Carcinoid tumors in Denmark 1978-1989 and the risk of subsequent cancers. A population-based study

Second primary neoplasms in patients with lung and gastroenteropancreatic neuroendocrine neoplasms: Data from a retrospective multi-centric study

BACKGROUND

Patients with sporadic neuroendocrine neoplasms may exhibit a higher risk of a second primary tumor than the general population.

AIM

This study aimed to analyze the occurrence of second primary malignancies.

METHODS

A retrospective cohort of 2757 patients with sporadic lung and gastro-entero-pancreatic neuroendocrine neoplasms, managed at eight Italian tertiary referral Centers, was included.

RESULTS

Between 2000 and 2019, a second primary malignancy was observed in 271 (9.8%) neuroendocrine neoplasms patients with 32 developing a third tumor. There were 135 (49.8%) females and the median age was 64 years. The most frequent locations of the second tumors were breast (18.8%), prostate (12.5%), colon (9.6%), blood tumors (8.5%), and lung (7.7%). The second primary tumor was synchronous in 19.2% of cases, metachronous in 43.2%, and previous in 37.6%. As concerned the neuroendocrine neoplasms, the 5- and 10-year survival rates were 87.8% and 74.4%, respectively. PFS for patients with a second primary malignancy was shorter than for patients without a second primary malignancy. Death was mainly related to neuroendocrine neoplasms.

CONCLUSION

In NEN patients the prevalence of second primary malignancies was not negligible, suggesting a possible neoplastic susceptibility. Overall survival was not affected by the occurrence of a second primary malignancy.

Gastroenteropancreatic neuroendocrine tumors in Iceland: a population-based study

OBJECTIVE

To determine the incidence, distribution, and prognosis of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) over the last 30 years and analyze changes over time.

METHODS

All patients diagnosed with GEP-NETs in Iceland from 1985 to 2014 were identified through the Icelandic Cancer Registry and pathology laboratory records. Relevant clinical information was obtained from medical records. In order to assess trends, the study period was divided into two periods, 1985-1999 and 2000-2014.

RESULTS

A total of 364 patients with GEP-NETs were identified. Overall, 18 patients diagnosed at autopsy or with primary tumors of an unknown site were excluded, leaving 346 patients with 351 primary tumors for final analysis. The overall mean annual incidence 1985-2014 was 3.65/100,000, 3.39/100,000 during 1985-1999 and 3.85/100,000 during 2000-2014 (p = NS). The most common primary tumor site was the appendix (32%), followed by the jejunum/ileum (24%) and stomach (17%). In all, 18% of patients presented with distant metastases at the time of diagnosis, most noticeably patients with primary tumors of the colon (47%), pancreas (46%) and jejunum/ileum (39%). The most favorable 5-year survival was observed for tumors of the appendix (94%) and rectum (88%) and the least favorable for tumors of the pancreas (31%), colon (47%) and jejunum/ileum (66%). There were no statistically significant changes in incidence, staging or survival between the two time periods.

CONCLUSIONS

In this population-based study, the incidence of GEP-NETs has not changed significantly over the last decades. The incidence of metastatic disease has remained stable and overall prognosis has not improved in recent years.

Global burden of neuroendocrine tumors and changing incidence in Kentucky

Background

Neuroendocrine tumors (NETs) have a low incidence but relatively high prevalence. Over the last three decades, the incidence of NETs has risen 6-fold in the United States. We conducted an observational study to compare the incidence of NETs reported to the Kentucky Cancer Registry (KCR) versus that reported to Surveillance, Epidemiology, and End Results Program (SEER). We also provide a systematic review of the state of neuroendocrine tumors worldwide, and compare the available global and local published data.

Methods

KCR and SEER databases were queried for NET cases between 1995 and 2015. A detailed literature review of epidemiological data for various nations worldwide summarize epidemiological data from various countries.

Results

KCR recorded 6179 individuals with newly diagnosed NETs between 1995 and 2015. Between 1995-2012, the incidence of NETs in KCR increased from 3.1 to 7.1 per 100,000 cases, while it increased from 3.96 to 6.61 in the SEER database. The incidence rates in both KCR and SEER databases were linear. 90.57% were Caucasians with 54.74% females. 27.67% of the Kentucky population was from the Appalachian region. Patients aged 50-64 years had the highest prevalence (38%). Lung NET (30.60%) formed the bulk of cases, followed by small intestine (16.82%), rectum/anus (11.35%) and colon (9.71%).

Conclusions

NETs incidence between 1995 and 2015 show a linear increase in both KCR and SEER databases. Because of this increased incidence it is imperative for community oncologists to familiarize themselves with this entity, which until recently was under-studied and with few viable treatment options.

