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ESMO WCGC 2013 Report – Recommendations for the management of rectal NET
A review of the presentation by Dermot O’Toole (pictured), Trinity College, Dublin. The incidence of Neuroendocrine tumours (NETs) has increased in recent years. The incidence is higher in Asia than in EU and is higher in black and Asian populations. At least 50% are discovered incidentally with the majority in non-expert community settings. Morphologically they are distinguishable from adenomas and hyperplastic polyps. Diagnosis is often difficult and there is a lack of uniformity in reporting. As with all tumours pathological classification and staging is crucial. The metastatic risk increases as the size of the tumour increases.
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Follow up post resection depends on tumour size and staging.
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| Tumour <1cm (T1aN0) | G1,G2 | No data to recommend regular follow-up |
| G3 | Annual and then as per adenomas | |
| Tumour 1-2cm | G1-G3 | Annual follow up then as per adenomatous polyp |
| Tumour >2cm | G1-G2 | Annual and as per adenomatous surveillance |
| G3 | Every 4 to 6 months | |
The guidelines recommend in rectal NETs that EUS, colonoscopy and MRI is performed. In Liver NETs MRI with hepatospecific contrast media with multi phasic liver scanning is the recommended test schedule.
The five year prognosis for advanced rectal disease is 15-30% for stage 4 disease and 54-73% for stage I-III. Chemotherapy is used in advanced stage IV disease although there is little evidence for a standard approach. There is a need for trials in this area.
In his conclusion Dermot O’Toole explained that rectal carcinoids are a frequent occurrence however there is a need for better recognition of the disease, especially in the west. Accurate staging is important as is the use of EUS. Specialised resection for small tumours is important and there is little data for systemic therapy in this area.
