245b neuroendocrine tumors Flashcards Preview

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Flashcards in 245b neuroendocrine tumors Deck (11):
1

neuroendocrine tumors - source? secrete anything? receptors? stain?

enterochromaffin cells

have granules that can secrete hormones and amines

functional (give syndrome) and non-functional

somatostatin receptors + other markers

chromogranin A (CgA) - monitor for treatment response

2

pancreatic neuroendocrine tumors - what peptides can be produced?

glucagon, insulin, somatostatin, pancreatic polypeptide, serotonin + ecotpopic hormones

50% don't product anything

3

carcinoid syndrome (first aid)

Rare syndrome caused by carcinoid tumors (neuroendocrine cells), especially metastatic small bowel tumors, which secrete high levels of serotonin (5-HT).

Not seen if tumor is limited to GI tract (5-HT undergoes first-pass metabolism in liver). Results in recurrent diarrhea, cutaneous flushing, asthmatic wheezing, and right-sided valvular disease.

increased 5-hydroxyindoleacetic acid (5-HIAA) in urine, niacin deficiency (pellagra).

Treatment: resection, somatostatin analog (octreotide)

rule of 1/ 3rds
1/3 metasize
1/3 present with 2nd malignnacy
1/3 are multiple

most common malignancy in small intestine

4

when do most NET become symptomatic?

metastasis

5

Zollinger-Ellison syndrome (first aid)

Gastrin-secreting tumor of pancreas or duodenum. Acid hypersecretion causes recurrent ulcers in distal duodenum and jejunum.

Presents with abdominal pain (peptic ulcer disease, distal ulcers), diarrhea (malabsorption). May be associated with MEN 1.

6

Insulinoma (first aid)

Tumor of " cells of pancreas --> overproduction of insulin --> hypoglycemia.

Whipple triad of episodic CNS symptoms: lethargy, syncope, and diplopia.

Symptomatic patients have decreased blood glucose and increased C-peptide levels (vs. exogenous insulin use).

Treatment: surgical resection.

7

imaging studies with NETs

somatostatin-receptor --> octreoscan

8

somatostatin - function? drug use? drug?

bioactive neuropeptide --> inhibitors effects throughout body including GI tract --> blocks gastric acid, amylase; anti-inhibitory

ocretoride prolongs life

drug is octreotide (longer half life)

9

somatostatin receptors - type of receptors? functions?

5 subtypes

GPCR

antisecretory, antiproliferative, apoptotic effects

10

mTOR - role? drug? cancer rx?

central role in proliferation pathways in cancers to include cell growth, angiogenesis, protein synthesis

downstream of signaling that is deregulated in cancer so good target

drug: everolimus --I mTOR

good for insulinoma and NETs

11

VEGF function? drug?

angiogenesis - NETs express VEGF for vessel growth

Bevacizumab --I VEGF