Management and Follow-up of Patients with a Bronchial Neuroendocrine Tumor in the Last Twenty Years in Ireland: Expected Inconsistencies and Unexpected Discoveries

Bronchial neuroendocrine tumors (NET) are classified into well-differentiated typical carcinoids (TC), atypical carcinoids (AC), large cell neuroendocrine carcinomas (LCNEC), and small cell lung carcinomas (SCLC). We retrospectively reviewed and analyzed the diagnostic and therapeutic aspects, follow-up data, and outcomes of all patients diagnosed with a bronchial NET from 1995 to 2015 at our institution. Patients with LCNEC or SCLC were excluded due to the biological and clinical differences from the other bronchial NET. The clinical, laboratory, imaging, treatment, and follow-up data were collected and analyzed keeping in mind the recently published international recommendations. Forty-six patients were included in the study. Of these, 37 had a TC and 5 an AC. In 4 patients, the histological characterization was inadequate. Forty-four patients underwent surgery. Four patients developed metastatic disease. Interestingly, 14 patients had one or more other tumors diagnosed at some stage and 3 of them had three different tumors. A total of 7 patients died. The analysis of the laboratory and pathology assessment identified some inconsistencies when compared to the international recommendations. Although the treatment of bronchial NET at our institution was consistent with the successively published recommendations, it appears that the diagnostic process and the follow-up surveillance were not. We think that a systematic multidisciplinary approach might improve bronchial NET patient care. A relatively high rate of occurrence of a second, or also a third, non-NET tumor was observed, though the statistical value of such observation could not be exhaustively elucidated in this numerically limited patient population. In our opinion, the observed high rate of second malignancies in this patient cohort highlights the necessity of optimizing the follow-up of the bronchial NET patients, also considering the very good survival rate achieved with regard to the bronchial NET.

Carcinoid Tumours in the Gastrointestinal Tract — A Population-Based Study from Western Norway

Objective:

To analyze population-based incidence, anatomic distribution and patient characteristics of gastrointestinal carcinoid tumours.

Background:

Neuroendocrine carcinomas (NE, carcinoid tumours) arise from neuroendocrine cells and are most commonly found in gastrointestinal tract and lungs. Previous studies on carcinoids report varying incidence rates, location of tumours and patient survival rates.

Methods:

Retrospective study.88 patients were diagnosed with carcinoids located in the gastrointestinal tract in the period 1983–2003 in the Norwegian counties Hordaland and Sogn og Fjordane. Patient and tumour characteristics, treatment and survival were analyzed in a sub-group of 51 patients treated at Haukeland University Hospital.

Results:

Incidence of carcinoids was 0.8 when analyzed from the counties Hordaland and Sogn og Fjordane as well as when analyzed from Haukeland University Hospital. There were 26 men and 25 women. Median age at surgery was 61 years (range 17–87 years). The tumours were located in the small bowel in 53%, appendix 18%, colon 4%, rectum 4%, stomach 8% and duodenum 10%. Five-year survival rate was 50% in stomach, 80% in duodenum, 43% in the small bowel, 100% for tumours in appendix, 40% in colon and 100% in rectum.

Conclusion:

Carcinoid tumours are relatively uncommon neoplasms and most of them are found in the small bowel. Carcinoids in the ileum tend to be more aggressive and carry a poorer prognosis than carcinoids at other locations. Tumours in the appendix are found at lower age and in an early stage. They rarely metastasize and have an excellent prognosis.

Natural history and outcome in Chinese patients with gastroenteropancreatic neuroendocrine tumours: - a 17-year retrospective analysis

BACKGROUND

There is rising incidence of gastroenteropancreatic neuroendocrine tumours (GEP- NETs) in many parts of the world, but epidemiological data from Asian populations is rare.

METHODS

We conducted a retrospective study in a tertiary medical centre in Hong Kong, using updated diagnostic criteria. The presentation, clinical features, and disease outcome were reviewed for all patients with GEP-NETs confirmed histopathologically at the Prince of Wales Hospital, the Chinese University of Hong Kong, between 1996 and 2013, according to the latest 2010 World Health Organization Classification.

RESULTS

Among 126 patients, GEP- NETs were found in pancreas (34.9 %), rectum (33.3 %), and stomach (8.7 %), and most of them were non- functional GEP- NETs (91.3 %), mostly of grade 1 (G1) (87.3 %), and about 20 % had metastases on presentation. Age under 55 years, G1 tumours and absence of metastases were significant favourable predictors for survival in univariate analysis; whereas G2/3 tumours, size ≥2 cm, and metastases were significant predictors for disease progression (p < 0.05). In multivariate analysis, age and metastases on presentation were significant predictors of mortality (respective hazard ratios [HR] 1.05 [95 % confidence interval {CI} 1.02-1.08] and 6.52 [95 % CI 3.22-13.2]) and disease progression (respective HRs 1.05 [95 % CI 1.02-1.07] and 4.12 [95 % CI 1.96-8.68]), while higher tumour grade also independently predicted disease progression (HR 5.17 [95 % CI 2.05-13.05]) (all p < 0.05).

CONCLUSION

Non-functional tumours with non-specific symptoms account for the vast majority of GEP-NETs in this Chinese series. Multidisciplinary approach in the management of patients with GEP-NETs may help improve the treatment efficacy and outcome.

