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Neuroendocrine tumor disease: An evolving landscape
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
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2012 (English)In: Endocrine-Related Cancer, ISSN 1351-0088, Vol. 19, no 5, R163-R185 p.Article, review/survey (Refereed) Published
Abstract [en]

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) represent a heterogenous group of tumors arising from a variety of neuroendocrine cell types. The incidence and prevalence of GEP-NENs have markedly increased over the last three decades. Symptoms are often absent in early disease, or vague and nonspecific even in advanced disease. Delayed diagnosis is thus common. Chromogranin A is the most commonly used biomarker but has limitations as does the proliferative marker Ki-67%, which is often used for tumor grading and determination of therapy. The development of amultidimensional prognostic nomogrammay be valuable in predicting tumor behavior and guiding therapy but requires validation. Identification of NENs that express somatostatin receptors (SSTR) allows for SSTR scintigraphy and positron emission tomography imaging using novel radiolabeled compounds. Complete surgical resection of limited disease or endoscopic ablation of small lesions localized in stomach or rectum can provide cure; however, the majority of GEP-NENs are metastatic (most frequently the liver and/or mesenteric lymph nodes) at diagnosis. Selected patients with metastatic diseasemay benefit from advanced surgical techniques including hepatic resection or liver transplantation. Somatostatin analogs are effective for symptomatic treatment and exhibit some degree of antiproliferative activity in small intestinal NENs. There is a place for streptozotocin, temozolomide, and capecitabine in the management of pancreatic NENs, while new agents targeting either mTOR (everolimus) or angiogenic (sunitinib) pathways have shown efficacy in these lesions.

Place, publisher, year, edition, pages
2012. Vol. 19, no 5, R163-R185 p.
Keyword [en]
5 hydroxyindoleacetic acid, angiopeptin, bevacizumab, capecitabine, chromogranin A, cyclophosphamide, dalotuzumab, everolimus, gefitinib, imatinib, Ki 67 antigen, motesanib, octreotide, pasireotide, pazopanib, somatostatin derivative, somatostatin receptor, sorafenib, streptozocin, sunitinib, temozolomide, temsirolimus, thalidomide, vasculotropin antibody, antiproliferative activity, cancer combination chemotherapy, cancer diagnosis, cancer epidemiology, cancer grading, cancer incidence, cancer localization, cancer prognosis, cancer surgery, delayed diagnosis, drug efficacy, gastric neuroendocrine tumor, gastrinoma, gastroenteropancreatic neuroendocrine neoplasm, glucagonoma, human, insulinoma, liver metastasis, lymph node metastasis, midgut neuroendocrine tumor, molecularly targeted therapy, neuroendocrine tumor, pancreatic neuroendocrine tumor, positron emission tomography, protein expression, review, treatment response, tumor ablation, vipoma
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-187934DOI: 10.1530/ERC-12-0024ISI: 000310913500008OAI: oai:DiVA.org:uu-187934DiVA: diva2:576192
Available from: 2012-12-12 Created: 2012-12-12 Last updated: 2012-12-19Bibliographically approved

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Åkerström, Göran
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