Diagnosis of Non-Functioning Neuro-Endocrine Gastro-Enteropancreatic Tumours

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Abstract
Non-functioning neuro-endocrine gastro-enteropancreatic tumours are neoplasms of neuro-endocrine differentiation without symptoms of hormonal hypersecretion. In pancreatic tumours, symptoms are related to an expanding tumour mass, while most midgut tumours are small and symptoms of intermittent intestinal entrapment are due to mesenteric fibrosis. Positive somatostatin receptor imaging indicates the neuro-endocrine differentiation of the tumour. The high spatial resolution of MRI/CT improves preoperative planning. In localized pancreatic tumours, curative resection of the primary improves survival. In midgut tumours, resection of the primary should be performed, irrespective of the presence of liver metastases. Palliative surgery and cytoreductive therapy of liver metastases may prolong survival in both, pancreatic and midgut tumours. Combination chemotherapy is effective in pancreatic disease, while in midgut tumours the response rate is only 22%. As the antiproliferative effect of biotherapy is still uncertain, it cannot yet be recommended as a routine treatment in non-functioning neuro-endocrine gastro-enteropancreatic tumours.