MODERN APPROACHES AND RECENT ADVANCES IN NEUROENDOCRINE TUMORS

Modern Approaches and Recent Advances in Neuroendocrine Tumors-kapak

GENERAL CHARACTERISTICS AND MANAGEMENT OF GASTRIC NEUROENDOCRINE TUMORS

Emine Sena Cünük1 Merve Yeşilsancak2 Emre Gönüllü3

1Sakarya University Training and Research Hospital, Department of General Surgery, Sakarya, Türkiye
2Sakarya University Training and Research Hospital, Department of General Surgery, Sakarya, Türkiye
3Sakarya University Training and Research Hospital, Department of Gastroenterology Surgery, Sakarya, Türkiye

Cünük ES, Yeşilsancak M, Gönüllü E. General Characteristics and Management of Gastric Neuroendocrine Tumors. In: Gönüllü E, Karaman K, editors. Modern Approaches and Recent Advances in Neuroendocrine Tumors. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.97-105.

ABSTRACT

Gastric neuroendocrine tumors (G-NETs) are rare neoplasms originating from enterochromaffin-like cells in the stomach. They account for a small percentage of all neuroendocrine tumors (NETs) and exhibit distinct biological behavior, classification, and treatment approaches. The incidence of G-NETs has been increasing due to advances in endoscopic and histopathologic techniques, with a higher prevalence in women and older individuals. G-NETs are classified into three main types based on their etiology and clinical behavior. Type 1 G-NETs, the most common subtype, are associated with chronic atrophic gastritis and hypergastrinemia. They are usually benign, slow-growing, and managed with endoscopic surveillance or resection in selected cases. Type 2 G-NETs are related to Zollinger-Ellison Syndrome (ZES) and Multiple Endocrine Neoplasia Type 1 (MEN1). These tumors tend to be multiple and require a combination of medical and surgical management. Type 3 G-NETs are sporadic, aggressive, and associated with a higher risk of metastasis. They necessitate a more extensive treatment approach, including surgical resection, chemotherapy, and targeted therapies. The pathogenesis of G-NETs involves multiple molecular pathways, including somatostatin receptor signaling, mTOR activation, and tumor neoangiogenesis. Diagnosis relies on biochemical markers such as chromogranin A, synaptophysin, and Ki-67 proliferative index, as well as imaging techniques like endoscopy, endoscopic ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and somatostatin receptor-based nuclear imaging. Treatment strategies vary according to tumor type and stage. Type 1 G-NETs are often managed conservatively, while Type 2 G-NETs may require surgical resection of the gastrinoma in addition to proton pump inhibitors. Type 3 G-NETs, due to their aggressive nature, require a multimodal approach, including radical gastrectomy and lymphadenectomy. Somatostatin analogs, peptide receptor radionuclide therapy (PRRT), and molecular-targeted therapies are increasingly being utilized for metastatic disease. The prognosis of G-NETs depends on tumor grade, size, and metastatic spread. Type 1 tumors generally have an excellent prognosis, whereas Type 3 tumors pose a significant risk of recurrence and mortality. Future research aims to refine personalized treatment strategies, integrating molecular and immunotherapeutic approaches to improve outcomes for patients with G-NETs.

Keywords: Gastric; Neuroendocrin tumors; Zollinger-Ellison syndrome; Gastrin; Chromogranin-A

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