What are the NCCN recommendations for the treatment of gastric carcinoid tumors?

Updated: Feb 12, 2019
  • Author: Cameron K Tebbi, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Answer

For gastric tumors, the NCCN recommendations are as follows [103] :

  • With hypergastrinemia and tumors ≤2 cm: Endoscopic resection with biopsy or observation; or octreotide or lanreotide for patients with Zollinger-Ellison syndrome.

  • With hypergastrinemia and tumors >2 cm: Endoscopic resection, if possible, or surgical resection

  • With normal gastrin levels: Radical gastric resection and regional lymphadenectomy; endoscopic or wedge resection can be considered for tumors ≤2 cm

Gastric carcinoids can be subclassified into the following three distinct groups [107] :

  • Type I – Those associated with chronic atrophic gastritis/pernicious anemia (70-80%)

  • Type II – Those associated with Zollinger-Ellison syndrome with multiple endocrine neoplasia type I (MEN I) (5%)

  • Type III – Sporadic NETs of the stomach (15-20%)

In 2013, NANETS released updated guidelines with the following recommendations for treatment of gastric carcinoid tumors [108] :

  • Type I or II, <1 cm: Surveillance or endoscopic removal

  • Type I, 1 cm to <2 cm: Surveillance with repeat endoscopy every 3 years or endoscopic resection

  • Type II, 1 cm to <2 cm: Endoscopic resection

  • Type I, ≥2 cm (≤6 polyps), or type II ≥2 cm: Endoscopic resection, if possible, or open surgical resection

  • Type I, ≥2 cm (>6 polyps): Individualized treatment required; surveillance, endoscopic resection, or surgical resection

  • Type III: Partial gastrectomy and lymph node dissection

The 2016 revised ENETS guidelines prefer conservative management strategies over surgery for type I tumors. The guidelines recommend resection of tumors ≥ 10 mm performed by experienced endoscopists in gastric tumors using either endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). [109]

For type II tumors, local or limited excision can be recommended, but this should be patient tailored at multidisciplinary NET centers of excellence. Type III tumors should be treated similarly to gastric adenocarcinoma with surgery(partial or total gastrectomy with lymph node dissection). Systemic therapies is required for inoperable or stage 4 disease. [109]


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