Site of Origin and Treatment of NETS

The panel underscored that neuroendocrine tumor (NET) management requires a nuanced, multidisciplinary approach, particularly regarding somatostatin receptor (SSTR) expression. Non-expression of SSTR in gastrointestinal NETs is especially concerning, while it’s more common and less worrisome in lung or certain cervical NETs. Dr. Arshad emphasizes balancing evidence-based guidelines with the “art” of oncology—applying patient-specific factors, tumor biology, clinical presentation, and patient values. Decision-making encompasses tumor site, size, aggressiveness, stage, and presence or absence of functional symptoms, as well as the patient’s age, comorbidities, preferences, and quality-of-life goals. For example, aggressive interventions and attempts at complete resection are prioritized in pancreatic NETs, while small bowel or more indolent NETs often justify a less intensive, sometimes observational approach. Treatment plans are shaped by the therapy’s impact—balancing eOicacy, side effects, and financial burden—with ongoing dialogue between specialists and patients to ensure choices align with both the latest evidence and individual patient goals.