Clinical
Briefing: Medical and Surgical Management
of Neuroendocrine Tumors
July/August 2007
Neuroendocrine tumors
(NETs) are characterized by slow growth
rates, tenacity, and discreet variability of presentation – attributes
that often combine to confound diagnosis and circumvent treatment
strategies.
Because the management of NETs requires interdisciplinary
collaboration, the specialists at Penn
Gastroenterology have
developed a multidisciplinary team to cohesively manage the
diagnosis, staging and medical and surgical treatment of
these rare tumors. This seamless network of care ensures
that patients with NETs obtain a level of care equivalent
to the complexity of their disease.
“When an effective
bridge exists between disciplines – gastroenterology,
surgery, radiology and oncology – neuroendocrine
tumors and their sequelae are highly treatable.”
– David Metz, MD
Associate Chief for Clinical Affairs, GI division
University
of Pennsylvania School of Medicine |
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Case Study
Mrs. G., a 54-year-old woman, was referred to the gastroenterology division at
Penn for evaluation of cramping abdominal
pain and diarrhea of several months duration.
Her past medical history was significant for a pancreatic resection five years prior to
excise a small insulinoma. Her family history was notable for her father's death at age
52 from persistent bleeding ulcers and “liver
disease.”
A complete laboratory workup for Mrs. G. demonstrated elevated
levels of serum gastrin, parathyroid
hormone, ionized calcium,
pancreatic polypeptide and chromogranin A. Upper endoscopy
revealed erosive esophagitis, hypertrophic gastric folds
and multiple small submucosal nodules in the duodenum. Gastric
pH was 1.3. Biopsies of the duodenal lesions identified NETs.
Endoscopic
ultrasound identified a small (2.5 cm) pancreatic lesion
without lymphadenopathy. MRI revealed no additional abdominal
lesions. These findings were confirmed by abdominal OctreoScan®.
Mrs. G. was diagnosed with multiple
endocrine neoplasia type 1 (MEN-1) with Zollinger-Ellison
syndrome complicated by
hyperparathyroidism and a probable pancreatic polypeptide-secreting
pancreatic NET.
Mrs. G. experienced complete resolution of her presenting symptoms with PPI therapy
and gastric analysis to control gastric acid hypersecretion. Eight weeks later, Penn endocrine
and oncologic surgeons performed an uncomplicated 3.5 gland parathyroidectomy. The
multidisciplinary team determined strict observation was the best treatment course for the
pancreatic tumor. Now eight months post-op, Mrs. G.'s disease state is stable. Referral to
Penn Medical Genetics is under way; she will follow-up with the team on an annual basis.
Our Team of Faculty
The successful management of NETs requires a multidisciplinary team
composed of skilled specialists. The dedicated NET management team at
Penn encompasses a variety of clinical disciplines, including gastroenterology,
gastrointestinal oncology, interventional gastroenterology, oncology, surgical
oncology, neurology, neurosurgery, nuclear radiology, interventional radiology,
endocrinology and genetic counseling.
Gastroenterology
David C. Metz
Professor of Medicine
Nuzhat Ahmad, MD
Assistant Professor of Medicine
Gregory G. Ginsberg, MD
Professor of Medicine
Timothy C. Hoops, MD
Clinical Assistant Professor of
Medicine
Michael L. Kochman, MD
Professor of Medicine
Anil K. Rustgi, MD
T. Grier Miller Professor of
Medicine and Genetics
Endocrinology
Kolin Hoff, MD
Assistant Professor of
Clinical Medicine
Susan J. Mandel, MD, MPH
Associate Professor of Medicine
Peter J. Snyder, MD
Professor of Medicine
Medical Genetics
Katherine L. Nathanson, MD
Assistant Professor of Medicine
Interventional Radiology
Michael C. Soulen, MD
Professor of Radiology
Nuclear Medicine
Abass Alavi, MD
Professor of Radiology
Hematology-Oncology
Daniel G. Haller, MD
Professor of Medicine
Weijing Sun, MD
Associate Professor of Medicine
Endocrine and Oncologic Surgery
Douglas Fraker, MD
Jonathan E. Rhoads Associate
Professor of Surgical Science
Access
Patient appointments are available at:
The Division of Gastroenterology
Hospital of the University of
Pennsylvania
3 Dulles Building
3400 Spruce Street
Philadelphia, PA 19104
The Gastrointestinal Surgery Division
Hospital of the University of
Pennsylvania
4 Silverstein Building
3400 Spruce Street
Philadelphia, PA 19104
The Division of Endocrine and
Oncologic Surgery
Hospital of the University of
Pennsylvania
4 Silverstein Building
3400 Spruce Street
Philadelphia, PA 19104
The Gastrointestinal Cancer Program
The Abramson Cancer Center
16 Penn Tower
3400 Spruce Street
Philadelphia, PA 19104
Division of Interventional Radiology
Hospital of the University of
Pennsylvania
Ground Dulles Building
3400 Spruce Street
Philadelphia PA 19104
To refer a patient and/or consult with a doctor:
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