CDX2,
islet1) may indicate primary tumour site.
10. (a) Microscopic section from a well differentiated
neuroendocrine carcinoma demonstrating low
mitotic rate and low grade
bland histology.
b) Microscopic section from a poorly
differentiated neuroendocrine carcinoma
demonstrating high mitotic rate and high grade
histology similar in appearance to small
cell carcinomas.
13. Serum CgA (s-CgA)
is the most commonly used biomarker in blood and elevated in the majority of patients with residual
NETs.
is a specific and sensitive marker of tumour progression and that basal s-CgA levels can predict overall
survival
Others- Fasting serum gastrin level(>500 pg/ml), insulin(>6μU/ml + hypoglycemia), C peptide.
Individuals with sporadic or familial bronchial or gastric carcinoid should have a family history evaluation
and consideration of testing for germline MEN1 mutations
14.
15. Oesophageal NETs
Are extremely rare (<1% of all NENs) with less than 1% of them being well differentiated NETs and
the rest poorly differentiated NECs
Clinical presentation:
There is a male predominance (6:1).
Dysphagia and weight loss, as well as hoarseness and pain.
Diagnostic procedures:
The most common setting is incidental finding during endoscopy.
Treatment:
Endoscopic or surgical removal of the primary tumour is recommended.
Due to the rarity of this tumour entity there are no data to base recommendations for systemic
treatment on.
16. Gastric NETs
• Type I gastric carcinoid ( Most common)
• Type II Gastric Carcinoid (Least common)
• Type III Gastric carcinoid (Sporadic)
17. Type I and II gastric NETs
Clinical presentation:
Most type I and II gastric NETs are incidental findings at gastroscopy & comprise 85%
of gastric NETs and result from hypergastrinemia.
In type I, the cause of hypergastrinemia is chronic atrophic gastritis.
Type II gastric Carcinoid develops in patients with gastrin-producing NETs
18. Diagnostic procedures:
Gastric NETs are usually multiple <2 cm and have a Ki-67 index 5%.
Multiple biopsies are recommended.
S-CgA and s-gastrin are usually highly elevated but the clinical value of repeated
measurements is questionable.
In type I, gastric acid secretion is low or not measurable (high pH), while in type II acid
secretion is elevated (low pH).
EUS with evaluation of tumour invasion and regional lymph nodes is mandatory
19.
20. Treatment
Tumours<1cm
should only undergo surveillance, since the lesions usually are benign.
Tumours >1cm
should be locally resected by endoscopic mucosal resection (EMR), or endoscopic
submucosal dissection (ESD) or by surgery depending on the number of lesions, and invasion
into the muscularis propria.
21. Follow-up and prognosis
Repeated endoscopies with 6–12 months interval should be performed.
EUS, CT/MRI and SRI should only be performed when tumour growth or metastases are
suspected.
In type I gastric NETs, lymph node metastases are rare and liver metastases almost never
seen.
In type II gastric NETs, regional metastases are found in 5–10% and liver metastases in
<2%.
22. Type III gastric NETs
Clinical presentation:
Type III gastric NETs are sporadic, not associated with hypergastrinemia and
constitute 10–20% of all gastric NETs
Patients may present with symptoms of GI bleeding, dyspepsia and gastric
obstruction.
Local or liver metastases are seen in >50% of the patients at diagnosis
23. Diagnostic procedures
The tumour is usually a solitary and >2 cm in diameter.
There are no specific biomarkers but s-CgA may be elevated.
EUS, CT/MRI and SRI should be performed for tumour staging.
24. Treatment
Surgical resection with lymph node dissection should be performed when possible similar
to gastric adenocarcinoma.
Although firm clinical data is missing, for disseminated cases, SSA may be used if Ki-
67<10%, while chemotherapy is an option if Ki-67>10%.
25. Follow-up and prognosis
Measurement of s-CgA, if elevated gastroscopy and imaging with CT/MRI should be
performed every 3–6 months.
Five-year survival is 50%
26. Duodenal NETs
Clinical presentation:
• The most common tumours are gastrinomas (40%) and somatostatinomas (30%) while gangliocytic
paragangliomas and calcitonin or serotonin-producing tumours are rare.
Diagnostic procedures:
• Histological examination distinguish between the different types.
• S-gastrin and s-CgA should be measured and, if indicated by symptoms, 5HIAA and p-calcitonin. CT/MRI, EUS
and SRI are recommended for staging.
27.
28. Treatment
Surgery:
If operated, duodenotomy with a thorough search for multiple tumours in the entire duodenum and
pancreas is preferred and intraoperative endoscopy or EUS performed if necessary.
