Neuro Endocrine Tumor (NET)

 

Mrs. R. Deepa¹, Mrs. D. Kavitha²

¹Associate Professor, College of Nursing, Sri Ramakrishna Institute of Paramedical Sciences, Coimbatore

²Nursing Tutor, College of Nursing, Sri Ramakrishna Institute of Paramedical Sciences, Coimbatore

 

ABSTRACT:

Neuro endocrine tumor is neoplasm that arise from the cells of endocrine and nervous system. Many are benign, while some are malignant. Intestine is the common site of this type of tumor, and also found in pancreas, lung and other rest of the body. Five –year survival rates can be as high as 90% when the tumors haven’t spread to distant organs or lymph nodes. It is diagnosed in early stages and properly treated, can be favorable. Case History: Mr. Mani, 65 years who admitted in a private hospital with severe abdominal pain, aphasia and constipation for the past few months. He is a known case of hypothyroidism, CVT.  On the day of admission, he was conscious and oriented. He was treated by anti-emetics, steroids, anti-platelet, anti-thyroid and anti-coagulant.

 

 

 

INTRODUCTION:

A neuroendocrine tumor is a rare tumor that affects the cells that release hormones into the bloodstream (neuroendocrine cells). It may be functional and non-functional type of neuro endocrine tumors.

 

History:

·         Small intestinal neuroendocrine tumors were first distinguished from other tumors in 1907. [1]

·         However, in 1938 it was recognized that some of these small bowel tumors could be malignant. [1][2]

 

Enterochromaffin cells, which give rise to carcinoid tumors, were identified in 1897 by Nikolai Kulchitsky and their secretion of serotonin was established in 1953 when the "flushing" effect of serotonin had become clinically recognized. Carcinoid heart disease was identified in 1952, and carcinoid fibrosis in 1961[2]

 

Incidence:

·         Approximately 2.5-5 per 100,000 clinically significant

·         The prevalence has been estimated as 35 per 100,000 and may be considerably higher if clinically silent tumors are included.

·         Routine microscopic study of three random sections of the pancreas found NETs in 1.6%, and multiple sections identified NETs in 10%. [3][4]

 

Causes:

·       Any family member has had any type of cancer

·       Excessive overflow of serotonin

·       Niacin deficiency

·       multiple endocrine neoplasia type 1 (MEN1)

·       neurofibromatosis type 1

·       Von Hippel-Lindau syndrome (VHL)

·       Neurofibromatosis

·       Tuberous sclerosis

·       Carney complex

 

Anatomic Distribution:

It arises in all areas of the body like pituitary gland, thyroid and parathyroid, thymus, pulmonary, Gastrointestinal, pancreas, liver, gall bladder, breast, genitourinary, skin and peripheral nervous system.[5]

 

Classification:

According to World Health Organization,

·      Well-differentiated neuroendocrine tumors, further subdivided into tumors with benign and those with uncertain behavior

·      Well-differentiated (low grade) neuroendocrine carcinomas with low-grade malignant behavior poorly differentiated (high grade) neuroendocrine carcinomas, which are the large cell neuroendocrine and small cell carcinomas. [6][7]

 

Symptoms of NET:

·         Gastrointestinal neuroendocrine tumor diarrhea, bowel obstruction, constipation or tummy pains

·         Pulmonary neuroendocrine tumor wheezing, pneumonia, weight loss, weakness, neuralgia, pleurisy or a persistent cough

·         Hematology tumor- Congestive Heart Failure, hemoptysis, diarrhea, bronchospasm, flushing, cramps, wheezing, peripheral edema, night sweats, low blood sugar, changes in BP and palpitation. [8][9]

 

Diagnostic Evaluations:

·      Blood test, urine tests, scans and a biopsy

·      Ultrasound

·      Endoscopy

·      CT / MRI / PET

Octreotide scans – where mildly radioactive liquid is injected into your veins and a special camera is used to highlight any cancerous cells [10]

 

Treatment of NET:

It depends on the location, its advanced status and status of the health Treatment for neuroendocrine tumors.

·         Somatostatin analogues- octreotide- considering the effect on the blood leukocyte count.

·         Embolization

·         Chemotherapy

·         Radiotherapy

·         Radiofrequency ablation – It is useful in patient with metastasis

·         Gene therapy

·         Cryoablation [11]

 

REFERENCES:

1.      Arnold R, Göke R, Wied M, Behr T (2003). "Chapter 15 Neuroendocrine Gastro-Entero-Pancreatic (GEP) Tumors". In Scheppach W, Bresalier RS, Tytgat GN (eds.). Gastrointestinal and Liver Tumors. Berlin: Springer. pp. 195–233. ISBN 978-3-540-43462-7.

2.      Modlin, I.M.; Shapiro, M.D.; Kidd, M. (2004). "Siegfried oberndorfer: Origins and perspectives of carcinoid tumors". Human Pathology. 35 (12): 1440–51. doi:10.1016/j.humpath.2004. 09.018. PMID 15619202.

3.      Öberg, K.; Castellano, D. (2011). "Current knowledge on diagnosis and staging of neuroendocrine tumors". Cancer and Metastasis Reviews. 30: 3–7. doi:10.1007/s10555-011-9292-1. PMID 21311954

4.      Kimura, W.; Kuroda, A.; Morioka, Y. (1991). "Clinical pathology of endocrine tumors of the pancreas". Digestive Diseases and Sciences. 36 (7): 933–42. doi:10.1007/BF01297144. PMID 2070707.

5.      Ramage JK, Davies AH, Ardill J, et al. (June 2005). "Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours". Gut. 54. 54 (Suppl 4): iv1–

6.      Klimstra, D.S.; Modlin, I.R.; Coppola, D.; Lloyd, R.V.; Suster, S. (2010). "The Pathologic Classification of Neuroendocrine Tumors". Pancreas. 39 (6): 707–12. doi:10.1097/MPA.0b013e 3181ec124e. PMID 20664470.

7.      Tan, E.H.; Tan, C. (2011). "Imaging of gastroenteropancreatic neuroendocrine tumors". World Journal of Clinical Oncology. 2 (1): 28–43. doi:10.5306/ wjco. V 2. i1.28. PMC 3095463. PMID 21603312.

8.      Kimura W, Kuroda A, Morioka Y (July 1991). "Clinical pathology of endocrine tumors of the pancreas. Analysis of autopsy cases". Dig. Dis. Sci. 36 (7): 933–42. doi:10.1007/BF01297144. PMID 2070707. "[In] 800 autopsy cases, incidence of tumor was 10%

9.      Arnold R, Göke R, Wied M, Behr T (2003). "Chapter 15 Neuroendocrine Gastro-Entero-Pancreatic (GEP) Tumors". In Scheppach W, Bresalier RS, Tytgat GN (eds.). Gastrointestinal and Liver Tumors. Berlin: Springer. pp. 195–233. ISBN 978-3-540-43462-7.

10.   Masters, Alexander (2014-10-14). "A plutocratic proposal". Mosaic. The Wellcome Trust. Archived from the original on 2016-05-29. Retrieved 2016-07-03.

11.   Warner, R.R.P. (2005). "Enteroendocrine Tumors Other Than Carcinoid: A Review of Clinically Significant Advances". Gastroenterology. 128 (6): 1668–84. doi:10.1053/j.gastro. 2005.03.078. PMID 15887158.

 

Received on 19.02.2020         Modified on 21.03.2020

Accepted on 10.04.2020       ©A&V Publications All right reserved