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Neuroendocrine tumours (NETs) often have a good prognosis and have peculiar biological characteristics, among which the ability to produce and release biologically active substances. Hypersecretion of hormones, biogenic amines or growth factors often cause severe syndromes that are very debilitating. Now sensitive assays for the measurement of these substances have been developed and this has improved the possibility of patient followup by means of in vitro examinations. The decision about which in vitro examination to be utilised for NET management is very difficult because of the NET low incidence, the very large number of measurable hormones, the difficulty or low patient compliance for some diagnostic tests. In this review we describe the most useful laboratory tests for determining the diagnosis of NET, their prognostic significance and the clinical value of specific marker evaluation in the follow-up of the NET patient. Particular consideration has been given to biomarkers for gastroenteropancreatic and sympatho-adrenal system tumours and for prostate and breast cancers with neuroendocrine differentiation.
KEY WORDS: Neuroendocrine rumours - Apudoma - Carcinoid tumor - Tumor markers, biological - Chromogranin A Neuron-specific enolase - 5-hydroxyindoleacetic acid Catecholamines - Homovanillic acid - Vanillylmandelic acid.
Neuroendocrine tumours (NETs) often have a good prognosis and are characterized by a peculiar biology. For these reasons such neoplasms are of particular interest to oncologists, in spite of their low incidence. NETs have the capacity to produce and release biologically active substances that are often responsible for severe syndromes (eg., carcinoid syndrome, Zollinger-Ellison syndrome, Verner-Morrison syndrome, etc.). The recent development of sensitive assays has allowed the measurement of these molecules and has improved the possibility of patient follow-up by means of in vitro examinations.I However, due to the low incidence of NETs and the very large number of measurable hormones, clinicians are compelled to choose only those measurements that have established clinical value and are cost-effective.2
In this paper, we provide essential information on the diagnostic tests to be used in determining the neudoendocrine differentiation of the neoplasm, the prognostic significance of the measurement of biomarkers in NETs and the clinical value of specific markers in the follow-up of NET patients.
General markers for neuroendocrine tumours
Cellular populations of the neuroendocrine systems (both confined and diffuse) have the capacity to synthesise...