In non-periampular NETs <1–2 cm EMR or ESD is selected.
>2cm NETs- local resection(s), pancreaticoduodenectomy or pancreatic sparing duodenectomy with
reimplantation of the ampulla of Vater may be performed.
Intraoperative US of the liver and pancreas is mandatory.
29. Systemic treatment:
Patients with gastrinomas should be treated with proton pump inhibitors,
often in high doses, since even very small duodenal gastrinomas may give
profound acid related symptoms.
Functional NETs may benefit from SSA treatment.
Metastatic disease should be treated as panNETs.
30. Follow-up and prognosis
Measurement of s-CgA, and tumour-specific hormones, endoscopy, EUS and CT/MRI
should be done every 3–12 months dependent on the malignant potential of the tumour.
Median survival is >100 months for local and regionally metastasised tumours.
For tumours with distant metastases the 5-year survival around 60%
33. Treatment of Advanced Disease
Somatostatin Analogs
Peptide receptor radionuclide therapy (PRRT)-Mostly used radionuclides include 90Y and 177Lu.
Interferon Alpha
Cytotoxic Chemotherapy
Molecular Targeted Therapy
34. Somatostatin Analogs
SSTRs are highly expressed on NETs and has 5 subtypes- SSTR1–5.
Somatostatin inhibits the release of pituitary hormones and GI hormones (e.g., insulin, gastrin, and
serotonin), inhibits flushing, diarrhea, and other symptoms of carcinoid syndrome.
It also has antiproliferative, proapoptotic, and antiangiogenic activity.
Analogs:
Octreotide: 2 forms, An aquaeous, immediate-release product and long-acting release (LAR) form.
Lanreotide and Lanreotide Autogel(new).
Pasireotide is a panreceptor agonist that binds SSTR1–3 and SSTR5 with high affinity
35. Follow-up and prognosis
• Patients with radically resected insulinomas have a good prognosis and one
postoperative clinical and biochemical follow-up is usually sufficient.
• Other radically operated patients should be followed with biochemical markers and
CT/MRI initially every 4–12 months, depending on proliferation index, later every 1–2
years for 5–10 years.
• Patients with residual disease should be monitored, initially every 3–6 months, with
biochemical markers, CT/MRI and, when indicated, SRI.
• The 5- and 10-year survival was 94% and 31% for localised disease and 31% and 18%
for patients with distant metastases in a large Norwegian cohort
36. Small intestinal NETs (SI-NET)
Clinical presentation:
• Approximately 25–30% of GEP-NENs are SI-NETs, most originating in the distal ileum. Most primary
tumours are small (1–2 cm) and may be multiple.
• Approximately 60% have metastasised at diagnosis mainly in the mesenteric and para-aortal lymph
nodes and the liver.
• The primary tumour, mesenteric lymph node metastases and tumour-induced fibrosis may cause
bowel obstruction and vascular encasement accompanied by abdominal pain, diarrhoea and weight
loss. Carcinoid syndrome with flushing and diarrhoea is present in less than 20% of the patients at
37.
38. Treatment
Surgery
• If an R0/R1 resection can be obtained patients should be considered for surgery independent of
tumour stage.
• Intra-operative palpation of the entire small intestine is recommended to identify multiple tumours.
• In case of acute surgery, extensive central mesenteric dissection should be avoided due to the high
risk of damage to the mesenteric vessels resulting in short bowel syndrome.
• In patients with stage IV disease, surgery is considered when there are symptoms of bowel
obstruction or ischaemia.
39. • A recent study did not demonstrate any survival benefit after primary tumour resection in
asymptomatic patients with metastatic disease.
• Instead, frequent need for reoperations for bowel obstruction after initial early surgery was
observed.
• Surgery of liver metastases may be considered if R0 resection can be obtained or if
needed to reduce endocrine symptoms.
40.
41. Follow-up and prognosis
• After radical surgery, follow-up is recommended every 3–12 months and later every 24 months for
at least 5 years and according to institutional preferences, with imaging including SRI and s-CgA,
since late recurrence may occur.
• Patients with metastatic disease should be examined every 3–12 months with CT/MRI and relevant
biomarkers.
• SRI should be performed when PRRT is considered and when CT/MRI findings, biochemistry and
the patients clinical status are contradictive.
• The 5- and 10-year survival was 77% and 63% for localised disease and 59% and 39% for patients
with distant metastases in a large Norwegian cohort
42. Appendix NETs
Clinical presentation
• Tumours are mostly incidental findings in surgical specimens after appendectomy due
to acute appendicitis.
