Neuroendocrine tumors (NETs) are a group of cancerous formations that can be located in different parts of the body. The most common localization of neuroendocrine tumors is the lungs and gastrointestinal tract.
Neuroendocrine tumors (NETs) develop from neuroendocrine cells present in various organs and systems. They produce hormones and biologically active peptides. Most neuroendocrine tumors grow slowly and do not show any clinical symptoms for a long time. But there are also aggressive types of neuroendocrine tumors with significant hormonal activity. All neoplasms of this type are prone to invasion and metastasis.
Neuroendocrine tumors (NETs) are neoplasms capable of synthesizing biologically active substances, the source of which is cells of the diffuse endocrine system.
NETs of the digestive system, according to various statistics, are detected with a frequency of about 12 – 15 patients per 1 million population. Among them, pancreatic neoplasms are found in about 70–80% of patients. The NETs of the pancreas, along with tumors of the lungs, bronchi, gastrointestinal tract, kidneys, and skin, account for less than 1% of all malignant tumors. Even large clinics rarely have the experience of treating more than about 100 patients with neuroendocrine tumors.
According to the statistics, in about 65–70% of patients, functioning NETs are isolated, which produce one or more biologically active substances that determine the corresponding clinical picture. In most cases, patients with NETs may develop severe clinical symptoms and pathological conditions caused by the hormonal activity of these tumors, such as hypoglycemic disease, Zollinger-Ellison syndrome, Werner-Morrison syndrome, and some other pathological conditions.
Besides, the development of some of these syndromes can be caused not only by a neoplasm of the pancreas but also by NETs of other localization – stomach or duodenum. In the case of a timely diagnosis and medical treatment with radical surgery, satisfactory results of therapy in the form of a 5-year survival rate is about 80 – 100%, and cytoreductive intervention is about 40 – 60%.
The reasons for the development of pathologies are unknown. Risk factors, however, for the development of the disease are:
- Hereditary syndromes (multiple endocrine neoplasia types 1 and 2), Von Hippel-Lindau syndrome, type 1 neurofibromatosis)
- Patients of older age-group (the disease is rarely diagnosed in children and adolescents)
- Female patients (pathology is more common in women)
There are no data on the negative impact of diet, bad habits, and environmental factors on the development of the disease.
Depending on the location there are several types of neuroendocrine tumors including:
- Gastroenteropancreatic neuroendocrine tumors (more than half of all cases)
They include neoplasms of the stomach, duodenum and small intestine, appendix, various parts of the large intestine, and pancreas.
- Bronchopulmonary neuroendocrine tumors – typical and atypical lung carcinoid, small cell carcinoma, large cell neuroendocrine carcinoma (about 25-30%)
- Extrapulmonary small cell carcinomas
- Pituitary neuroendocrine tumors (located in front of the neuroendocrine gland)
- Hepatic neuroendocrine tumors
- Neoplasms of the peripheral nervous system (schwannomas, paragangliomas, neuroblastomas)
- Genitourinary system tumors (neuroendocrine cancer and carcinoid of the urinary tract, neuroendocrine tumors of the ovaries, cervix, prostate, and testicles)
- Merkel cell carcinoma
According to hormonal activity, neoplasms are divided into:
Most of the tumors listed above are located in the pancreas.
There are 4 stages of development of neuroendocrine tumors:
Stage 1 of neuroendocrine cancer includes primary neuroendocrine tumor up to 2 cm in diameter; lymph nodes are not affected.
In the second stage, the size of the formation exceeds 2 cm, but does not spread to other tissues or lymph nodes; at the advanced second stage, the process involves nearby connective tissues, muscles, cartilage, and bones without affecting the lymph nodes.
In the third stage, the neuroendocrine tumor has spread to lymph nodes, adjacent cartilage, bones, muscles, connective tissues.
During the fourth stage, metastases from the tumor are found in the liver, lungs, brain, and bones.
The symptoms that patients with neuroendocrine tumors experience depend, first of all, on the type of hormones produced by the tumor. Most often with the serotonin production, patients experience:
- Hot flashes
- Telangiectasia (a condition in which widened venules cause threadlike red lines or patterns on the skin)
- Shortness of breath, wheezing, and cough associated with bronchospasm
- Diarrhea (sometimes up to 10-15 liters per day)
- Weight gain
- Murmurs (produced when blood is pumped across a heart valve and creates a sound loud enough to be heard with a stethoscope) when listening to the heart
- Hypertension and low blood pressure
- Fibrous changes in the endocardium
- Signs of stagnation in the pulmonary circulation (cough, shortness of breath, pulmonary edema)
In stressful situations, after anesthesia or surgery, a carcinoid crisis may develop. It is caused by a significant release of serotonin. It is manifested by sudden changes in pressure, tachycardia, severe diarrhea, and pronounced redness of the face. The condition is of a medical emergency. With insulinoma, the following symptoms can manifest:
- In severe cases, coma
The diagnosis of neuroendocrine tumors (NETs) and treatment of the disease in the form of radical operations can only be performed after the confirmed diagnosis.
Laboratory research begins with general clinical tests, and if the diagnosis is not clear based on the results, studies of the levels of certain hormones or their metabolites are prescribed.
Many neuroendocrine tumors are very small and it is really difficult to identify their location.