Republished: gastric neuroendocrine neoplasms and related precursor lesions

Gastric neuroendocrine neoplasms (NENs) are a heterogeneous group of tumours showing different clinicopathological features and behaviour, implying a wide spectrum of therapeutic options. They are currently classified using the 2010 WHO classification of digestive neuroendocrine neoplasms into G1-neuroendocrine tumours (NETs), G2-NETs, neuroendocrine carcinomas (NECs) and mixed adenoneuroendocrine carcinomas (MANECs). However, most gastric NENs are composed of ECL-cells (ECL-cell NETs) that can be preceded by ECL-cell hyperplastic and dysplastic lesions, whose oncologic potential has not yet been completely elucidated. ECL-cell NETs differ considerably in terms of prognosis depending on the proliferative status and clinicopathological background. The integration of both aspects in the diagnostic pathway may help to better classify tumours in different prognostic categories, especially when diagnosing them in small bioptic specimens. NECs are all poorly differentiated, highly aggressive carcinomas, while MANECs can show different morphological features that are directly associated with different prognoses. Precursor lesions of such carcinomas are not entirely understood. In this review, the clinicopathological features of gastric NENs and related precursor lesions will be described to give the reader a comprehensive overview on this topic.

Epidemiology and classification of gastroenteropancreatic neuroendocrine neoplasms using current coding criteria

BACKGROUND

The lack of uniform criteria for coding of gastroenteropancreatic neuroendocrine neoplasia (GEP-NEN) has hampered previous epidemiological studies. The epidemiology of GEP-NEN was investigated in this study using currently available criteria.

METHODS

All patients diagnosed with GEP-NEN between January 2003 and December 2013 in a well defined Norwegian population of approximately 350 000 people were included. Age- and sex-adjusted incidence rates were calculated. The current 2010 World Health Organization criteria, European Neuroendocrine Tumour Society classification and International Union Against Cancer (UICC) classification were used.

RESULTS

A total of 204 patients (114 male, 55.9 per cent) were identified. The median age at diagnosis was 61 (range 10-94) years. The annual overall crude incidence was 5.83 per 100,000 inhabitants, with an increasing trend (P = 0.033). The most frequent location was small intestine (60 patients, 29.4 per cent) followed by appendix (48 patients, 23.5 per cent) and pancreas (33 patients, 16.2 per cent). Grade 1 tumours were more common in gastrointestinal (100 patients, 58.5 per cent) than in pancreatic (9 patients, 27 per cent) NEN. According to the UICC classification, 77 patients (37.7 per cent) had stage I, 17 patients (8.3 per cent) stage II, 37 patients (18.1 per cent) stage III and 70 patients (34.3 per cent) had stage IV disease. No patient with stage I disease had grade 3 tumours; advanced tumour grade increased with stage.

CONCLUSION

A high crude incidence of GEP-NEN, at 5.83 per 100,000 inhabitants, was noted together with a significant increasing trend over time.

Gastric neuroendocrine neoplasms and related precursor lesions

Gastric neuroendocrine neoplasms (NENs) are a heterogeneous group of tumours showing different clinicopathological features and behaviour, implying a wide spectrum of therapeutic options. They are currently classified using the 2010 WHO classification of digestive neuroendocrine neoplasms into G1-neuroendocrine tumours (NETs), G2-NETs, neuroendocrine carcinomas (NECs) and mixed adenoneuroendocrine carcinomas (MANECs). However, most gastric NENs are composed of ECL-cells (ECL-cell NETs) that can be preceded by ECL-cell hyperplastic and dysplastic lesions, whose oncologic potential has not yet been completely elucidated. ECL-cell NETs differ considerably in terms of prognosis depending on the proliferative status and clinicopathological background. The integration of both aspects in the diagnostic pathway may help to better classify tumours in different prognostic categories, especially when diagnosing them in small bioptic specimens. NECs are all poorly differentiated, highly aggressive carcinomas, while MANECs can show different morphological features that are directly associated with different prognoses. Precursor lesions of such carcinomas are not entirely understood. In this review, the clinicopathological features of gastric NENs and related precursor lesions will be described to give the reader a comprehensive overview on this topic.

Incidence of gastroenteropancreatic neuroendocrine tumours: a systematic review of the literature

Based on the current medical literature, the worldwide incidence of neuroendocrine tumours (NETs) seems to have increased; however, a systematic literature overview is lacking. This study aimed to collect all available data on the incidence of gastroenteropancreatic (GEP)-NETs and characteristics of population to establish their epidemiology. A sensitive MEDLINE search was carried out. The papers were selected via a cascade process that restricted the initial pool of 7991 articles to 33, using predefined inclusion and exclusion criteria. Original articles evaluating the incidence of sporadic GEP-NETs in regional, institutional and national registries were considered. The majority of data originated from the US National Cancer Institute Surveillance, Epidemiology and End Results database and from national cancer registries in Western Europe. Generally, because of the retrospective nature of existing databases the outcomes of studies might be biased, which hinders the drawing of firm conclusions. The age-adjusted incidence of GEP-NETs has increased steadily over the past four decades (1973-2007), increasing 3.65-fold in the USA and 3.8- to 4.8-fold in the UK. Incidence has changed variably from one anatomical site to another. The greatest increase in incidence occurred for gastric and rectal NETs, while the smallest increase occurred for small intestine NETs. There were gender and racial differences, which differed site by site and, in some cases, changed over time. The incidence rates (IRs) of GEP-NETs have increased significantly in the last 40 years. Data are only available from North America, Western Europe and Japan. A site-by-site analysis revealed that the IRs of some NETs increased more than those of others.

