The Path to a Neuroendocrine Tumor Diagnosis

Jonathan R. Strosberg, MD, of Moffitt Cancer Center, and Simron Singh, MD, MPH, of Sunnybrook Odette Cancer Centre, describe how patients with neuroendocrine tumors (NETs) reach a diagnosis, moderated by Daniel M. Halperin, MD, of Winship Cancer Institute of Emory University. Strosberg frames NETs as a family of related but distinct cancers. Small bowel NETs often present with abdominal pain, and hormonal syndromes such as carcinoid syndrome, insulinoma, and Zollinger-Ellison syndrome can occur. Many tumors are now found incidentally on scans or endoscopy, raising the problem of overdiagnosis of clinically insignificant tumors. In the United States, patients often see a gastroenterologist first or present to the emergency department; about 20% of patients with well-differentiated NETs have years of symptoms before diagnosis. Singh urges referring clinicians to recognize the wide spectrum of disease behavior and the anxiety the word cancer causes. Strosberg advises considering NETs when patients have unexplained recurrent abdominal pain, bowel obstruction, or chronic diarrhea.