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Endocrine Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
How would your management plan change if the histology report confirmed a goblet-cell carcinoid tumour?This is a more malignant variant, also called an ‘atypical’ carcinoid.It does not express somatostatin receptors.Cannot be visualised by an octreotide scan.There is a possibility of aggressive spread in the mesoappendix and intraperitoneally. This patient needs a completion extended ileocolic and mesenteric resection and may need chemotherapy.They have a less favourable survival (60% 10-year survival rate).For aggressive tumours, cytoreductive surgery can be offered (omentectomy, splenectomy and peritonectomy).
Neuroendocrine tumours
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Sairah R Khan, Kathryn L Wallitt, Adil Al-Nahhas, Tara D Barwick
Change in therapy decisions based on 68Ga-DOTA-peptide PET-CT has also been demonstrated by a number of other groups. A recent meta-analysis of 14 studies highlighted that imaging with 68Ga-DOTA-peptide PET-CT is vital for patient management. PET-CT findings resulted in management changes in 44% of the patients (range 16%–71%). Management was also changed in 39% of patients whom had already undergone a previous 111In-octreotide scan (95).
Liver Transplantation for Neuroendocrine Tumors
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
Nir Lubezky, Parissa Tabrizian, Myron E. Schwartz, Sander Florman
A complete picture of the extent of disease is extremely valuable both in planning treatment and in properly informing the patient. Common sites of extrahepatic metastasis include abdominal lymph nodes, lung, and bone. CT of the chest and bone scan are thus routinely performed. As the majority of NETs demonstrate avidity for octreotide, nuclear scanning with labeled octreotide is often useful in the detection of disease in unlikely locations, as well as to confirm the nature of questionable disease seen on imaging studies. However, the sensitivity of the octreotide scan is only 50%–80% [44, 45], and better imaging modalities are needed. The Ga68 DOTATOC PET/CT and DOPA PET/CT scans have recently been introduced, giving information on both location and function, and have a much higher sensitivity, reaching 80%–96% [39, 46], and a resolution value of 5 mm, compared with 15 mm for the octreotide scan.
Use of octreotide long acting repeatable (LAR) as second-line therapy in advanced neuroendocrine tumors in different clinical settings: an Italian Delphi survey
Published in Expert Opinion on Pharmacotherapy, 2020
Massimo Falconi, Nicola Fazio, Diego Ferone, Annibale Versari
Statement 1 considered that reevaluation of somatostatin receptors is needed only for staging and is not strictly required if the sole objective is to continue administration of octreotide LAR. The high level of consensus reached for this statement likely arises from the fact that the recommendation is already considered in current guidelines [18]. It was, however, commented that 68 Ga-DOTA-peptide-PET/CT can provide further information about the type of progression, which may have a potential impact on the type of second-line therapy chosen. In fact, compared to octreotide scan, 68 Ga-DOTA-peptide-PET/CT shows high accuracy for staging and is superior in detection of lesions throughout the body; it also allows for calculation of standardized uptake value, is associated with less radiation exposure and takes less time to perform [22].
Therapeutic options in thymomas and thymic carcinomas
Published in Expert Review of Anticancer Therapy, 2022
A Phase 2 study was conducted by ECOG to evaluate the efficacy of subcutaneous octreotide and oral prednisolone in patients with octreotide scan-positive TETs [67]. Among the 16 patients, octreotide (octreotide was replaced by the long-acting analog lanreotide in 8 cases) with prednisolone yielded an RR of 37%. Another Phase 2 study of 38 patients with octreotide scan-positive TETs who were fully assessable showed two complete (5.3%) and 10 partial responses (26%) [68]. The NCCN guidelines suggest octreotide as a second-line option for patients with TETs, especially for those with thymoma who have a positive octreotide scan or carcinoid syndrome [21].
Carcinoid tumor causing ileoceccal intussusception in an adult patient
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Jennie Zhang, Dena H. Tran, Lance Uradomo, Avelino C. Verceles, R. Dobbin Chow
Intussusception may be the only manifestation of carcinoid tumor; therefore, the cause of intussusception should always be assiduously uncovered. As carcinoid tumors may secrete 5-hydroxyindole acetic acid (5-HIAA) and chromogranin A, serial measurement of 24-hour urinary 5-HIAA can aid in evaluating for possible metastatic involvement or recurrence. Octreotide scan may be warranted during follow up to further evaluate for any metastatsis. Other possible treatment options include somatastatin, which works by decreasing the levels of serotonin secretion and also decreasing the breakdown of serotonin.