In European hospitals, patients with suspected neuroendocrine tumor undergo:
- Endoscopic examination of the gastrointestinal tract, if suspicious formations are detected, a biopsy is taken for histological examination
- Abdominal ultrasound
- Chest X-ray to visualize the formation
- CT or MRI of various parts of the body (special contrast agents are used)
- Positron emission tomography (PET) allows the accumulation of isotope-labeled glucose to identify even the smallest fast-growing tumor foci
Resection is a surgery that completely removes the neuroendocrine tumor along with some healthy tissue nearby. Resection is the main medical treatment for most NETs that haven’t metastasized yet.
Surgery resection of NETs implies either the removal of the neoplasm itself within healthy tissues or (in the case of serious damage) the radical surgery resection of the entire organ. Often, nearby lymph nodes are also excised. In most cases, surgery resection for neuroendocrine tumors has a favorable prognosis.
Before surgery resection, beyond measures of the diagnosis patients usually undergo:
- Clinical and biochemical blood tests
- Assessment of the functional parameters of the liver and kidneys
- A study of the concentration in the blood of tumor markers
- Assessment of the work of the blood coagulation system
- Testing for syphilis, HIV, hepatitis B and C
- Determination of blood group and Rh factor
- General and biochemical urine tests
- Determination of the concentration of serotonin in the blood
- Urine analysis for metabolites (5-HIAA)
- Assessment of the concentration of pancreatic hormones that are capable of producing tumor cells (somatostatin, insulin, vasoactive intestinal peptide, glucagon, gastrin)
- Biopsy of a suspicious area with further histological examination of the material obtained
During surgery resection for the treatment of patients with NETs, it is extremely important to ensure that all malignant cells have been removed. For this, a tissue site that is affected by a tumor is removed and sent for express analysis to a laboratory. There, a specialist examines the edges of the tissue under a microscope. If the surgery resection is successful, only healthy cells should remain. This means that the neuroendocrine tumor of the lung, stomach, intestine, pancreas, or other organ has been completely removed.
In patients with an advanced stage of tumor development, a surgery resection may be considered inappropriate. In this case, cytoreductive intervention is sometimes performed in European hospitals, the purpose of which is to minimize the volume of tumor tissue in the patient’s body. Further, reserved radiation therapy and modern schemes of specific pharmacological drugs (including targeted therapy and immunotherapy) are considered possible additional therapeutic techniques for patients with NETs.
Among the minimally invasive operations, it is worth noting radiofrequency ablation and embolization of the arteries that feed the neoplasm. Such interventions demonstrate the best results in patients with neuroendocrine liver tumors.
After surgery resection of a neuroendocrine tumor, the patients are under the supervision of doctors. The length of stay (from 1 to 14 days) depends on the scale of the operation and the presence or absence of postoperative complications in patients.
The prognosis of the treatment is largely determined by the organ in which the neoplasm was detected, as well as at what stage of tumor development the treatment was started. If the spread of malignant cells has not yet begun and the surgery resection was performed on time, then, according to statistics, a 5-year survival rate is observed in about 92% of patients. The age of patients and the general state of health also play a role in determining the prognosis.
After discharge from the hospital, the patients are recommended systematic observation. Patients must attend preventive examinations with an oncologist every 3 months during the first two years after the operation and once every six months thereafter.
Side effects can happen with any type of treatment for NETs, but everyone’s experience is different. Some patients have multiple side effects; other patients have only a few side effects.
Side effects can develop any time during, immediately after, or a few days or weeks after the surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.
Side effects of surgery for NETs treatment will depend mainly on the type of surgery, resection area in the body, and patient’s overall health condition.
Where can I undergo treatment with surgery resection abroad?
Health tourism becomes more and more popular these days, as medicine abroad, often ensures a much better quality of medical treatment with surgery resection.
The following European hospitals show the best success rates in medical treatment with surgery resection:
- Academic Hospital Brothers of Mercy Munich, Germany
- Memorial Sisli Hospital Istanbul, Turkey
- University Hospital of Ludwig Maximilian University of Munich, Germany
- Charite University Hospital Berlin, Germany
- University Hospital Ulm, Germany
You can find more information about the European hospitals on the Booking Health website.
The cost of treatment with surgery resection
The prices in European hospitals listed on Booking Health are relatively low. With Booking Health, you can undergo medical treatment with surgery resection at an affordable price.
The cost of treatment varies, as the price depends on the hospital, the specifics of the disease, and the complexity of its treatment.
The cost of treatment with surgery resection in Germany is 18,602 – 30,583 EUR.
The cost of treatment with surgery resection in Turkey is 12,424 – 15,466 EUR.
You might want to consider the cost of possible additional procedures and follow-up care. Therefore, the ultimate cost of treatment may differ from the initial price.
To make sure that the overall cost of treatment is suitable for you, contact us by leaving the request on the Booking Health website.
How can I undergo treatment with surgery resection abroad?
It is not easy to self-organize any treatment abroad. It takes certain knowledge and expertise. Thus, it is safer, easier, and less stressful to use the services of a medical tourism agency.
As the largest and most transparent medical tourism agency in the world, Booking Health has up-to-date information about the treatment with surgery resection in the best European hospitals. We will help you select the right clinic taking into account your wishes for treatment.
We want to help you and take on all the troubles. You can be free of unnecessary stress, while Booking Health takes care of all organizational issues regarding medical treatment. Our services aimed at you safely and successfully undergoing treatment with surgery resection.
Medical tourism can be easy!
All you need to do is to leave a request on the Booking Health website and our manager will contact you shortly.