Ferga C. Gleeson, MD from the Division of Gastroenterology and Hepatology at Mayo Clinic in Rochester, Minnesota discusses her Original Article “Endoscopically identified well-differentiated rectal carcinoid tumors: impact of tumor size on the natural history and outcomes.”
A paucity of data pertain to the natural history and outcome of patients with incidentally identified well-differentiated rectal carcinoids or neuroendocrine tumors (NETs) at the time of colonoscopy. Such lesions are recognized to have malignant potential. The management of intermediate-sized lesions (11-19 mm) is debated, with some recommending radical resection versus others who favor a transanal excision (TAE) or other local endoscopic therapy approach.
The broad goal of this study was to collect data that may address current gaps in the management strategy for a substantial cohort of patients with rectal carcinoid tumors.
Our data support the contention that a well-differentiated rectal carcinoid tumor ≤10 mm has a generally benign disease course. The clinical behavior of 11-19 mm tumors appears to mimic that of larger (>20 mm) lesions with respect to the presence of metastasis at diagnosis and disease progression. Therefore, if local therapy is contemplated, it may be prudent to make a distinction between ≤10-mm and 11- to 19-mm tumors, favoring an aggressive staging and management protocol for 11- to 19-mm carcinoid tumors.
Figure 3. Proposed assessment and treatment strategy for well-differentiated rectal carcinoid tumor. Complete line represents localized disease; dashed line represents local and distant metastatic disease.
We believe that initial staging should routinely incorporate EUS but question the utility of endoscopic surveillance for identifying local disease recurrence. Despite our uncertainty regarding the merits and ideal means of biochemical, radiologic, and endoscopic surveillance, we aim to perform an annual clinical and radiologic assessment of patients with local therapy–managed tumors 11-19 mm in size.
Read the abstract for this article online.
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