We diagnose and treat a range of NETs which are classified according to where the cancer started in the body
- Small bowel
- Large bowel
We also treat these rare types of NETs found elsewhere in the body:
- Bile ducts
- Skin (known as Merkel cell cancer)
- Phaeochromocytoma (arising in the adrenal gland)
- Paragangliomas (arising outside the adrenal gland)
We also treat these NETs (more commonly located in the small bowel, large bowel or appendix), which can overproduce a hormone-like substance called serotonin to cause a collection of symptoms called the carcinoid syndrome.
Other NETs that can cause symptoms
Neuroendocrine tumours (NETs) arise from cells of the endocrine (hormonal) and nervous systems. They most commonly occur in the intestine, where they are often called carcinoid tumours, but they are also found in the pancreas, lung and the rest of the body. Neuroendocrine tumours are classified according to where the cancer started (where the primary tumour is) in the body. For example:
- Small bowel NETs
- Large bowel NETs
- Appendiceal NETs
- Pancreatic NETs
- Gastric NETs
- Lung NETs
- Pituitary NETs
Rarely, NETs are found in other locations in the body such as the liver, gallbladder, bile ducts, kidneys, ovaries or testes or in the skin and is called Merkel cell cancer.
A number of NETs can cause symptoms due to overproduction of hormones. Some NETs, more commonly located in the small bowel, large bowel or appendix, may overproduce a hormone-like substance called serotonin and cause a characteristic collection of symptoms called the carcinoid syndrome. Other NETs that can cause symptoms are insulinomas, gastrinomas, glucagonomas, VIPomas and somatostatinomas.
Phaeochromocytoma (arising in the adrenal gland) and paragangliomas (arising outside the adrenal gland) are rare types of NETs that arise from the same tissue and treatment for these types of NETs is also available at The Christie NHS Foundation Trust.
Please click the areas below for further information:
The large bowel is also called the large intestine or colon and is the last part of the digestive system. It absorbs water and the remaining waste material is stored as faeces before being removed. This is a rare NET and not normally associated with ‘carcinoid syndrome’.
Symptoms are associated with tumour size: abdominal pain, weight loss and bleeding from the rectum. These are often aggressive types of NET and have a high risk of metastasising.
There are two ovaries as part of the female reproductive system. This type of NET is quite rare ( about 30 cases per year) and are found in the ovary. They tend to be faster growing NETs with only about 30% being less aggressive.
The appendix sits in the lower right abdomen and is a tube-shaped sac attached to and opening into the lower end of the large bowel. Appendiceal NETs are usually discovered incidentally and if small curative surgery is often performed.
Goblet cell carcinoid is a more aggressive form of appendiceal NET type called goblet cell carcinoma. These arise from the appendix but have a different shape under the microscope and can metastasise.
The stomach is a muscular organ located on the left side of the upper abdomen and receives food from the oesophagus. The stomach secretes acid and enzymes (proteins) that digest food.
There are 3 types of neuroendocrine tumours found in the stomach:
- Type 1 – these are associated with high gastrin levels, pernicious anaemia and vitamin B deficiency and are small, often multiple tumours and are the least aggressive type of gastric NET
- Type 2 – these are associated with high levels of gastric acid and also tend to have an associated syndrome (group of symptoms) called Zollinger-Ellison syndrome. They tend to be larger tumours and can metastasise
- Type 3 – These are the largest of gastric NETs and are of high risk to metastasise. They may not be related to high gastrin levels or high levels of gastric acid and are the most aggressive type of gastric
The liver is the largest solid organ in the body and is located under the ribs on the right side of the body. It can absorb nutrients and detoxify and remove harmful substances from the blood.
The rectum is the last section of the large intestine which finishes at the anus. These tumours are often found incidentally as patients may have minor symptoms. If symptoms are present they may be bleeding from the rectum or change in bowel habit. They account for around 16% of all neuroendocrine tumours.
The pancreas is a large gland that lies behind the stomach and secretes digestive enzymes (proteins) into the duodenum and can also produce hormones such as insulin and glucagon.
These NETs can be split into 2 types; functioning and non-functioning. The functioning ones will have a related syndrome and include:
The non-functioning pancreatic NETs will not have an associated syndrome and the patient may present with symptoms such as jaundice, weight loss, back pain or abdominal pain. Around 20-40% of these patients will be diagnosed with a genetically inherited condition called MEN1.
The lungs are a pair of organs situated within the ribcage which allow your body to take in oxygen from the air.
Neuroendocrine tumours of the lung can be split into 5 different types. A small proportion of patients may have an associated ‘carcinoid syndrome’:
- DIPNECH – Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia tends to be low grade process and patients can present with a persistent cough and shortness of breath.
- Typical Lung NET – these tend to have a slower rate of growth and are the most common lung NET.
- Atypical Lung NET – these can be faster growing NETs and tend to metastasise.
- Small cell Neuroendocrine Carcinoma – this is a rare presentation for a lung NET and is similar to small cell lung cancer.
- Large Cell neuroendocrine carcinoma – this would be the most aggressive form of lung NET. Download PDF
The small bowel is the part of the digestive system that extends from the stomach to the large bowel. It is divided into three main parts; the duodenum, jejunum and ileum.
These are the most common bowel NETs. Around 30% have an associated ‘carcinoid syndrome’.
Symptoms are rarely noticeable in the early stages of the disease and therefore the tumour may have already spread at the time of diagnosis.
These are rare NETs of another part of the small bowel. This is the first part of the bowel after the stomach.
75% of NETs found in the duodenum are associated with high gastrin levels and a collection of symptoms known as ‘Zollinger Ellison Syndrome’. Symptoms may include pain, ulcers that do not heal, diarrhoea, vomiting and anaemia.