Peter Hyrdel, Ivan Režňák, Mária Hladká, Rudolf Hyrdel
Despite their diversity and variety of their clinical presentations Neuroendocrine Tumours of Gastro-Entero-Pancreatic Tract (GEP NET) are fascinating not only for clinicians but also for many physicians and clinical investigators. Their various clinical presentations depend on tumour functionality. That is on their ability to reproduce and to release biologically active substances. For the sake of their multiform clinical manifestation patients are often monitored by professionals from various clinical disciplines and they can have determined a lot of incorrect diagnoses just on the basis of rich symptomatology. Therefore time to a correct diagnosis lasts 5-7 years on average. GEP NETs can occur also hereditary, but most of tumours occur sporadically. Within last 30 years NET incidence has increased five times. The most useful diagnostic marker is Chromogranin A, because it is a universal marker almost for all GEP NETs. Determination of hydroxyl-indol acetic acid (5-HIAA/5-HIOK) and neuronspecific enolase is also useful. As the most sensitive and specific imaging method for pancreas and stomach NETs we consider endoscopic ultrasound: of a significant importance is also Somatostatin receptor scintigraphy, but also CT, MRI, PET/CT and stimulation arterial tests. Most GEP-NETs are relatively indolent in growth but ultimately with a significant malignant potential. Only complete surgical tumour resection can be considered as curative. In advanced stages of highly differentiated NE carcinomas with metastases the method of choice is bio-therapy with Somatostatin analogues. It is highly effective but its main advantage is that it is well tolerated in general. Regional radiotherapies and systemic chemo-radiotherapies are reserved for badly differentiated NETs in advanced stages. Recently, new kinds of therapies are available for patients. It is so-called targeted (to SSP receptors) radiotherapy. This overview is focused on clinical symptoms, diagnostics, localization and management of GEP NETs. Its aim is to point out to symptoms and laboratory investigations which will ease and accelerate right diagnosis stating.