• More than 60% are <1 cm and G1 tumours
Diagnostic procedures:
• Most appendix NETs (85%) are morphologically similar to SI-NETs and serotonin
immunoreactive.
• Some (<20%) are small tubular carcinoids negative for serotonin but positive for
glucagon.
• Biochemical markers(s-CgA and u/p-5HIAA) are usually normal.
43.
44. Treatment
Appendectomy is sufficient treatment in >90% of cases.
Right-sided hemicolectomy is not indicated for R0 resected tumours <1cm regardless of the presence
of risk factors.
Risk factors for malignant disease include
Invasion of mesoappendix >3 mm, vascular invasion, lymphatic
invasion and Ki-67 >10% .
R0 resected tumours 1–2 cm
with the presence of two or more risk factors is an indication for right-sided hemicolectomy with lymph
node dissection
45. If the tumour size is >2 cm, SRI is recommended, followed by right-sided hemicolectomy.
Right-sided hemicolectomy should be performed if the tumour involves resection
margins, or has spread to regional lymph nodes irrespective of size.
In metastatic disease, medical treatment is similar to that for SI-NETs.
46. Follow-up and prognosis
• In patients where appendectomy is sufficient, no further follow-up is required.
• After right-sided hemicolectomy, follow-up is only necessary if lymph node metastases or
residual tumour is present. For patients who have undergone right-sided hemicolectomy
with findings of lymph node metastases and in patients with advanced disease.
• Follow-up should be identical to that of SINETs.
• The 5-year survival is close to 100%.
47. Colon NETs
Clinical presentation:
• <1% of colonic malignancies.
• Common site involvement is caecum, are G1-2 tumours and resemble SI-NET .
• Tumours in the remaining part of the colon are usually NECs.
Diagnostic procedures:
• S-CgA should be measured in all patients and 5HIAA should be measured in NETs originating in the
right colon.
• Colonoscopy with biopsy is mandatory.
48. Treatment
• Surgical treatment includes bowel resection with lymph node dissection.
• The medical treatment for G1-2 NET is as for SI-NET.
• Follow-up and Prognosis: Same as SI-NETs
49. Rectal NETs
Clinical presentation:
Comprise Approx. 20% of GEP-NENs and are usually small, benign polyps found incidentally at
routine endoscopy.
Hormone-related symptoms are never seen.
Diagnostic procedures:
Tumours show a trabecular growth pattern with positive synaptophysin, CgA and glucagon
immunohistochemistry but negative for serotonin.
S-CgA and u/p-5HIAA are usually normal.
In G1 tumours >1 cm and in G2 tumours, irrespectively of size, CT/MRI and SRI are recommended.
50.
51. Treatment
• Rectal NETs <2 cm can often be radically resected by Endoscopic procedures.
• Before attempts on endoscopic resection, EUS is recommended in tumours >0.5–1 cm to investigate
the depth of tumour growth.
• Invasion into the muscularis propria is a contraindication for endoscopic removal.
• If endoscopic removal is not possible, the tumour should be surgically treated according to the same
principles as for Rectal adenocarcinomas.
• Medical treatment is as for SI-NET.
52. Follow-up and prognosis
• Radically resected G1 polyps <1 cm do not need further surveillance.
• Higher grade lesions, or with lymph node metastases, should be followed as SI-NET.
• If NETs G1-3 are incompletely resected, flex-endoscopy with biopsies should be performed
immediately and then yearly for 3 years, and thereafter every 2–3 years for at least 10 years.
• Five-year survival for patients with G1 and G2 tumours with localised disease is >90%, regional
disease 50% and distant disease 30–40%.
53. Management of NET liver metastases
• Single or few hepatic metastases may be resected with radical intent.
• Palliative debulking surgery and, if surgery is not possible, RF/microwave ablation can be indicated to
reduce severe hormonal or local symptoms, but the impact on survival is uncertain.
• Larger tumour burden confined to the liver may be treated by embolisation of the hepatic artery or its
branches. Beneficial effects on hormone-induced symptoms as well as reduction of tumour size is seen
in >50% of the patients with a duration of 10–24 months.
54. Radio-embolisation with intrahepatic infusion of 90Y coated resin or glass particles has
shown promising results.
In systematic reviews, there has not been shown any differences in effect between bland-
chemo- and radioembolization of the liver.
Orthotopic liver transplantation is rarely indicated, but may be considered in carefully
selected young patients without extrahepatic disease and with a Ki-67 index <10%.
Approximately 20% are recurrence free after 5 years and the 5-year survival rate may be
as high as 90%