Editorial
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2011; 3(7): 133-139
Published online Jul 16, 2011. doi: 10.4253/wjge.v3.i7.133
Management of early gastrointestinal neuroendocrine neoplasms
Hans Scherübl, Robert T Jensen, Guillaume Cadiot, Ulrich Stölzel, Günter Klöppel
Hans Scherübl, Departments of Gastroenterology, Gastrointestinal Oncology and Infectious Diseases, Vivantes Klinikum Am Urban, Berlin 10967, Germany
Robert T Jensen, Digestive Diseases Branch, NIH, Bethesda, MD 20892, United States
Guillaume Cadiot, Service d’Hépato-Gastroentérologie, Hôpital Robert Debré, Reims 51092, France
Ulrich Stölzel, Departments of Gastroenterology and Gastrointestinal Oncology, Klinikum Chemnitz, Chemnitz 09116, Germany
Günter Klöppel, Department of Pathology, Technical University München, Klinikum rechts der Isar, München 81675, Germany
Author contributions: Scherübl H performed data aquisition, manuscript conception and writing; Jensen RT performed clinical interpretation and writing; Cadiot G performed clinical interpretation and writing; Stölzel U performed clinical interpretation and writing; Klöppel G performed clinical interpretation, manuscript conception and writing.
Correspondence to: Hans Scherübl, MD, Professor, Klinik für Innere Medizin - Gastroenterologie, Gastrointestinale Onkologie und Infektiologie, Vivantes-Klinikum Am Urban, Akademisches Lehrkrankenhaus der Charité, Dieffenbachstrasse 1, Berlin 10967, Germany. hans.scheruebl@vivantes.de
Telephone: +49-30-130225201 Fax: +49-30-130225205
Received: January 15, 2011
Revised: May 4, 2011
Accepted: May 18, 2011
Published online: July 16, 2011
Abstract

Neuroendocrine neoplasms (NENs) of the stomach, duodenum, appendix or rectum that are small (≤ 1 cm) and well differentiated can be considered “early” tumors, since they generally have a (very) good prognosis. In the new WHO classification of 2010, these neoplasms are called neuroendocrine tumors/ carcinoids (NETs), grade (G) 1 or 2, and distinguished from poorly differentiated neuroendocrine carcinomas (NECs), G3. NETs are increasing, with a rise in the age-adjusted incidence in the U.S.A. by about 700 % in the last 35 years. Improved early detection seems to be the main reason for these epidemiological changes. Both the better general availability of endoscopy, and imaging techniques, have led to a shift in the discovery of smaller-sized (≤ 10-20 mm) intestinal NETs/carcinoids and earlier tumor stages at diagnosis. Endoscopic screening is therefore effective in the early diagnosis, not only of colorectal adenocarcinomas, but also of NETs/carcinoids. Endoscopic removal, followed up with endoscopic surveillance is the treatment of choice in NETs/carcinoids of the stomach, duodenum and rectum that are ≤ 10 mm in size, have a low proliferative activity (G1), do not infiltrate the muscular layer and show no angioinvasion. In all the other intestinal NENs, optimal treatment generally needs surgery and/or medical therapy depending on type, biology and stage of the tumor, as well as the individual situation of the patient.

Keywords: Neuroendocrine tumor; Carcinoid; Stomach; Duodenum; Gut; Appendix; Rectum; Small size; Prognosis; Treatment