2024 Resistant gastroenteropancreatic neuroendocrine tumors: a definition and guideline to medical and surgical management

Abstract

Gastroenteropancreatic neuroendocrine tumors (NETs), also historically known as carcinoids, are tumors derived of hormone-secreting enteroendocrine cells. Carcinoids may be found in the esophagus, stomach, small intestine, appendix, colon, rectum, or pancreas. The biologic behavior of carcinoids differs based on their location, with gastric and appendiceal NETs among the least aggressive and small intestinal and pancreatic NETs among the most aggressive. Ultimately, however, biologic behavior is most heavily influenced by tumor grade. The incidence of NETs has increased by 6.4 times over the past 40 years. Surgery remains the mainstay for management of most carcinoids. Medical management, however, is a useful adjunct and/or definitive therapy in patients with symptomatic functional carcinoids, in patients with unresectable or incompletely resected carcinoids, in some cases of recurrent carcinoid, and in postoperative patients to prevent recurrence. Functional tumors with persistent symptoms or progressive metastatic carcinoids despite therapy are called “resistant” tumors. In patients with unresectable disease and/or carcinoid syndrome, an array of medical therapies is available, mainly including somatostatin analogues, molecular-targeted therapy, and peptide receptor radionuclide therapy. Active research is ongoing to identify additional targeted therapies for patients with resistant carcinoids.

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Faculty credentials/disclosure 

Dr. Davis is a surgical oncologist at Baylor University Medical Center in Dallas and a clinical assistant professor of surgery at Texas A&M University School of Medicine. Dr. Laird is the chief of the Section of Endocrine Surgery at the Rutgers Cancer Institute of New Jersey. Dr. Libutti is the director of the Rutgers Cancer Institute of New Jersey and is an internationally known expert in the management of neuroendocrine tumors. The authors and planner for this educational activity have no relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients.

Process

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Expiration date:

Credit eligibility for this article is set to expire on January 31, 2025.

Target Audience

Surgeons and Oncologists

Learning Objectives

After completing the article, the learner should be able to:

  • Recognize functional gastroenteropancreatic neuroendocrine tumors/carcinoids with persistent symptoms or progressive metastatic carcinoids despite therapy as “resistant” tumors.
  • Understand the array of medical therapies available for patients with unresectable disease and/or carcinoid syndrome, including somatostatin analogues, molecular-targeted therapy, and peptide receptor radionuclide therapy.
  • Describe the accepted role for surgical debulking of metastatic gastroenteropancreatic tumors, especially those that are grade 1 or 2, and recognize the more nuanced role of surgical management for high-grade or resistant widely metastatic carcinoids.
Course summary
Available credit: 
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME Medical Knowledge of the American Board of Surgery's Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
01/01/2024
Course expires: 
12/31/2024
Cost:
$25.00
Rating: 
0

    Catherine H. Davis, MD, MPH 

    • Division of Surgical Oncology, Baylor University Medical Center, Dallas, Texas USA
    • Texas A&M University School of Medicine, Dallas, Texas, USA

    Amanda M. Laird, MD

    • Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
    • Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA

    Steven K. Libutti, MD

    • Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
    • Rutgers Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA

     

    Accreditation

    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Designation

    AMA PRA Category 1 Credit

    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    American Board of Surgery Maintenance of Certification (MOC)

    ABS CC: Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

    Available Credit

    • 1.00 American Board of Surgery (ABS) Accredited CME
      Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME Medical Knowledge of the American Board of Surgery's Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
    • 1.00 AMA PRA Category 1 Credit
      The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
    • 1.00 Attendance

    Price

    Cost:
    $25.00
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