Epidemiology of gastroenteropancreatic neuroendocrine tumours

Gastroenteropancreatic neuroendocrine tumours are a heterogeneous group of tumours arising from diffuse endocrine cells, causing unique clinical syndromes. These tumours, formerly named carcinoid, can involve any part of the gastrointestinal tract and the endocrine pancreas and have a wide range of malignant potential: from benign to poorly differentiated tumours. In this review we will summarize the data available on the epidemiology of gastroenteropancreatic tumours as it is reported from around the world. This includes annual incidence rates at the various anatomic sites, and trends in incidence rates with time. In addition age and stage at presentation, gender and racial differences and finally prognosis and survival were collected when reported.

Rare lung disease research: strategies for improving identification and recruitment of research participants

Research in rare lung diseases faces methodologic limitations by virtue of the small number of participants available to be studied. We explored several strategies that may improve researchers' ability to identify and recruit research participants with rare lung diseases. We provide an overview of strategies based on available evidence, previously used approaches, and reasoning. First, disease detection is generally poor and may be improved through strategies targeted at primary care practitioners or directly at patients, thus increasing the pool of patients available for research studies. Next, standardization of case definitions in rare lung diseases is often lacking, hindering research recruitment efforts because of confusion over appropriate recruitment criteria. Expert consensus statements can enhance both clinical care and research recruitment by standardizing definitions. Finally, recruitment strategies using rare lung disease registries, clinical research networks, novel Internet-based direct patient recruitment approaches, and patient organizations may facilitate recruitment of patients with rare lung diseases. In summary, although several strategies for improving the identification and recruitment of research participants with rare lung diseases have been proposed, published examples are few. Objective measurement and reporting of novel recruitment methods and collaboration among researchers facing the same limitations across various rare lung diseases are required. Advancements in this area are vital to the design and performance of much-needed robust clinical studies across the spectrum of rare lung diseases.

[Complete and sustained remission of liver metastases from neuroendocrine tumor with somatostatin analogue therapy]

Somatostatin analogues represent a major treatment modality in the therapy of neuroendocrine tumors. Their efficacy is well documented in the inhibition of hormone secretion; however, novel data seem to underline their effectiveness in tumor regression, as well. In this report authors present a case of type 1 neuroendocrine tumors of the stomach associated with liver metastases. Somatostatin analogue treatment resulted in a complete regression of the primary tumor and the metastases within two years. This case draws attention on the importance of somatostatin analogue treatment not only in the control of hormonal symptoms but also in the inhibition of tumor growth.

Neuroendocrine tumors in children and young adults: rare or not so rare

This review focuses on neuroendocrine tumors (NETs) that arise in the diffuse neuroendocrine system; these rare tumors can develop in any organ that has dispersed single endocrine cells, for example, the intestine, or in an organ that has clusters of endocrine cells, for example, pancreatic islets. Previously considered benign, NETs are now recognized to recur locally or metastasize to liver and bone if not completely excised early in their course of development. This article summarizes the epidemiology and reviews the diagnostic and therapeutic challenges of NETs in children and youth, noting especially those NETs that are more prevalent in young people than in older adults.

Recent progress in the understanding, diagnosis, and treatment of gastroenteropancreatic neuroendocrine tumors

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are relatively rare tumors that arise from the diffuse neuroendocrine system. This heterogeneous group of tumors was often considered a single entity. This belied their biological diversity, and the biggest advance in understanding these tumors over the past decades has been in understanding this diversity. Diagnosis of these tumors has been aided by advances in pathological diagnosis and classification and tumor imaging with endoscopic ultrasound and somatostatin receptor fusion imaging. Genetic and molecular advances have identified molecular targets in the treatment of these tumors. Surgery remains the mainstay of treatment, amply supported by interventional radiological techniques, including embolization. Treatment of metastatic disease has improved significantly with the addition of several new agents, including tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, and yttrium-90-DOTA (1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid) and lutetium-177-DOTA octreotate. Despite significant advances in the understanding and management of GEP-NETs, the survival of patients remains largely unchanged and there remains a need for the development of national and international research collaborations to spearhead future efforts.

Carcinoid tumors of the gastrointestinal tract: trends in incidence in England since 1971

OBJECTIVES

The epidemiology of gastrointestinal neuroendocrine tumors (GI-NETs) is poorly understood. Recent analyses have suggested changes in the incidence and distribution of such tumors, but have generally used data sets containing small patient numbers. We aimed to define trends in the epidemiology of GI-NETs in England over a 36-year period.

METHODS

We analyzed data from the national population-based cancer registry, which covers a population in excess of 50 million, over the period 1971-2006.

