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Vol. 29, No. 4, 2012
Issue release date: November 2012
Free Access
Dig Surg 2012;29:331–348
(DOI:10.1159/000342988)

Gastric NeuroendocrineTumours

Crosby D.A.a · Donohoe C.L.a · Fitzgerald L.a · Muldoon C.b · Hayes B.b · O’Toole D.c · Reynolds J.V.a
aDepartment of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin/St James’s Hospital, and Departments of bHistopathology and cGastroenterology, St. James’s Hospital, Dublin, Ireland
email Corresponding Author

Abstract

Background: Gastric neuroendocrine tumours (NETs) are increasingly recognised, and management decisions may be difficult due to an incomplete understanding of aetiology, natural history and optimum therapy. This article presents a current understanding based on recent advances in epidemiology, classification, molecular profiling, and treatment. Methods: Relevant medical literature was identified from searches of PubMed and references cited in appropriate articles identified. Selection of articles was based on peer review, journal and relevance. Results: Gastric NETs may be divided into three clinical prognostic groups: type I is associated with autoimmune atrophic gastritis and hypergastrinaemia, type II is associated with Zollinger-Ellison syndrome, and type III lesions are gastrin-independent, have the greatest metastatic potential and poorest prognosis. There has been an increased frequency of gastric NETs reported. Management approaches have evolved in parallel with advances in endoscopic staging and surgery, as well as improved understanding of the biology and natural history of NETs. Conclusions: Gastric NETs present a spectrum of activity from indolent tumours to metastatic malignancy. Treatment decisions for patients must be individualised and are best managed by a multidisciplinary team approach. The current evidence base is limited to small series and efforts to treat patients within clinical networks of expertise are warranted.


 Outline


 goto top of outline Key Words

  • Autoimmune atrophic gastritis
  • Chromogranin A
  • Clinical and pathological staging
  • Gastrin-independent lesions
  • Gastric neuroendocrine tumours
  • 5-Hydroxyindolacetic acid
  • Hypergastrinaemia
  • Neuroendocrine tumours
  • Type I–III gastric NETs
  • Zollinger-Ellison syndrome

 goto top of outline Abstract

Background: Gastric neuroendocrine tumours (NETs) are increasingly recognised, and management decisions may be difficult due to an incomplete understanding of aetiology, natural history and optimum therapy. This article presents a current understanding based on recent advances in epidemiology, classification, molecular profiling, and treatment. Methods: Relevant medical literature was identified from searches of PubMed and references cited in appropriate articles identified. Selection of articles was based on peer review, journal and relevance. Results: Gastric NETs may be divided into three clinical prognostic groups: type I is associated with autoimmune atrophic gastritis and hypergastrinaemia, type II is associated with Zollinger-Ellison syndrome, and type III lesions are gastrin-independent, have the greatest metastatic potential and poorest prognosis. There has been an increased frequency of gastric NETs reported. Management approaches have evolved in parallel with advances in endoscopic staging and surgery, as well as improved understanding of the biology and natural history of NETs. Conclusions: Gastric NETs present a spectrum of activity from indolent tumours to metastatic malignancy. Treatment decisions for patients must be individualised and are best managed by a multidisciplinary team approach. The current evidence base is limited to small series and efforts to treat patients within clinical networks of expertise are warranted.

Copyright © 2012 S. Karger AG, Basel


 goto top of outline Author Contacts

Prof. John V. Reynolds
Trinity Centre for Health Sciences
St. James’s Hospital
Dublin 8 (Ireland)
E-Mail reynoljv@tcd.ie


 goto top of outline Article Information

Received: June 15, 2012
Accepted after revision: August 24, 2012
Published online: October 17, 2012
Number of Print Pages : 18

Additional supplementary material is available online - Number of Parts : 1


 goto top of outline Publication Details

Digestive Surgery

Vol. 29, No. 4, Year 2012 (Cover Date: November 2012)

Journal Editor: Tilanus H.W. (Rotterdam), Wijnhoven B.P.L. (Rotterdam), Gouma D.J. (Amsterdam), van Lanschot J.J.B. (Rotterdam)
ISSN: 0253-4886 (Print), eISSN: 1421-9883 (Online)

For additional information: http://www.karger.com/DSU


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Background: Gastric neuroendocrine tumours (NETs) are increasingly recognised, and management decisions may be difficult due to an incomplete understanding of aetiology, natural history and optimum therapy. This article presents a current understanding based on recent advances in epidemiology, classification, molecular profiling, and treatment. Methods: Relevant medical literature was identified from searches of PubMed and references cited in appropriate articles identified. Selection of articles was based on peer review, journal and relevance. Results: Gastric NETs may be divided into three clinical prognostic groups: type I is associated with autoimmune atrophic gastritis and hypergastrinaemia, type II is associated with Zollinger-Ellison syndrome, and type III lesions are gastrin-independent, have the greatest metastatic potential and poorest prognosis. There has been an increased frequency of gastric NETs reported. Management approaches have evolved in parallel with advances in endoscopic staging and surgery, as well as improved understanding of the biology and natural history of NETs. Conclusions: Gastric NETs present a spectrum of activity from indolent tumours to metastatic malignancy. Treatment decisions for patients must be individualised and are best managed by a multidisciplinary team approach. The current evidence base is limited to small series and efforts to treat patients within clinical networks of expertise are warranted.



 goto top of outline Author Contacts

Prof. John V. Reynolds
Trinity Centre for Health Sciences
St. James’s Hospital
Dublin 8 (Ireland)
E-Mail reynoljv@tcd.ie


 goto top of outline Article Information

Received: June 15, 2012
Accepted after revision: August 24, 2012
Published online: October 17, 2012
Number of Print Pages : 18

Additional supplementary material is available online - Number of Parts : 1


 goto top of outline Publication Details

Digestive Surgery

Vol. 29, No. 4, Year 2012 (Cover Date: November 2012)

Journal Editor: Tilanus H.W. (Rotterdam), Wijnhoven B.P.L. (Rotterdam), Gouma D.J. (Amsterdam), van Lanschot J.J.B. (Rotterdam)
ISSN: 0253-4886 (Print), eISSN: 1421-9883 (Online)

For additional information: http://www.karger.com/DSU


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.