Pancreatic Neuroendocrine Tumor Diagnosis Challenges

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Moderator, Matthew H. Kulke, MD, introduces a panel discussion focused on the treatment of patients with pancreatic neuroendocrine tumors, with a particular emphasis on the effective sequencing of treatment options. The discussion includes expert perspectives from Diane Reidy-Lagunes, MD, MS, Rodney F. Pommier, MD, and Jonathan R. Strosberg, MD.

In general, 60% to 80% of patients with pancreatic neuroendocrine tumors (pNETs) have metastatic disease at the time of diagnosis, notes Pommier. These tumors frequently metastasize to the liver, which is also usually the point of biopsy. Unfortunately, the biopsy from a liver lesion does not help identify the site of primary origin. It is important to find the primary location, since multiple therapies exist for patients specifically with pNETs.

The four classic neuroendocrine tumors in the pancreas are insulinomas, glucagonomas, gastrinomas, and VIPomas, Pommier notes. Usually gastrinomas and insulinomas are not metastatic at diagnosis, due to high levels of hormone secretion at an early stage. The glucagonomas and VIPomas are commonly diagnosed in the metastatic stage. However, Pommier notes that he usually sees nonfunctional metastatic tumors that are not one of these class syndromes.

For the diagnosis, it is important to start with several imaging modalities, such as CT scans and MRI, believes Strosberg. Beyond this, other tests may be utilized, including endoscopic ultrasound and exploratory surgery. The tests utilized can be personalized based on lymph node status and symptoms, suggests Reidy-Lagunes.

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