RESULTS

In all, 10,324 cases of GI-NETs were identified. The overall incidence increased from 0.27 (per 100,000 per year) to 1.32 for men and from 0.35 to 1.33 for women. The anatomic distribution of tumors in the latest period analyzed was stomach 12%, small intestine 29%, appendix 38%, colon 13%, and rectum 8%. The largest absolute increase in incidence was seen in the appendix (from 0.03 to 0.41 in men; from 0.05 to 0.59 in women). The greatest relative increase was in gastric NETs, increasing 2,325% in men, and 4,746% in women. Overall, 48% of GI-NETs occurred in men. Sex-specific incidence rates for gastric, colonic, and rectal NETs are similar, whereas appendiceal lesions were more common in females, and small intestinal tumors in men.

CONCLUSIONS

Large increases in the incidence of GI-NETs were observed, along with changes in anatomical distribution. Such changes may partly reflect changes in classification or improved detection through the increased use of endoscopy and imaging techniques. In view of the magnitude of these changes, particularly for gastric tumors, further studies to examine the underlying etiology of these changes are urgently indicated.

Treatment with the radiolabeled somatostatin analog [177 Lu-DOTA 0,Tyr3]octreotate: toxicity, efficacy, and survival

PURPOSE

Despite the fact that most gastroenteropancreatic neuroendocrine tumors (GEPNETs) are slow-growing, median overall survival (OS) in patients with liver metastases is 2 to 4 years. In metastatic disease, cytoreductive therapeutic options are limited. A relatively new therapy is peptide receptor radionuclide therapy with the radiolabeled somatostatin analog [(177)Lu-DOTA(0),Tyr(3)]octreotate. Here we report on the toxicity and efficacy of this treatment, performed in over 500 patients.

PATIENTS AND METHODS

Patients were treated up to a cumulative dose of 750 to 800 mCi (27.8-29.6 GBq), usually in four treatment cycles, with treatment intervals of 6 to 10 weeks. Toxicity analysis was done in 504 patients, and efficacy analysis in 310 patients.

RESULTS

Any hematologic toxicity grade 3 or 4 occurred after 3.6% of administrations. Serious adverse events that were likely attributable to the treatment were myelodysplastic syndrome in three patients, and temporary, nonfatal, liver toxicity in two patients. Complete and partial tumor remissions occurred in 2% and 28% of 310 GEPNET patients, respectively. Minor tumor response (decrease in size > 25% and < 50%) occurred in 16%. Median time to progression was 40 months. Median OS from start of treatment was 46 months, median OS from diagnosis was 128 months. Compared with historical controls, there was a survival benefit of 40 to 72 months from diagnosis.

CONCLUSION

Treatment with [(177)Lu-DOTA(0),Tyr(3)]octreotate has few adverse effects. Tumor response rates and progression-free survival compare favorably to the limited number of alternative treatment modalities. Compared with historical controls, there is a benefit in OS from time of diagnosis of several years.

Hereditary neuroendocrine tumors of the gastroenteropancreatic system

Approximately 5-10% of neuroendocrine tumors (NETs) of the gastroenteropancreatic system (GEP) have a hereditary background. The known inherited syndromes include multiple endocrine neoplasia type 1, neurofibromatosis type 1, von Hippel-Lindau disease, and the tuberous sclerosis complex. This review discusses for each of these syndromes the: (1) involved genes and specific types of mutations, (2) disease prevalence and penetrance, (3) affected neuroendocrine tissues and related clinical syndromes, (4) special morphological features of NETs and their putative precursor lesions. In addition, GEP-NETs clustering in individual families or associated with other malignancies without known genetic background are discussed.

Tumours of the midgut (jejunum, ileum and ascending colon, including carcinoid syndrome)

(Neuro-)endocrine tumours of the gastrointestinal tract are also called 'carcinoids'. (Neuro-)endocrine midgut tumours can be categorized according to their clinical behaviour. Most tumours are non-functioning. Functioning tumours are responsible for the carcinoid syndrome. The carcinoid syndrome is almost uniquely associated with midgut carcinoids. Symptoms of the carcinoid syndrome are caused by an excess of biogenic amines, peptides and other factors in the circulation. The typical symptoms of the carcinoid syndrome are diarrhoea, flushing, and carcinoid heart disease. Carcinoid heart disease involves the tricuspid and pulmonary valves and the endocardium. Serum chromogranin A and urinary excretion of 5-hydroxy-indoleacetic acid (5-HIAA) are biochemical markers. Carcinoid tumours express large numbers of high-affinity somatostatin receptors. These can bind the currently available octapeptide somatostatin analogues. In inoperable patients, biotherapy with somatostatin analogues and interferon-alpha is the treatment of choice. Somatostatin analogues and interferon-alpha significantly improve symptoms.

Incidence of Small Bowel Cancer in the United States and Worldwide: Geographic, Temporal, and Racial Differences

OBJECTIVE

To examine the demographic and geographic patterns of small bowel cancer incidence in the United States and worldwide.

