It is important to monitor your NET patients for progression, changes in disease status, and response to management interventions.1 For example, imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) can more definitively identify hepatic and extrahepatic disease spread, and morphologic patterns that may be different than those of the primary neoplasm.2-5 Tests for bioactive substances secreted by certain types of functional NETs may also be helpful in giving an indication of progressive disease.1 Symptom progression or the appearence of new symptoms may also indicate that a patient's disease has progressed.6

Many of the same tools that are used to diagnose NETs can be effective for monitoring them.1 Click on the descriptions below to learn more.

Imaging

Computed tomography (CT): A widely available monitoring tool for the localization and staging of solid tumors, including NETs.7
Learn more

Magnetic resonance imaging (MRI): A well-recognized imaging technique, useful in the localization of NETs and their metastases.3,5,7
Learn more

Octreoscan™: In conjunction with CT or MRI, Octreoscan may be particularly helpful in identifying previously unsuspected extrahepatic and lymph node metastases.3,8
Learn more

Octreoscan is a trademark of Covidien AG or one of its affiliates.

Biomarkers

Chromogranin A (CgA): up to 90% of patients with NETs have elevated levels of CgA.9,10
Learn more

5-Hydroxyindoleacetic acid (5-HIAA): 5-HIAA can be used to monitor NET patients. It also has prognostic value in NETs associated with carcinoid syndrome.11-13
Learn more

Other Monitoring Techniques

GI endoscopy: In certain cases, endoscopy may be appropriate for monitoring NETs, particularly those in the stomach, duodenum, and rectum.11
Learn more

Echocardiogram: Cardiac heart disease occurs in up to two thirds of patients with carcinoid syndrome.11 An echocardiogram may be considered at the time of initial diagnosis and can also be used to monitor certain NET patients.14

Biochemical tests

Some of the biochemical tests that can be used in the diagnosis of NETs also may be used to monitor change(s) in disease status (progression).1

The role of histology in prognosis

NETs can be characterized by their histologic features, including tumor necrosis, increased mitotic count, undifferentiated growth pattern, degree of nuclear pleomorphism, and vascular or lymphatic invasion. These features are used to classify grade 1 and grade 2 NETs and grade 3 neuroendocrine carcinomas, and can be correlated with disease-specific survival and risk of metastases.11 Additionally, some medical experts believe that lower grade NETs have the potential to transform into higher grade carcinomas.

Using monitoring tools in multidisciplinary centers

One advantage of a team-based, multidisciplinary approach to monitor existing NETs is that most centers have agreed-upon protocols for serial hematologic, biochemical, urinary, and radiologic assessments based on input from key specialists. These protocols enable centers to provide a formal assessment of therapeutic response, and afford them the opportunity to carry out controlled trials.15