Sheffield Teaching Hospitals
European Neuroendocrine Tumour
Centre of Excellence
Professor John Newell-Price
Dr Alia Munir
Consultant Endocrinologists
Agenda
• What are neuroendocrine tumours / cancers?
• What is special about imaging and
management?
• What is special about Sheffield?
Agenda
• What are neuroendocrine tumours / cancers?
• What is special about imaging and
management?
• What is special about Sheffield?
Neuroendocrine tumours / cancers
• Cancers
• Some benign tumors
• Often slow growing
• Symptoms due to
effects of tumour size
and production of
hormones
• Gut tumours – often
widespread disease at
presentation
Incidence
600
6.00
All malignant neoplasm
Plateau
5.25
5.00
500
4.00
400
3.00
300
2.00
1.09
200
100
1.00
Neuroendocrine tumors
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
0.00
Adapted from: Yao JC, et al. J Clin Oncol. 2008;26(18):3063-3072.
0
NETs Are the 2nd-Most Prevalent
Gastrointestinal Tumor:
NET Prevalence in the US, 2004
1,200
Median survival (1988 – 2004)
103,312
• Localized
cases
• Regional
(35/100,000)
• Distant
1,100
203 months
114 months
39 months
100
0
Colon
Neuroendocrine
Stomach
Pancreas
29-year limited duration prevalence analyses
based on SEER
Adapted from: Yao JC, et al. J Clin Oncol. 2008;26(18):3063-3072.
Esophagus
Hepatobiliary
NET: Demographics:
Lepage C, et al. Gut. 2004;53(4):549-553.
Pathways to diagnosis
Carcinoid Syndrome
Caused by hormone secreted from tumour
• Abdominal pain
• Flushing of face
• Diarrhoea – bowels open 10-20 times per day
Agenda
• What are neuroendocrine tumours / cancers?
• What is special about imaging and
management?
• What is special about Sheffield?
Imaging in NET
Arterial Phase
CT
T2 MRI
Portal venous phase CT
Somatostatin receptor scintigraphy
Indium- 111 DTPA D-Phe1 Octreotide
Advances in imaging
Octreoscan – available
In Sheffield
Gallium dotatate PET
Therapy of NETs
Three principles
Surgical
Symptomatic
Antiproliferative
therapy
therapy
therapy
• Control of hormonal
symptoms – use of
somatostatin
analogues –
monthly injection
• Control of tumor
growth
• Improvement in
survival
• Somatostatin
analogues
• Cure
• Debulking
• Treatment /
Prevention of
complications
Somatostatin analogue therapy
STR2
Somatostatin
analogue
Somatostatin
analogue
Modified Somatostatin
Switches off
hormone
secretion from
tumour cell
S
Monthly
depot
injections
Concept & design by M Schultz
Peptide Receptor Radionuclide Therapy (PRRT)
177Lu-DOTA,Tyr3]octreotate
STR2
Vector
(NOC)
Vector Linker
(NOC) (DOTA
)
LinkerLu 177
(DOTA
)
Modified Somatostatin
β
Concept & design by M Schultz
Lu 177
Agenda
• What are neuroendocrine tumours / cancers?
• What is special about imaging and
management?
• What is special about Sheffield?
UK NET Centres of Excellence
30 Centres in total
in Europe
Sheffield Teaching Hospitals European
Neuroendocrine Tumour Centre of Excellence
Referring Hospitals
Chesterfield
Mansfield
Lincoln
Sheffield NET Centre: Our Mission
• To provide the highest quality clinical care
• Right
– Care, time, place, team and every time
• To offer our patients individualised care based
on the best scientific evidence available
• Patient-centered, holistic approach
• NET MDT
• NET clinic specialists with MDT approach
• Both in MDT and clinic consultation
Sheffield Teaching Hospitals Databases
• Unique eNET DB
• ICE
–
–
–
–
Biochemistry
Radiology
Pathology
Openet
• PACS
• Sharepoint
• Lorenzo
Patient Flow
Endocrinology Investigations Unit
• Endocrine Investigations Unit
• Staff resource
– 3 Nurse specialists
– 1 Receptionist
• 4 networked computer stations
• 4 patients treatment areas
• Academic Unit of Endocrinology and Diabetes
Sheffield NET Centre
• 80+ new referrals per year – anticipated increase
of 20% over next 1-3 years
• Only centre with radionuclide therapy in Yorks
and Humber
• New therapy suite WPH
• 270 gastrointestinal NET patients on follow up
• 55 Patients with genetic mutations and high risk
of developing adrenal NETS
• 30+ patients with Multiple Endocrine Neoplasia
Sheffield NET Centre
National NET Cancer Day 10th
November 2015
Royal Hallamshire Hospital
Sheffield Teaching Hospitals NHS
Foundation Trust
Other Affiliations
UKINETS
– Executive Committee and Treasurer
– Database
– Guidelines 2012
North of England NETS (NONETS)
– Manchester, Liverpool, Sheffield, Newcastle, Leeds, Hull, Lancaster
– Pooling outcome data
– Agree common pathways
– Research
National Cancer Research Institute
– Clinical studies Group (part of Upper GI) (JW)
ENETS (European Neuroendocrine Tumour Society)
– Bid for recognition as a “Centre of Excellence
Patient Groups
NET Patient Foundation
AMEND (MEN)
Sheffield Teaching Hospitals
European Neuroendocrine
Tumour Centre of Excellence
Support/ physicians
Maintenance of NET COE
2016-2021
•
•
•
•
•
•
•
MDT Funding
Hub and spoke
Research
Gallium Scanner in Sheffield
Permanent Data manager
Permanent Endocrine Investigations Unit
Vascular intervention