Follow-up investigations for Neuroendocrine Cancers, should include clinical symptom monitoring, biochemical parameters (bloods/urine), conventional scans (e.g. CT +/- MRI scan) and SSTR imaging (e.g. Octreotide, Tektroyd, MIBG and/or Gallium 68).
In patients with R0/R1 resected disease, the interval of assessment is dependent on grade – from 2-3mthly for G3 NEC to 6-12mthly for low Ki67 G1 or G2 NET.
Similar re-staging/assessment intervals apply to advanced and/or inoperable disease.
Follow-up should be life long, although the assessment intervals can be extended to 1–2 years with increasing length of follow-up (>5 years), except in G3 NEN, where shorter intervals should be kept. This is because, late recurrences even after 10–20 years have been described, although rare.
In contrast, small localised NET G1 (<1 cm in size) with origin in the appendix or rectum do not need any follow-up if they have been completely (R0) resected and do not have adverse histological features.
Follow up should be expert informed & evidence /research based but also tailored to you and what is appropriate for your best care.
Pavel et al (2020) Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology SPECIAL ARTICLE: 31: 7: 844-860.
See tumour site for site specific expert guideline recommendations.