Endoscopy is a crucial tool in the diagnosis and management of gastrointestinal neuroendocrine tumours (NETs). It allows for direct visualisation and biopsy of tumours within the digestive tract, offering precise information that guides treatment decisions.
The ability to both detect and sample these tumours endoscopically has revolutionised the approach to diagnosing NETs, particularly those that are difficult to detect through non-invasive methods.
Neuroendocrine Cancer Australia (NECA), is dedicated to supporting individuals diagnosed with NETs, and their families. NECA offers a wealth of resources, educational programs, and advocacy efforts aimed at deepening the understanding of NETs, improving patient care, and encouraging research advancements. Patients diagnosed with NETs, can engage with NECA’s comprehensive support and information by calling the NET nurse line.
Endoscopy plays a pivotal role in identifying and diagnosing gastrointestinal NETs.
Given that these tumours often develop within the lining of the digestive tract, endoscopy can:
This direct approach is especially important for diagnosing early-stage NETs, which may not produce significant symptoms and could be missed by other diagnostic methods.
The main advantage of endoscopy in diagnosing NETs is the ability to visualise and biopsy tumours directly.
Unlike imaging techniques that provide indirect evidence of a tumour, endoscopy allows for real-time assessment and immediate tissue sampling.
This capability is essential for accurate diagnosis, as it provides histopathological confirmation of the tumour type and grade, which are critical for developing an effective treatment plan.
There are several different kinds of endoscopic procedures available to patients and health care teams. Each is used to assess a particular set of symptoms or area of the body.
Upper gastrointestinal endoscopy, involves inserting a flexible tube with a camera through the mouth to examine the oesophagus, stomach, and duodenum.
This procedure is commonly used to investigate:
During the procedure, suspicious lesions can be biopsied for histopathological examination, enabling accurate diagnosis and grading.
Colonoscopy is an endoscopic procedure that involves examining the interior of the large intestine (colon) and rectum using a flexible, lighted tube with a camera.
This procedure is essential for:
Endoscopic ultrasound (EUS) combines traditional endoscopy with ultrasound imaging, allowing for detailed visualisation of the layers of the gastrointestinal wall and nearby structures. This combination is particularly useful for identifying and characterising NETs that are not easily seen on standard endoscopy or imaging studies.
EUS is particularly valuable for:
When combined with fine-needle aspiration (FNA), it allows for precise biopsy of the tumour, aiding in accurate diagnosis. By using ultrasound to guide the needle, physicians can target specific areas of the tumour, obtaining high-quality samples for histopathological analysis.
Endoscopic retrograde cholangiopancreatography (ERCP) is a specialised endoscopic procedure used to evaluate and sample tumours in the bile ducts and pancreas.
Here’s how it works:
ERCP is not only used for diagnosis but also plays a significant role in the treatment of biliary and pancreatic NETs. Stents can be placed to relieve blockages caused by tumours, improving bile flow and reducing symptoms like jaundice.
This procedure is particularly valuable in palliative care, where the goal is to manage symptoms and improve the quality of life for patients with advanced disease.
Capsule endoscopy is a non-invasive procedure that involves swallowing a small, pill-sized camera that takes thousands of pictures as it travels through the digestive tract. This technique is particularly useful for visualising the small intestine, an area that is difficult to reach with traditional endoscopy.
Capsule endoscopy is valuable for detecting occult NETs, which may not be visible with other imaging or endoscopic techniques. This procedure is often used when there is a suspicion of small intestine NETs based on symptoms or blood tests, but standard endoscopy has failed to identify the tumour.
While endoscopic procedures are generally safe, there are some risks associated with endoscopic biopsy. These risks are typically low, but they can be more significant in patients with underlying health conditions or those taking blood-thinning medications.
Some risks can include:
One of the main challenges of endoscopic procedures is diagnosing small or submucosal tumours, which may not be easily visible or accessible. These tumours can be missed during standard endoscopy, particularly if they are located beneath the mucosal surface or in areas that are difficult to reach.
Endoscopy is most effective for detecting superficial tumours within the mucosal lining of the gastrointestinal tract. However, it has limitations in detecting non-superficial tumours that are located deeper within the tissue or in adjacent organs. In such cases, additional imaging or biopsy techniques may be required.
Endoscopy plays a critical role in staging and assessing the spread of gastrointestinal NETs. By providing detailed visualisation of the tumour and allowing for targeted biopsies, endoscopy helps determine the extent of the disease, which is crucial for developing an effective treatment plan.
The information obtained through endoscopy is essential for guiding both surgical and non-surgical treatment decisions.
Here’s how endoscopy can work:
Research is ongoing to improve endoscopic technology for diagnosing NETs. Modern advances include:
Emerging techniques in endoscopy, such as confocal laser endomicroscopy and molecular imaging, are being explored in clinical trials for their potential to improve NET diagnosis.
These innovations aim to enhance the accuracy of endoscopic procedures, making it easier to detect and characterise NETs at an earlier stage.
Further information and support for people diagnosed with NETs is available by calling the NECA NET nurse line.