METHODS

Incidence data from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 to 2000 were used to analyze the four histologic types of small bowel cancer, adenocarcinomas, carcinoid tumors, lymphomas, and sarcomas. International comparisons were made using data from Cancer Incidence in Five Continents (CIVIII). Geographic correlations between small bowel and both large bowel and stomach cancer incidence, were performed.

RESULTS

Men had higher rates than women for all types of small bowel cancer. Blacks had almost double the incidence of carcinomas and carcinoid tumors compared to whites (10.6 vs. 5.6 per million people; 9.2 vs. 5.4 per million people, respectively). Small bowel cancer incidence has risen, with the greatest increase for carcinoid tumors (21%) and black men (120%). A geographic correlation between small and large bowel cancer incidence, but not small bowel and stomach cancer, were observed.

CONCLUSIONS

Small bowel cancer incidence in the U.S. is higher in blacks compared to whites, particularly for carcinomas and carcinoid tumors. Small bowel cancer incidence is rising, particularly in black men. The geographic correlation between large and small bowel cancer suggests shared etiologies.

Neuroendocrine tumors of the appendix

The vast majority of neuroendocrine neoplasms of the appendix are carcinoid tumors. Most are of enterochromaffin (EC) cell type, although rare examples are of L cell type. EC cell carcinoids of the appendix differ from those encountered elsewhere in the gastrointestinal system. For example, they are remarkably common given the small size of the appendix, are usually benign, occur in younger patients, and typically contain sustentacular cells that express S-100. Origin from subepithelial neuroendocrine cells could explain these characteristics. It has also been suggested that most appendiceal carcinoids are hyperplastic rather than neoplastic, although this hypothesis requires further study. Nevertheless, truly neoplastic EC cell carcinoids of the appendix undoubtedly occur, and those greater than 2 cm in diameter have a significant risk of producing distant metastases. Carcinoid syndrome is a very rare presentation. Tubular carcinoids are unusual benign neoplasms; it has been proposed that they represent L cell carcinoids with a predominant tubular pattern of growth. Goblet cell carcinoids tend not to produce a grossly visible tumor mass but diffusely infiltrate the wall. They typically exhibit tight clusters of goblet cells, usually with scattered neuroendocrine cells and sometimes with Paneth cells, sometimes surrounding a small lumen. They may behave as a low-grade malignancy. The distinction between goblet cell carcinoid and other types of tumor is of great importance because of the implications for treatment and prognosis. Frank adenocarcinoma can arise from goblet cell carcinoids, and tumors with both components are classified as mixed goblet cell carcinoid-adenocarcinoma. The carcinoma component of the latter determines their prognosis, which would be worse than for a goblet cell carcinoid alone.

Epidemiology of neuroendocrine tumours

Neuroendocrine tumours account for only 0.5% of all malignancies. The incidence is approximately 2/100,000 with a female preponderance under the age of 50 years due to appendiceal location. The main primary sites are the gastrointestinal tract (62-67%) and the lung (22-27%). Presentation with metastatic disease accounts for 12-22%. In the last decades, the incidence has been rising. This might be due to more awareness, improved diagnostic tools or a change in definition. Most neuroendocrine tumours are mainly sporadic, but association with the multiple endocrine neoplasia type 1 syndrome and clustering within families is known. Also an increased risk of secondary cancers has been reported, but numbers are small. The 5-year survival is mainly associated with stage: 93% in local disease, 74% in regional disease and 19% in metastatic disease. In metastatic disease, survival increased since 1992, when treatment with octreotide became largely available in The Netherlands.

Malignant carcinoids in the USA, SEER 1992-1999. An epidemiological study with 6830 cases

Most of our knowledge on the epidemiology of carcinoid tumours in the USA relies on studies updated during the 1980s. The aim of this study was to describe USA population-based case-series incidence in the period 1992-1999. Data were retrieved from a Surveillance Epidemiology and End Results (SEER) Program public-use file. Incidence rates, male-to-female standardized ratios, estimated annual percentage changes and 5-year relative survival rates were computed, and 6830 malignant carcinoid incident during 1992-1999 were analysed. The overall age-adjusted incidence rates were 1.9 per 100 000 for men and women. There was an excess in women for lung and stomach carcinoids, while rates were higher among men for carcinoids of the small intestine and rectum. From 1992 to 1999, incidence rates showed a 3% estimated annual increase. Thirteen per cent of the cases had metastasis at diagnosis. In the present series, 24% of carcinoid patients had more than one tumour. The overall 5-year relative survival rate was 82%. In conclusion, improvements in diagnostic techniques seem to have influenced the epidemiology of carcinoid tumours, leading to a slightly different site distribution and a better stage distribution at diagnosis. Increasing incidence and improving survival rates were shown.

A 5-decade analysis of 13,715 carcinoid tumors

BACKGROUND

Carcinoid tumors represent an unusual and complex disease spectrum with protean clinical manifestations. This compilation of several large United States-based databases comprising patients from 1950 to 1999 examines 13,715 carcinoid tumors and provides epidemiologic information regarding the natural history and evolution of the detection and diagnosis of this entity.

