Patient-Based Council

Neuroendocrine Tumors Council

Neuroendocrine tumors are rare and can behave very differently from one patient to another. Accurate grading and determining functional status form the basis of the treatment decision.

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About the disease

Neuroendocrine tumors (NETs) arise from hormone-producing cells and can occur in many organs, most often the digestive system and the lungs. Some secrete hormones and cause symptoms (functional), while others remain silent.

Grading based on the Ki-67 index and mitotic count (G1, G2, G3), together with the distinction between well-differentiated NET and poorly differentiated NEC, is the single most critical step in determining the treatment path.

The sequence between somatostatin receptor imaging (Ga-68 DOTA PET), somatostatin analogues, PRRT (Lu-177), targeted agents and surgery is decided jointly according to disease extent and growth rate.

Which specialties evaluate it?

In this council your case is reviewed jointly by the disciplines below.

Medical Oncology
Nuclear Medicine
Endocrinology
General Surgery
Gastroenterology
Radiology
Pathology
Radiation Oncology

Files requested from the patient

Pathology report (Ki-67 index, mitotic count, grade)
Immunohistochemistry results (chromogranin A, synaptophysin, etc.)
Ga-68 DOTA PET/CT or somatostatin receptor imaging report
CT / MRI images and reports
Hormone and tumor marker results (chromogranin A, 5-HIAA, etc.)
Discharge summary and details of treatments received (analogues, PRRT, surgery)

Clinical questions answered

How do my tumor’s grade and differentiation affect my treatment choice?
Is somatostatin analogue therapy suitable for me?
Am I eligible for PRRT (Lu-177), and when should it be considered?
Is surgery still an option, and how should liver metastases be approached?
How can my functional symptoms be brought under control?
How often should I be followed up and with which tests?

Scope of the council report

Written opinion confirming the case was reviewed by a multidisciplinary council
Council confirmation of the diagnosis, stage and risk group
Recommended treatment options and the reasoning behind them
Alignment with current guidelines (ESMO / NCCN) and a level-of-evidence note
Comparison of alternative options and their expected side-effect profiles
Recommendations for any additional tests or consultations
Potentially suitable clinical trial options

Scope of the second opinion

Independent review of the current diagnosis and staging
Re-evaluation of pathology and imaging findings
Confirmation that the ongoing or planned treatment is appropriate
Comparative presentation of alternative treatment approaches
Clarification of unanswered clinical questions
Assessment of how well the decision fits the patient’s priorities and quality-of-life goals