Neuroendocrine Tumors
James C. Yao, MD
Associate Professor Deputy Chairman, Gastrointestinal Medical Oncology University of Texas M. D. Anderson Cancer Center
Yao 1
Neuroendocrine Tumors
• Spectrum of neoplasms.
– WHO classification
• Well differentiated neuroendocrine tumor • Well differentiated neuroendocrine carcinoma • Poorly differentiated neuroendocrine carcinoma
• Generally more indolent then adenocarcinoma of the same site. • Capable of producing hormonal syndrome (ie carcinoid syndrome).
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Epidemiology
SEER
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0
1
2
3
4
5
6
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Yao, unpublished data
All malignant neoplasm
Malignant NETs
0 100 200 300 400 500
19 7 19 3 7 19 4 7 19 5 7 19 6 7 19 7 7 19 8 7 19 9 8 19 0 8 19 1 8 19 2 8 19 3 8 19 4 8 19 5 8 19 6 8 19 7 8 19 8 8 19 9 9 19 0 9 19 1 9 19 2 9 19 3 9 19 4 9 19 5 9 19 6 9 19 7 9 19 8 9 20 9 0 20 0 0 20 1 0 20 2 03
600
2004 Prevalence estimate
29-year limited duration prevalence analyses
~ ~
~ ~
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Yao, unpublished data
Neuroendocrine versus nonneuroendocrine histologies
Localized Regional Distant
1.00 0.90 0.80 1.00 0.90 0.80 0.70 Survival Probability 0.60 0.50 0.40 0.30 Survival Probability 0 1 2 3 4 5 Years 6 7 8 9 10 1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00
0.70
Survival Probability 0.60 0.50 0.40 0.30 0.20 0.10 0.00 0 1 2 3 4 5 Years 6 7 8 9 10
0.20
0.10 0.00
0
1
2
3
4
5
Years
6
7
8
9
10
NET Non-NET
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Significant differences among neuroendocrine tumors of various sites
Localized Regional
Survival probability Months
Distant
Median survival in months
Color
Site Appendix Cecum Colon Duodenum Gastric Liver Lung Pancreas Rectum Sm Bowel Thymus
Localized 135 261 107 154 50 227 136 290 111 110
Regional 107 36 101 71 14 154 77 90 105 68
Distant 27 41 5 57 13 12 16 24 22 56 40
Yao 7
Survival probability Months
Neuroendocrine Tumors: Current Situation (1)
• Diagnosed incidence is on the rise. • Vastly different outcome compare to more common neoplasm of the same anatomic site. • Vastly different treatment offered.
– Adenocarcinoma: Cytotoxic chemotherapy +/newer targeted agents – Neuroendocrine: Hormonal therapy, interferon, newer targeted agents
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Neuroendocrine Tumors: Current Situation (2)
• No ICD-9-CM diagnosis codes except:
– 157.4 Malignant neoplasm, Islets of Langerhans (pancreatic subset of neuroendocrine tumors). – 259.2 Carcinoid syndrome (only small subset of neuroendocrine patients has carcinoid syndrome).
• This leads to…
– Lack of precision in coding. – Misleading statistics. – No way to accurately bill for services.
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