METHODS

The authors evaluated 10,878 carcinoid tumors that were identified by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (NCI) from 1973 to 1999 in addition to 2837 carcinoid tumors that were registered previously by two earlier NCI programs. To the authors' knowledge, this represents the largest current epidemiology series addressing carcinoid tumors to date.

RESULTS

Specific trends in incidence for carcinoid tumors of certain sites were identified. Among the most recently collected subset of data, sites that demonstrated the greatest incidence of carcinoids were the gastrointestinal tract (67.5%) and the bronchopulmonary system (25.3%). Within the gastrointestinal tract, most carcinoid tumors occurred in the small intestine (41.8%), rectum (27.4%), and stomach (8.7%). For all sites, age-adjusted incidence rates were highest in black males (4.48 per 100,000 population per year). Associated noncarcinoid tumors were frequent in conjunction with small intestinal (29.0%), gastric (20.5%), colonic (20.0%), and appendiceal (18.2%) carcinoids. The highest percentages of nonlocalized lesions were noted for cecal (81.5-83.2%) and pancreatic (71.9-81.3%) carcinoids, whereas the highest percentage of localized disease was found among rectal (81.7%), gastric (67.5%), and bronchopulmonary (65.4%) carcinoids. The best 5-year survival rates were recorded for patients with rectal (88.3%), bronchopulmonary (73.5%), and appendiceal (71.0%) carcinoids; these tumors exhibited invasive growth or metastatic spread in 3.9%, 27.5%, and 38.8% of patients, respectively.

CONCLUSIONS

Carcinoids appear to have increased in overall incidence over the past 30 years; for some sites, this trend has been evident for nearly half a century. Recent marked increases in gastric and rectal carcinoids and a concomitant decrease in appendiceal carcinoid incidence may be due in part to varying rules of registration among the compiled databases examined in this report or to improvements in diagnostic technology; increased awareness of and about carcinoid tumors also may play a significant role. In 12.9% of all patients with carcinoid, distant metastases already were evident at the time of diagnosis; the overall 5-year survival rate for all carcinoid tumors, regardless of site, was 67.2%. These findings bring into question the widely promulgated relative benignity of carcinoid disease. Certain carcinoid tumors, such as those of the rectum, appear to be over-represented among the black and Asian populations within the United States, suggesting the role of genetics in the development of this intriguing disease.

Diagnostic, surgical and medical aspect of the midgut carcinoids

This review covers the incidence, prognosis, diagnosis and treatment of midgut carcinoids with emphasis on the surgical and peri-operative aspects. Midgut carcinoids are rare neuro-endocrine tumours which become manifest once they have metastasized to the liver. Treatment of metastatic disease may include radical resection but is usually palliative. The tumour grows relatively slow. Besides the biochemical effects resulting in the carcinoid syndrome, patients may suffer from mechanical mass effects of the tumour. Medical treatment can alleviate the biochemical effects of the tumour, but has a limited effect on tumour growth. The introduction of octreotide was a milestone in palliation of these symptoms and has led to more aggressive treatment protocols. Treatment aimed at cytoreduction of hepatic metastasis and diminished secretion of bioactive amines may achieve good palliation. Cytoreduction may be performed by means of surgery, hepatic arterial ligation, (chemo)embolization, cryosurgery, radio-frequency ablation, internal radiation or even liver transplantation. The role of these options will be discussed in this review.

Incidence trends and risk factors of carcinoid tumors: a nationwide epidemiologic study from Sweden

BACKGROUND

Carcinoids are rare indolent neuroendocrine tumors, mainly located in bowel, stomach, and lung. Their etiology is virtually unknown although a family history is a minor cause.

METHODS

Site specific incidence trends and several risk factors of carcinoid tumors were studied based on the nationwide Swedish Family-Cancer Database of 10.2 million individuals and their more than 1 million tumors. Data on a total of 5184 carcinoid tumors were retrieved from the Cancer Registry covering years 1958-1998.

RESULTS

The overall age-adjusted incidence rates were 2.0 for men and 2.4/100,000 for women in 1983-1998. Appendix was the main site for women whereas small intestine was the main site for men. The incidence of all carcinoids, including those at the main sites increased during the follow-up period but appeared to plateau in the middle of the 1980s. Appendiceal carcinoids showed an unusually early onset with a maximum incidence at age 15-19 years for women and 20-29 years for men. Among women, parity was not related to the age specific incidence of carcinoid tumors. A Poisson regression analysis showed that family history of carcinoids in first-degree relatives (relative risk, 3.6), well educated social background (relative risk for professionals, 2.8), and birth in large cities were risk factors.

CONCLUSIONS

The data suggest that the increase in carcinoid tumors may be largely ascribed to the application of advanced medical viewing techniques that detect asymptomatic tumors. However, the difference in incidence between men and women in appendiceal tumor may be real and independent of parity.

