Neuroendocrine tumours Flashcards
What Ki67 index is equivalent to a G1, G2 and G3 NET?
G1 is 3% or less, G2 is 3-20%, G3 >20%
What is the management of choice for well differentiated pancreatic NET with limited liver metastatic disease?
Surgical resection
When is surveillance appropriate in NET?
If well differentiated NET <2cm
What percentage of NETs are functional?
20%
What are the most common presenting functional symptoms in small bowel NET?
Flushing, palpitations and diarrhoea. Can cause mesenteric fibrosis.
What investigations are required in suspected functional small bowel NET?
24hr urine 5-HIAA and raised chromogranin, octreotide scan
How do functional pancreatic NETs present?
Gastrinoma or insulinoma
How can functional lung NETs present?
Atypical Cushings or carcinoid but most are non functional.
What can be used to control diarrhoea in functional NETs if not controlled by long acting SSA?
Can give supplemental doses of short acting, loperamide or telotristat
On progression of gastropancreatic NETs after SSA, what would be the next line option?
Peptide receptor radionuclide therapy- Lutetium-177 DOTATATE
How do you manage long acting SSA around peptide receptor radionuclide therapy?
Stop around 4-6 weeks before but can start again after 24hrs.
What must be given concurrently and following Lutetium-177 DOTATATE?
Amino acid solution for renal protection
Third line options?
Everolimus, Sunitinib, platinum based chemotherapy
