Gynecologic NETs: Reviewing Treatments

Neuroendocrine tumors (NETs) can be classified as either poorly differentiated, aggressive neuroendocrine carcinomas (NECs) that have a high propensity for distant metastatic spread or well-differentiated, slow growing NETs with good long-term prognoses. NECs of the gynecologic tract comprise 2% of cervical cancers. Well-differentiated NETs of the gynecologic tract, such as primary ovarian carcinoid tumors, comprise less than 0.1% of ovarian neoplasms and 5% of carcinoid tumors overall. In recent years, an increased incidence in the diagnosis of NETs of the gynecologic tract has been observed in clinical investigations. Currently, limited data are available to guide clinicians on the diagnosis and treatment on NETs, making management especially challenging. The Society of Gynecologic Oncology Clinical Practice Committee requested that my colleagues and I develop a clinical document on NETs of the gynecologic tract. Published in the July 2011 issue of Gynecologic Oncology, our study sought to provide a comprehensive review of NETs and a platform from which clinicians can select the most appropriate treatment options. Managing Neuroendocrine Tumors For most cases of NETs of the gynecologic tract, a multimodality, individualized therapeutic approach is recommended. Treatments largely depend upon extent of the disease and the primary organ of involvement. NECs usually arise from the cervix, and a management algorithm has been created that separates NECs on the basis of early- or late-stage tumors. The algorithm presented in our paper stresses that surgical resection with radical hysterectomy and lymphadenectomy for early-stage NECs of the cervix is appropriate and should be followed by adjuvant chemotherapy with etoposide and cisplatin. Surgery may be required to identify a cervical cancer as an NEC cell type. For...