Familial carcinoid tumors and subsequent cancers: a nation-wide epidemiologic study from Sweden

Carcinoids are rare neuroendocrine tumors, mainly located in the bowel, stomach and lung. Familial risks in carcinoid tumours are not well known apart from multiple endocrine neoplasia 1 (MEN1). We used the nation-wide Swedish Family-Cancer Database on 10.1 million individuals for assessment. Carcinoid tumors were retrieved from the Cancer Registry covering the years 1958-1998. The offspring generation, aged 0-66 years, accumulated 190 million person-years at risk. The age-adjusted incidence rates were 0.76 for men and 1.29/100,000 for women. Standardized incidence ratios (SIRs) were calculated for offspring when their parents had a carcinoid or any other cancer. When parents presented with carcinoids, SIRs for offspring were 4.35 (n = 8, 95% CI 1.86-7.89) for small intestinal and 4.65 (n = 4, 95% CI 1.21-10.32) for colon carcinoids. If both offspring and parents presented with small intestinal carcinoids, the SIR was 12.31 (n = 4, 95% CI 3.20-27.34). Offspring carcinoids were also increased if parents presented with bladder and endocrine gland tumors, the latter association probably partially due to MEN1. Risks for second cancers were increased, particularly at sites where familial risks were found, including carcinoids in the small intestine.

Incidence trends and risk factors of carcinoid tumors: a nationwide epidemiologic study from Sweden

BACKGROUND

Carcinoids are rare indolent neuroendocrine tumors, mainly located in bowel, stomach, and lung. Their etiology is virtually unknown although a family history is a minor cause.

METHODS

Site specific incidence trends and several risk factors of carcinoid tumors were studied based on the nationwide Swedish Family-Cancer Database of 10.2 million individuals and their more than 1 million tumors. Data on a total of 5184 carcinoid tumors were retrieved from the Cancer Registry covering years 1958-1998.

RESULTS

The overall age-adjusted incidence rates were 2.0 for men and 2.4/100,000 for women in 1983-1998. Appendix was the main site for women whereas small intestine was the main site for men. The incidence of all carcinoids, including those at the main sites increased during the follow-up period but appeared to plateau in the middle of the 1980s. Appendiceal carcinoids showed an unusually early onset with a maximum incidence at age 15-19 years for women and 20-29 years for men. Among women, parity was not related to the age specific incidence of carcinoid tumors. A Poisson regression analysis showed that family history of carcinoids in first-degree relatives (relative risk, 3.6), well educated social background (relative risk for professionals, 2.8), and birth in large cities were risk factors.

CONCLUSIONS

The data suggest that the increase in carcinoid tumors may be largely ascribed to the application of advanced medical viewing techniques that detect asymptomatic tumors. However, the difference in incidence between men and women in appendiceal tumor may be real and independent of parity.

Second primary neoplasms after 19281 endocrine gland tumours: aetiological links?

The nationwide Swedish Family-Cancer Database of 9.6 million individuals was used to analyse the development of second neoplasia after 6909 thyroid and 12697 other endocrine tumours. Tumour cases were retrieved from the Swedish Cancer Registry from 1958 to 1996. The risk of a second endocrine tumour was markedly increased compared with first endocrine tumour; e.g. the standardised incidence ratios (SIRs) were well over 10 for adrenal tumours after thyroid cancer, and vice versa. Familial risks were higher for the development of second compared with first neoplasms, and the SIRs for men were usually higher than those for women. Many increases between different endocrine glands can probably be ascribed to known cancer syndromes. Even cancers at some other sites were increased after the development of primary endocrine tumours. Notably, small intestinal carcinoids were increased after thyroid and other endocrine tumours, and brain menigiomas were increased after parathyroid and pituitary adenomas. These novel associations suggest shared risk factors for these sites. However, many endocrine tumours are benign and the diagnosis of the first tumour may increase the likelihood of a second diagnosis.

Epidemiology and survival in patients with carcinoid disease in The Netherlands. An epidemiological study with 2391 patients

BACKGROUND

Carcinoid tumours are rare malignant neuroendocrine tumours. In 1992 octreotide was introduced in the Netherlands as a palliative treatment for the carcinoid syndrome in metastatic carcinoid disease. The aims of this epidemiological study were to evaluate epidemiological data and the impact of octreotide on survival in metastatic carcinoid disease.

PATIENTS AND METHODS

Between 1989 and 1996, 2391 patients with carcinoid disease were diagnosed in the Netherlands. Survival data from two Registries were available in 619 patients, diagnosed between 1980 and 1997.

RESULTS

Between 1989 1996, incidence was 1.95/100,000. Under the age of 50 years a significant female predominance was observed. Under the age of 35 years, appendiceal carcinoid was the most frequently diagnosed primary site. Incidence of distant metastases at diagnosis for appendix and lung primary sites was 1.6% and 5.5%, compared to 40%, in the other primary sites. Multivariate analysis of 619 patients revealed that age, stage and appendix localisation predicted survival. In metastatic disease, however, only year of diagnosis after 1992 independently predicted survival (P = 0.012).

CONCLUSIONS

The female predominance found under the age of 50 years suggests hormonal influence. Improved survival in metastatic carcinoid disease might relate to the use of octreotide.