Advances in the detection and management of neuroendocrine (carcinoid and pancreatic islet cell) tumours

Abstract

Purpose of reviewOur review will focus on gastroenteropancreatic neuroendocrine tumours, summarizing recent data on their diagnosis and management. Recent findingsHistopathological classification is currently essential not only in establishing the diagnosis of gastroenteropancreatic tumours but also guiding further management. The detection rate of all imaging modalities has greatly improved and, in particular, the introduction of radionuclide modalities has identified occult lesions and improved the staging of gastroenteropancreatic tumours. While somatostatin analogues successfully control the symptoms of functioning tumours and may frequently control their growth, radical tumour resection represents the only curative approach; it is also increasingly being used for palliation, even with advanced disease. The majority of gastroenteropancreatic tumours are well differentiated and slow-growing and are best treated with somatostatin analogues or α-interferon. Treatment with radiolabelled somatostatin analogues represents an alternative therapeutic modality for tumours exhibiting uptake on a diagnostic scan. Chemotherapy is reserved for poorly differentiated or progressive but well differentiated gastroenteropancreatic lesions. Novel individual therapies and new combinations of established therapies are evolving and undergoing clinical assessment. In all cases, a multidisciplinary approach is essential. SummarySuccessful treatment requires a multimodal approach aimed at symptomatic control and prevention of further tumour growth. Advances in modalities using radionuclides have been incorporated into the diagnosis, staging and therapy of gastroenteropancreatic neuroendocrine tumours.