title: Diagnosis and management of gastrointestinal neuroendocrine tumors: An evidence-based Canadian consensus.
abstract: The majority of neuroendocrine tumors originate in the digestive system and incidence is increasing within Canada and globally. Due to rapidly evolving evidence related to diagnosis and clinical management, updated guidance on the diagnosis and treatment of gastrointestinal neuroendocrine tumors (GI-NETs) are of clinical importance. Well-differentiated GI-NETs may exhibit indolent clinical behavior and are often metastatic at diagnosis. Some NET patients will develop secretory disease requiring symptom control to optimize quality of life and clinical outcomes. Optimal management of GI-NETs is in a multidisciplinary environment and is multimodal, requiring collaboration between medical, surgical, imaging and pathology specialties. Clinical application of advances in pathological classification and diagnostic technologies, along with evolving surgical, radiotherapeutic and medical therapies are critical to the advancement of patient care. We performed a systematic literature search to update our last set of published guidelines (2010) and identified new level 1 evidence for novel therapies, including telotristat etiprate (TELESTAR), lanreotide (CLARINET), everolimus (RADIANT-2; RADIANT-4) and peptide receptor radionuclide therapy (PRRT; NETTER-1). Integrating these data with the clinical knowledge of 16 multi-disciplinary experts, we devised consensus recommendations to guide state of the art clinical management of GI-NETs.
authors.affiliation: Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, 2075 Bayview Ave. Room T2-047, Toronto, Ontario M4N 3M5, Canada. Electronic address: simron.singh@sunnybrook.ca.
authors.forename: Simron
authors.initials: S
authors.lastname: Singh
authors.affiliation: University Health Network, Department of Pathology, University of Toronto, Toronto, Ontario M5G 2C4, Canada. Electronic address: sylvia.asa@uhn.ca.
authors.forename: Sylvia L
authors.initials: SL
authors.lastname: Asa
authors.affiliation: Sunnybrook Health Sciences Centre, Department of Medical Imaging, University of Toronto, 2075 Bayview Ave. Room MG-182, Toronto, Ontario M4N 3M5, Canada. Electronic address: c.dey@utoronto.ca.
authors.forename: Chris
authors.initials: C
authors.lastname: Dey
authors.affiliation: BC Cancer Agency, Division of Medical Oncology, University of British Columbia, 600 West 10th Avenue, Vancouver, BC V5Z 4E1, Canada. Electronic address: hkennecke@bccancer.bc.ca.
authors.forename: Hagen
authors.initials: H
authors.lastname: Kennecke
authors.affiliation: St. Joseph's Health Care London, Division of Nuclear Medicine, University of Western Ontario, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada. Electronic address: david.laidley@lhsc.on.ca.
authors.forename: David
authors.initials: D
authors.lastname: Laidley
authors.affiliation: Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, 2075 Bayview Ave. Room T2-001, Toronto, Ontario M4N 3M5, Canada. Electronic address: calvin.law@sunnybrook.ca.
authors.forename: Calvin
authors.initials: C
authors.lastname: Law
authors.affiliation: The Ottawa Hospital Cancer Centre, Division of Medical Oncology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H8L6, Canada. Electronic address: tiasmis@toh.ca.
authors.forename: Timothy
authors.initials: T
authors.lastname: Asmis
authors.affiliation: Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, 2075 Bayview Ave. Room T2-047, Toronto, Ontario M4N 3M5, Canada. Electronic address: dlhchan1@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Chan
authors.affiliation: Princess Margaret Cancer Centre, Departments of Medicine & Oncology, University of Toronto, 610 University Ave. Room 7-327, Toronto, Ontario M5G 2N2, Canada. Electronic address: shereen.ezzat@utoronto.ca.
authors.forename: Shereen
authors.initials: S
authors.lastname: Ezzat
authors.affiliation: The Ottawa Hospital Research Institute, Department of Medical Oncology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H8L6, Canada. Electronic address: rgoodwin@toh.on.ca.
authors.forename: Rachel
authors.initials: R
authors.lastname: Goodwin
authors.affiliation: University Health Network, Department of Pathology, University of Toronto, Toronto, Ontario M5G 2C4, Canada. Electronic address: ozgur.mete2@uhn.ca.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Mete
authors.affiliation: Tom Baker Cancer Center and Foothills Medical Centre, Departments of Surgery & Oncology, University of Calgary, 1403 29th Street NW, North Tower Floor 10, Calgary, Alberta T2N 2T9, Canada. Electronic address: janice.pasieka@ahs.ca.
authors.forename: Janice
authors.initials: J
authors.lastname: Pasieka
authors.affiliation: McGill University Health Centre - Glen Campus, Bloc C - C04.5190, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada. Electronic address: juan.rivera@mcgill.ca.
authors.forename: Juan
authors.initials: J
authors.lastname: Rivera
authors.affiliation: CancerCare Manitoba, St Boniface General Hospital, 407 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada. Electronic address: rwong2@cancecare.mb.ca.
authors.forename: Ralph
authors.initials: R
authors.lastname: Wong
authors.affiliation: St Vincent's Clinical School, University of New South Wales, 438 Victoria St, Darlinghurst, NSW 2010, Australia. Electronic address: e.segelov@unsw.edu.au.
authors.forename: Eva
authors.initials: E
authors.lastname: Segelov
authors.affiliation: QEII Health Sciences Centre, Division of Medical Oncology, Dalhousie University, Suite 457A Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada. Electronic address: daniel.rayson@nshealth.ca.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rayson
mesh_terms: D002170:Canada; D019317:Evidence-Based Medicine; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D018358:Neuroendocrine Tumors / Q000175:diagnosis* / Q000628:therapy*
keywords: Canadian consensus; Carcinoid tumor; Disease management; Gastrointestinal neoplasms; Malignant carcinoid syndrome; Neuroendocrine tumors