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Genetics and Neuroendocrine Tumors


In my article ‘Ever wonder what caused your NET’, I concluded that currently, the only known scientifically explained causes for NETs were heredity/genetic in nature.  This is mostly associated with those who have MEN syndromes (yes, they are a syndrome not a type of tumour) and a few other less common types of NET including Pheochomocytoma/Paraganglioma (Pheo/Para) and Medullary Thyroid Carcinoma (MTC) (the familial version of MTC is often referred to as FMTC). However, please note this does not mean that all those diagnosed with Pheo/Para and MTC will have any heredity or genetic conditions, many will simply be sporadic tumors.

In recent years, it has become increasingly apparent that a number of Neuroendocrine tumours arise as a result of germline genetic mutations and are inherited in an autosomal dominant pattern. The number of genes implicated is increasing.

Apparently, 5-10% of Gastroenteropancreatic NETs (GEP NETs) are estimated to have a hereditary background. Syndromes associated with these include Multiple Endocrine Neoplasia (MEN), Von Hippel Lindau (VHL), Neurofibromatosis Type 1 (NF1) and Tuberous Sclerosis (TS), each of which are briefly outlined in the above reference. People who have a genetic condition may present with the tumors (perhaps along with an associated hormonal syndrome) and so the genetic condition if there is one, may not be known at this point.  Thus why I was interested in a paper published in Springer Link last week:

Crossref DOI link: https://doi.org/10.1007/s11154-017-9430-3

In this review, the authors examined the features which may lead a clinician to suspect that a patient may have an inherited cause of a NET and they outlined which underlying conditions should be suspected. They also discussed what type of screening may be appropriate in a variety of situations. If there is a way to identify which patients are likely to have a germline mutation, this would enable clinicians to counsel patients adequately about their future disease risk, and allows for earlier detection of at-risk patients through family screening. There’s a couple of minor errors in the text but I’ve contacted the authors.

The authors focused on presentations of NETs of the gastrointestinal system, chromaffin cell tumours (Pheochromocytoma and Paraganglioma) and Medullary Thyroid Carcinoma. Pituitary tumors (normally associated with MEN1), were not considered in scope for the review.  Interesting, the review includes news of a move by endocrinologists to reclassify ‘Pituitary Adenomas’ as Pituitary NETs (PitNETs). Read the abstract here.  This would appear to be in line with a gradual shift from the benign nomenclature associated with certain NETs to the ‘malignant’ potential of these type of tumors.  The abbreviation is also in line with others, e.g. pNET, SiNET, etc.  A useful reminder that we must stop using the term ‘Carcinoid‘ as this is regressing this extremely useful initiative to highlight the malignant potential of all NETs.

There also appears to be some linkage to the study looking at the possibility of familial Small Intestine NETs (SiNETs).  You can read more about a US registered trial here (with apologies for use of the now defunct term ‘Carcinoid‘).

Crossref DOI link: https://doi.org/10.1007/s11154-017-9430-3

This is a complex subject and the text above is very basic. If you wish to dig further, the quoted reference is a good read.  Just to emphasise, it’s aim is to provide advice about when to recommend genetic testing for NETs, and in doing so provides some useful reference information.  It’s broken down into 4 distinct tumor groupings:

1.  Gastroenteropancreatic (GEP NETs)

2.  Bronchial/Thymic NETs

3.  Pheochromocytoma/Paraganglioma

4.  Medullary Thyroid Carcinoma

You may also find this article from the National Cancer Institute very useful.  It has a wider scope but a different aim. Genetics of Endocrine and Neuroendocrine Neoplasias (PDQ®)–Health Professional Version”

I also noted the UKINETS Guidelines for NETs has a section on genetics and includes something called Carney Complex.

Thanks for reading

Ronny

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5 Comments

  1. I’m so interested in this topic. Until this year, every doctor said it was a mutation, but now, signs are pointing to genetics and I have a family member who’s passing is very suspect. Looking forward to more research on this. Thanks for starting the conversation.

    Liked by 1 person

  2. Deanna Vickery, Mrs says:

    Very interesting post Ronny, thankyou.

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    Liked by 1 person

  3. I would like to add the SDHx mutations (SDHA, SDHB, SDHC, and SDHD) that can present as paras/pheos/gists/RCC. My father died of paras. His sister died of paras. I have only had Gist tumors (and lots of them). The reason it is important to know if you have a mutation is because your children could inherit your disease or another disease associated with the germline mutation. I put up my own website because SDHB Deficient Gists are such a small subset but we all have a extended family history of cancer and are often miss diagnosised by our GP and surgeons (benign) when it is most likely NOT benign. http://www.SDHcancer.org

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