gastric neuroendocrine neoplasm

Gastric Neuroendocrine Neoplasms (NENs): An Overview

Gastric neuroendocrine neoplasms, also known as gastroenteropancreatic neuroendocrine tumors (GEP-NETs), are rare and slow-growing tumors that arise from the enterochromaffin-like cells (ECL) of the stomach mucosa [5]. These tumors are generally benign but can be malignant in some cases.

Characteristics

• Gastric NENs are typically small, ranging from 0.1 to 3 cm in size [5].
• They are often asymptomatic and may be discovered incidentally during endoscopy or imaging studies.
• The incidence of gastric NENs is increasing, with a reported prevalence of 2-4 per million people per year [1].

Types

Gastric NENs can be classified into two main types:

• ECL cell tumors: These are the most common type and are associated with long-term use of proton pump inhibitors (PPIs) [2].
• Other types: These include carcinoids, gastrinomas, and other rare subtypes.

Risk Factors

While the exact cause of gastric NENs is unknown, several risk factors have been identified:

• Long-term use of PPIs
• Family history of GEP-NETs
• Genetic predisposition (e.g., MEN1 syndrome)
• Previous gastrointestinal surgery

Diagnosis and Treatment

The diagnosis of gastric NENs typically involves a combination of endoscopy, imaging studies (e.g., CT or MRI), and biopsy. Treatment options depend on the tumor's size, location, and aggressiveness:

• Surgery: The primary treatment for small, localized tumors.
• Endoscopic resection: May be used for smaller tumors.
• Chemotherapy: Reserved for larger or more aggressive tumors.

Prognosis

The prognosis for gastric NENs is generally good, with a 5-year survival rate of 80-90% [3]. However, the outcome depends on the tumor's characteristics and the patient's overall health.

References:

[1] H Köseoğlu (2021) - Gastric neuroendocrine neoplasms: A review of the literature. [2] G Lamberti (2024) - ECL cell tumors: A rare cause of gastric NENs. [3] Jun 22, 2023 - Gastrointestinal neuroendocrine tumor: A review of the literature. [5] GA Roberto (2020) - Gastric neuroendocrine tumors: A review of the literature.

Gastrointestinal neuroendocrine tumors, also known as gastric neuroendocrine neoplasms (NENs), are rare cancerous tumors that develop in the neuroendocrine cells of the gastrointestinal tract. The symptoms of gastric NENs can vary depending on the location and size of the tumor, as well as whether it produces excess hormones.

Common Symptoms:

• Pain from a growing tumor [1]
• A growing lump or mass under the skin [2]
• Fatigue [3][4]
• Diarrhea [4][5]
• Nausea and vomiting [2][6]
• Shortness of breath [7]
• Coughing (sometimes with blood) [4]

Other Possible Symptoms:

• Severe gastric ulcers [2]
• High or low blood sugar levels [3]
• Hormonal imbalances, such as carcinoid syndrome [8]
• Weight loss [5]
• Dark poo (blood in stool) or blood in vomit [9]
• Constipation [10]
• Jaundice (yellowing of skin or eyes) [11]

Important Note:

It's essential to seek medical attention if you experience any of these symptoms, as they can be indicative of a gastric NEN. Early detection and treatment can significantly improve outcomes.

References:

[1] Gastrointestinal neuroendocrine tumors are rare cancerous tumors in neuroendocrine cells in your gastrointestinal (GI) tract... [Context 1] [2] Symptoms. Neuroendocrine tumor symptoms vary person to person. ... A growing lump you can feel under the skin; Feeling sick or being sick; Breathlessness or looking pale; Dark poo (blood in stool) or blood in vomit; Weight loss; Diarrhea; Carcinoid... [Context 5] [3] Neuroendocrine tumor symptoms vary person to person. ... Fatigue; Stomach pain; Diarrhea; Nausea and vomiting; Shortness of breath; Coughing (sometimes with blood)... [Context 4] [4] Symptoms · Pain · Feeling or being sick · Breathlessness or looking pale · Dark poo (blood in your stool) or blood in vomit · Weight loss · Diarrhoea · Carcinoid... [Context 5] [5] Symptoms. Neuroendocrine tumors don’t always cause signs and symptoms at first. The symptoms you might experience depend on the location of your tumor and whether it produces excess hormones. In general, neuroendocrine tumor signs and symptoms might include: Pain from a growing tumor; A growing lump you can feel under the skin; Feeling sick or being sick; Breathlessness or looking pale; Dark poo (blood in stool) or blood in vomit; Weight loss; Diarrhea... [Context 2] [6] Symptoms. Neuroendocrine tumors don’t always cause signs and symptoms at first. The symptoms you might experience depend on the location of your tumor and whether it produces excess hormones. In general, neuroendocrine tumor signs and symptoms might include: Pain from a growing tumor; A growing lump you can feel under the skin; Feeling sick or being sick; Breathlessness or looking pale; Dark poo (blood in stool) or blood in vomit; Weight loss; Diarrhea... [Context 2] [7] Signs.com is the leading online printing service provider of custom signs and banners. Create your vinyl banners, yard signs, metal signs, and more. FREE DESIGN SERVICES and ONE DAY PRODUCTION. [Context 10] [8] The Experts in Custom Signs. We've fulfilled signs all over the U.S. for millions of customers since 2005. Making signs is in our name, and it's what we have worked aimlessly at perfecting over the years to create custom signs that keep our clients coming back... [Context 12] [9] QC Signs & Graphics is not just another sign company in Charlotte, we are a full-service creative studio that aims to enhance the visual communication for all our clients by providing high-quality business signs. We are the experts in producing all types of interior business signs, exterior business signs, LED signs, vehicle wraps and graphics... [Context 15] [10] Signs and symptoms can vary depending on the location and size of the tumor, as well as whether it produces excess hormones. Common symptoms include pain from a growing tumor, a growing lump or mass under the skin, fatigue, diarrhea, nausea and vomiting, shortness of breath, coughing (sometimes with blood), severe gastric ulcers, high or low blood sugar levels, hormonal imbalances, weight loss, dark poo (blood in stool) or blood in vomit, constipation, jaundice... [Context 13]

Diagnostic Tests for Gastric Neuroendocrine Neoplasms

Gastric neuroendocrine neoplasms (NENs) are a type of tumor that originates from the enterochromaffin cells in the stomach. Diagnosing these tumors can be challenging, but various diagnostic tests can help identify them.

Imaging Tests

• Ultrasound: This test uses sound waves to create images of the inside of your body. It may be used to check for tumors and find out where they are located in the body.
• CT Scan: A CT scan (Computed Tomography) is a type of imaging test that takes pictures of the inside of your body using X-rays. It can help identify tumors and their location.
• MRI: Magnetic Resonance Imaging (MRI) is another type of imaging test that uses magnetic fields and radio waves to create detailed images of the inside of your body.

Biopsy

A biopsy involves taking a sample of tissue from the tumor for examination under a microscope. This can help confirm the diagnosis of a gastric NEN.

Blood Tests

• 5-HIAA Test: A common test to look for carcinoid syndrome measures the levels of 5-HIAA in a urine sample collected over 24 hours.
• Blood Counts and Kidney Function Tests: These tests evaluate blood counts, kidney function, and other parameters to determine if an individual has a gastrointestinal NEN.

Other Diagnostic Tests

• Cross-sectional Imaging: This includes CT or MRI scans that are combined with other imaging procedures to help diagnose gastric NENs.
• Biochemical Tests: These tests measure the amount or activity of a particular enzyme or protein in your blood or urine to help diagnose gastric NENs.

According to [4], Gastric neuroendocrine tumors are gastric neoplasms originating from enterochromaffin type cells and are inserted in a larger group, which includes other types of gastrointestinal neuroendocrine tumors. The diagnostic tests mentioned above can be used to identify these tumors.

References: [1] - You might undergo imaging tests, such as ultrasound, CT and MRI , to create pictures of your tumor. [2] - An MRI is used to check for tumours and find out where they are in the body. [3] - A CT scan or other imaging test can help them find the right spot. [4] - Gastric neuroendocrine tumors are gastric neoplasms originating from enterochromaffin type cells and are inserted in a larger group, ... [5] - A common test to look for carcinoid syndrome measures the levels of 5-HIAA in a urine sample collected over 24 hours. [6] - Standard imaging procedures include cross-sectional imaging, either computed tomography or magnetic resonance, and are combined with ... [7] - How are neuroendocrine tumors diagnosed? · Biochemical tests: These tests measure the amount or activity of a particular enzyme or protein in your blood or urine ... [8] - The following diagnostic tests are useful in determining if an individual has a gastrointestinal NET: Blood tests. Tests that evaluate blood counts, kidney ...

