Dr. Hal Gerstein– Cancer Institute of Long Island

NETs are a diverse group of malignancies – that can be categorized as functional (producing something / or non functional)

The number of yearly DX rate is going up – not sure if we are better at dx them or something new is causing them.  The rate is increasing faster than the average of other cancers.

NETs can be undetected for years before either symptom caused by peptide release or obstructions allow for a dx

Locations are Fore, Mid and Hind gut

KI-67 from tissue biopsy is one of the best ways to predict outcome with Ki-67 under 2 and no spread being best and KI-67 >10 with distant mets  being worst.

Median life expectancy with Ki-67>10 and distant spread is 33 months – with KI-67<2 and being local in scope - this increases to 223 months.  With 102 and with regional mets – this is 111 months.

Why no early detection? – Symptoms are wide ranging and could be a number of other issues as well

Carcinoid Syndrome
Flushing – wheezing – usually but not always with mets to the liver

Need to understand patient’s history – Diarrhea not related to eating (night time) one good clue for diagnosis

BIO Markers (please see Interscience Institute website for complete bio markers and how to take tests)
CgA
5HIAA
For all blood test make sure you follow precautions about foods and medications to avoid or false positive can be seen – Do not take PPI for CgA and many fruits and vegs and nuts should be avoided for 5HIAA

Imaging
CT or MR
OSCAN to see functional or not (uptake of octreotide)
Upper Endoscope (PNETs only)
PET

Evolving treatment
Treatment is moving from symptom to control to some reduction in tumors – trying to get to chronic disease.  New drugs approved for some forms of NETs (Evrolimus / Sutent) approved this year for treatment.