New insights in diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms

Abstract

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are rare epithelial neoplasms derived from pluripotent endocrine cells along the gastrointestinal tract and pancreas. GEP-NENs are classified into well-differentiated neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas. Despite overlapping morphological features, GEP-NENs vary in molecular biology, epigenetic, clinical behavior, treatment response, and prognosis features and remain an unmet clinical challenge. In this review, we introduce recent updates on the histopathologic classification, including the tumor grading and staging system, molecular genetics, and systemic evaluation of the diagnosis and treatment of GEP-NENs at different anatomic sites, together with some insights into the diagnosis of challenging and unusual cases. We also discuss the application of novel therapeutic approaches for GEP-NENs, including peptide receptor radionuclide therapy, targeted therapy, and immunotherapy with immune checkpoint inhibitors. These findings will help improve patient care with precise diagnosis and individualized treatment of patients with GEP-NENs.

Keywords: Gastroenteropancreatic neuroendocrine neoplasms; Neuroendocrine tumours; Neuroendocrine carcinoma; World Health Organization classification; Diagnosis; Treatment

Core Tip: Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are rare tumors, but their incidence rates have been steadily increasing over the past 3 decades. GEP-NENs consist of a genetically heterogeneous group of tumors ranging from slow-growing well-differentiated neuroendocrine tumor to aggressive, poorly differentiated neuroendocrine carcinoma. Surgery is the cornerstone for the clinical management of localized tumors. However, GEP-NENs have frequently been diagnosed at a later stage and, therefore, remain an unmet clinical challenge. In this review, we discuss recent updates on the histopathologic classification, molecular genetics, and systemic evaluation of diagnosis and treatment of GEP-NENs at different anatomic sites.