Gastro-Entero-Pancreatic Tumors FDG Positron Emission Tomography/Computed Tomography

Gastro-entero-pancreatic neuroendocrine neoplasms are a class of neoplasms that originate from embryonic neural crest cells. Clinically and biologically diverse, these tumors may histologically range from well differentiated to poorly differentiated. Clinical behavior ranges from indolent, slowly growing to aggressive tumors that spread quickly to other parts of the body; these neoplasms display a broad behavioral spectrum. Neuroendocrine neoplasms (NENs) can seem as sporadic, solitary tumors or as fa-milial tumor syndromes such as in the setting of multiple endocrine neoplasia 1. These tumors can release active peptides, which may have physiologic effects and cause carcinoid syn-drome or other symptoms such as hypoglycemia.1 Clinically, neuroendocrine neoplasms can be divided into different groups depending on their primary origin, differentiation, Ki67 proliferation index, somatostatin receptor (SSTR) expression, extent of metastatic disease, and secretory status.2 For larger or functioning tumors, surgical resection is considered the best treatment option with curative intent. However, for carefully selected patients, active surveillance may be an option.3 In some cases of widespread metastatic disease, surgery may be performed to reduce tu-mor burden or to treat refractory carcinoid syn-drome. For most tumors, initial treatment, if warranted, consists of long-acting somatostatin analogs (SSAs). If patient progresses on first-line therapy, peptide receptor radionuclide therapy (PRRT), chemotherapy, and immunotherapy are all options for patients with advanced disease who do not qualify for surgical resection.(4)