Neuroendocrine tumours Flashcards

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1
Q

What Ki67 index is equivalent to a G1, G2 and G3 NET?

A

G1 is 3% or less, G2 is 3-20%, G3 >20%

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2
Q

What is the management of choice for well differentiated pancreatic NET with limited liver metastatic disease?

A

Surgical resection

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3
Q

When is surveillance appropriate in NET?

A

If well differentiated NET <2cm

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4
Q

What percentage of NETs are functional?

A

20%

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5
Q

What are the most common presenting functional symptoms in small bowel NET?

A

Flushing, palpitations and diarrhoea. Can cause mesenteric fibrosis.

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6
Q

What investigations are required in suspected functional small bowel NET?

A

24hr urine 5-HIAA and raised chromogranin, octreotide scan

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7
Q

How do functional pancreatic NETs present?

A

Gastrinoma or insulinoma

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8
Q

How can functional lung NETs present?

A

Atypical Cushings or carcinoid but most are non functional.

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9
Q

What can be used to control diarrhoea in functional NETs if not controlled by long acting SSA?

A

Can give supplemental doses of short acting, loperamide or telotristat

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10
Q

On progression of gastropancreatic NETs after SSA, what would be the next line option?

A

Peptide receptor radionuclide therapy- Lutetium-177 DOTATATE

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11
Q

How do you manage long acting SSA around peptide receptor radionuclide therapy?

A

Stop around 4-6 weeks before but can start again after 24hrs.

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12
Q

What must be given concurrently and following Lutetium-177 DOTATATE?

A

Amino acid solution for renal protection

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13
Q

Third line options?

A

Everolimus, Sunitinib, platinum based chemotherapy

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