DIARRHEA AS A CLINICAL MARKER OF NEUROENDOCRINE TUMORS

Abstract

Neuroendocrine tumors (NET) are a rare, but dangerous disease, and often have malignant character. The frequency is about 35 cases at 100.000 population, with 2-5 new cases on 100.000 people a year. The majority of NET produce the active substances in various degree influencing exocrine function and motility of the gastrointestinal tract (GIT). The frequent clinical manifestation of NET is diarrhea. It is necessary to carry out a differential diagnosis of NET in patients with the persistent not stopped diarrhea and/or ulcer damage of a GIT. The purposes of treatment of NET are the elimination of primary tumor (and its metastasizes - if they are) and normalization of a hormonal background that leads to a regress of clinical symptoms. The randomized controlled studies PROMID and CLARINET with a high degree of substantiality have shown symptomatic improvement and significant anti-proliferative effect of somatostatin analogs in the treatment of NET. In the CLARINET study, the lanreotide Autogel was effective at a wide range of patients with highly - and moderate differentiated NET (Ki-67 <10%), including with primary tumor in a small intestine and pancreas, with a primary tumor of unknown localization, and with metastatic damage of a liver. Now somatostatin analogs are considered as the first line of drug treatment of patients with highly - and moderate differentiated NET of digestive tract regardless of the extent of metastatic damage of a liver.