oncology and supportive care
Neuroendocrine tumors – a life-limiting disease
Neuroendocrine tumors (NET) are a collective name for a group of slow-growing cancerous tumors that originate from cells in the endocrine and nervous systems. It is a relatively rare, chronic and life-limiting disease that is often diagnosed late.
Rising cases and varied symptoms – neuroendocrine tumors
The neuroendocrine tumors can occur throughout the body, including in the abdomen and lungs. Gastroenteropancreatic neuroendocrine tumors, GEP-NET, is the most common subgroup of NETs where the tumors are located in the gastrointestinal tract or pancreas.1
Steadily rising prevalence of neuroendocrine tumors
The incidence and prevalence of neuroendocrine tumors are steadily increasing in both North America, Asia and Europe, with the highest increase recorded in North America and there is today an estimated 350,000 patients with GEP-NET in the EU and US.2,3 Better utilization of healthcare resources, with more efficient and earlier diagnosis, is likely to be a contributing factor to the increase in disease incidence. In parallel with access to better treatment options, survival for patients with GEP-NET has improved over time.2,4
Heterogeneous disease and display of neuroendocrine tumor symptoms
NET can be present with or without symptoms. The most common syndrome of NET, carcinoid syndrome, is predominantly characterized by flushing, diarrhea, and asthma-like symptoms.4 Symptoms of NET can be very diverse, and depend on the tumor location, size and hormone produced by the affected cells. Often, a person has no symptoms until the tumor spreads, making NET hard to diagnose due to the slow growth rate of the tumor.
Depending on the tumor’s location, size and which hormone is secreted by the tumor cells, the symptoms can be extremely variable. The most significant clinical symptoms together constitute so called carcinoid syndrome, which may include abdominal pain and cramps, severe diarrhea, redness of the skin, and asthma-like symptoms. Often a person has no symptoms until the tumor starts to spread, which makes NET difficult to diagnose. The average age at diagnosis is 55-65 years old, and the disease is equally common in women and men.
The average age at diagnosis is 55-65 years old, and the disease is equally common in women and men.1
Principles of neuroendocrine tumors treatment
The primary goal with GEP-NET treatment is to surgically remove the tumor. In almost half of cases which cannot be treated through surgery6, standard medical treatment is somatostatin analogues (SSA), such as octreotide and lanreotide. Treatment with SSA aims to prevent tumor growth and further spread of the tumor, as well as to alleviate symptoms of an uncontrolled hormone production.7
- Boudreaux JP, et al. The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum. Pancreas. 39(6):753-766, 2010.
- Das, S., et al. Epidemiology, Incidence, and Prevalence of Neuroendocrine Neoplasms: Are There Global Differences?. Current Oncology Reports. Mar 14; 23(4): 43, 2021.
- Sandvik O., et al. Epidemiology and classification of gastroenteropancreatic neuroendocrine neoplasms using current coding criteria. Br J Surg. 2016;103(3):226-32.
- Dasari, A., et al. Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United States. JAMA Oncology. 3(10):1335-1342, 2017.
- INCA International Neuroendocrine Cancer Alliance. https://incalliance.org/ncd-2022/campaign-messages/
- Globe Life Sciences rapport 2022, data on file.
- Díez M., et al. Gastroenteropancreatic neuroendocrine tumors: diagnosis and treatment. Ann Gastroenterol. 2013; 26(1): 29-36.
in the EU and US are estimated to have GEP-NET2,3
of patients with GEP-NET are initially misdiagnosed with for example irritable bowel syndrome (IBS), gastritis or anxiety5
- Redness of the skin (flushing)
- Diarrhea, stomach pain
- Asthma-like symptoms
- Carcinoid heart disease
Diagnosis of NET is based on clinical symptoms, imaging studies and biochemical tests.
Several factors help define the appropriate treatment of NET, including tumor location, invasiveness, hormone secretion, and proliferation. Surgery is often performed either as a cure or for symptom relief. In secretory tumors, somatostatin analogs are used to relieve symptoms by blocking the release of hormones.