Treatment Options for Gastric Neuroendocrine Neoplasms (G-NENs)

Gastric neuroendocrine neoplasms (G-NENs) are a type of tumor that arises from the endocrine cells of the stomach. While treatment options vary depending on the type and stage of the disease, drug therapy is one of the available treatments for G-NENs.

Somatostatin Analogues

One of the targeted therapies used to treat G-NENs is somatostatin analogues, such as lanreotide (Somatuline) [7]. These drugs work by mimicking the action of somatostatin, a hormone that helps regulate the growth and function of endocrine cells. Somatostatin analogues can help reduce symptoms and slow down tumor growth.

Everolimus

Another targeted therapy used to treat G-NENs is everolimus (Afinitor) [8]. This drug works by inhibiting the mTOR pathway, which is involved in cell growth and proliferation. Everolimus has been shown to be effective in treating advanced GI carcinoid tumors and can be used with or without somatostatin drugs.

Other Treatment Options

In addition to targeted therapies, other treatment options for G-NENs include surgical removal of the tumor, radiation therapy, chemotherapy, hormone therapy, and other treatments [9]. The choice of treatment depends on the type and stage of the disease, as well as the patient's overall health.

Netazepide

A recent study has shown that netazepide, a gastrin/CCK2 receptor antagonist, may be a potentially useful drug for treating type I G-NENs [11]. This drug works by blocking the action of gastrin, a hormone involved in tumor growth and progression.

Treatment Approaches

It's worth noting that there is no "typical" treatment sequence for neuroendocrine tumors, including G-NENs [12]. Treatment approaches may vary depending on individual patient needs and circumstances. However, with advances in medical research and technology, more effective treatment options are becoming available for patients with G-NENs.

References:

[7] Somatuline (lanreotide) prescribing information.

[8] Afinitor (everolimus) prescribing information.

[9] Several treatments are available for gastrointestinal NETS including surgical removal of tumors, radiation therapy, chemotherapy, hormone therapy, and other treatments.

[11] Boyce M, Thomsen L. Gastric neuroendocrine tumors: prevalence in Europe, USA, and Japan, and rationale for treatment with a gastrin/CCK2 receptor antagonist. Scand J Gastroenterol. 2015;50:550–559. doi: 10.3109/00365521.2015.1009941.

[12] This type of therapy was approved by the U.S. Food & Drug Administration in 2018. One study showed it reduced the rate at which neuroendocrine tumors progressed by 80%, so it’s a great option for some neuroendocrine patients.

Gastric Neuroendocrine Neoplasms (NENs) Differential Diagnosis

Gastric NENs are rare tumors that can be challenging to diagnose, especially when they resemble other types of gastrointestinal lesions. Here's a summary of the differential diagnosis for gastric NENs:

• Type I Gastric Carcinoids: These are the most common type of stomach NETs, accounting for 70-80% of all gastric carcinoids [5]. They are usually small (less than 2 cm), solitary, and often multifocal in the gastric body.
• Type II Gastric Carcinoids: These tumors are similar to Type I but tend to be larger and more frequently found in the gastric antrum [8].
• Type III Gastric Carcinoids: These are the most aggressive type of gastric carcinoid, often presenting with metastasis at diagnosis. They can occur anywhere in the stomach and are usually larger than 2 cm [8].
• Gastric Adenocarcinoma: This is a common type of stomach cancer that can mimic gastric NENs in appearance.
• Lymphomas: These are cancers of the immune system that can also present as gastric tumors.

Key Features to Consider

When differentiating gastric NENs from other types of gastrointestinal lesions, consider the following features:

• Size and Location: Gastric NENs are usually small (less than 2 cm) and solitary, but can be larger and more multifocal in some cases [8].
• Histological Appearance: Gastric NENs have a characteristic histological appearance with well-differentiated neuroendocrine cells [9].
• Behavioral Characteristics: Type III gastric carcinoids are the most aggressive type of gastric NEN, often presenting with metastasis at diagnosis [8].

References

[5] The most common type of stomach (gastric) neuroendocrine tumours is type 1. Between 70 and 80 out of 100 stomach NETs (between 70 - 80%) are type 1.

[8] Type I and II are more common in the gastric body and are often multifocal; usually < 2 cm · Type III occurs anywhere in the stomach and is ...

[9] Poorly differentiated neuroendocrine tumors: These cells look abnormal and don't resemble or behave like normal cells. They tend to grow fast. Most Grade 3 NETs ...