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Review
. 2018 Aug;14(8):471-482.
doi: 10.1200/JOP.18.00135.

Management of Small Bowel Neuroendocrine Tumors

Aaron T Scott  1 , James R Howe  1
Affiliations
Review

Management of Small Bowel Neuroendocrine Tumors

Aaron T Scott et al. J Oncol Pract. 2018 Aug.

Abstract

Small bowel neuroendocrine tumors (NETs) are increasing in incidence and are now the most common primary malignancies of the small intestine. Despite this increase, the vague presentation and slow growth of these tumors lead to long delays in diagnosis, and many patients present with metastases. Patients with metastatic small bowel NETs have a favorable disease prognosis, particularly when contrasted with other GI malignancies, and benefit from aggressive, multimodal therapy. During the past decade, the options for the diagnosis and treatment of small bowel NETs have increased considerably. This review provides a practical framework for the physician who seek to understand the epidemiology, presentation, diagnosis, and management of small bowel NETs.

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Figures

Fig 1.
Fig 1.
Top left: A spiculated, partially calcified nodal mesenteric mass seen on computed tomography scan. Top right: Intraoperative image of a primary small bowel neuroendocrine tumor with narrowing of the bowel lumen. Bottom left: Intraoperative image of a mesenteric nodal mass. Bottom right: Contrast-enhanced T1-weighted magnetic resonance imaging in the arterial phase that shows multiple hepatic metastases.
Fig 2.
Fig 2.
Top left: Octreoscan showing hepatic metastases of small bowel neuroendocrine tumor. Bottom left: Gallium-68 positron emission tomography/computed tomography (68Ga-PET/CT) of the same patient that demonstrates improved resolution of the metastatic lesions. Right: Coronal section of a 68Ga-PET/CT that demonstrates a mesenteric nodal mass and multiple metastatic lesions to the liver and left supraclavicular node.
Fig 3.
Fig 3.
An algorithmic approach to the diagnosis and treatment of small bowel neuroendocrine tumors (NETs). BNP, brain natriuretic peptide; CAPTEM, capecitabine and temozolomide; CT, computed tomography; DTIC, dacarbazine; Ga-PET, gallium positron emission tomography; IFN, interferon; In-SRS, indium somatostatin receptor scintigraphy; IRI, irinotecan; LAR, long-acting repeatable; NEC, neuroendocrine carcinoma; OX, oxaliplatin; PRRT, peptide receptor radionuclide therapy; SSA, somatostatin analog; STZ, streptozocin; TMZ, temozolomide.
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