title: Management of early gastrointestinal neuroendocrine neoplasms.
abstract: Neuroendocrine neoplasms (NENs) of the stomach, duodenum, appendix or rectum that are small (≤ 1 cm) and well differentiated can be considered "early" tumors, since they generally have a (very) good prognosis. In the new WHO classification of 2010, these neoplasms are called neuroendocrine tumors/ carcinoids (NETs), grade (G) 1 or 2, and distinguished from poorly differentiated neuroendocrine carcinomas (NECs), G3. NETs are increasing, with a rise in the age-adjusted incidence in the U.S.A. by about 700 % in the last 35 years. Improved early detection seems to be the main reason for these epidemiological changes. Both the better general availability of endoscopy, and imaging techniques, have led to a shift in the discovery of smaller-sized (≤ 10-20 mm) intestinal NETs/carcinoids and earlier tumor stages at diagnosis. Endoscopic screening is therefore effective in the early diagnosis, not only of colorectal adenocarcinomas, but also of NETs/carcinoids. Endoscopic removal, followed up with endoscopic surveillance is the treatment of choice in NETs/carcinoids of the stomach, duodenum and rectum that are ≤ 10 mm in size, have a low proliferative activity (G1), do not infiltrate the muscular layer and show no angioinvasion. In all the other intestinal NENs, optimal treatment generally needs surgery and/or medical therapy depending on type, biology and stage of the tumor, as well as the individual situation of the patient.
authors.affiliation: Hans Scherübl, Departments of Gastroenterology, Gastrointestinal Oncology and Infectious Diseases, Vivantes Klinikum Am Urban, Berlin 10967, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Scherübl
authors.forename: Robert T
authors.initials: RT
authors.lastname: Jensen
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cadiot
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stölzel
authors.forename: Günter
authors.initials: G
authors.lastname: Klöppel