High Grade Neuroendocrine tumors (Neuroendocrine carcinoma, NECs) are by far the most challenging and deadly kind of neuroendocrine cancers. We (physicians) really struggle with this type of cancer. They can arise from many places in the body, including: the lungs, colon, cervix, pancreas, rectum, and other places).
Now, understand, not all high grades are the same. In general, the grade is decided based on the pathology report (where the pathologist looks at your tumor under the microscope). They decide that based on how fast the cells are replicating (based on mitotic index or Ki67). If the mitotic index is greater than 10 mitoses per high power field or the Ki67 is > 20%, then it is classified as high grade. However, those cut offs are a little arbitrary and even within high grade there is more shades of gray.
Usually, we treat high grades with aggressive chemotherapy. But we’ve seen some good effects with PRRT and oral medicines. Surgery is NOT common unless it is used to serve a specific purpose (helping with symptoms, obstruction, or bleeding).
There aren’t a whole lot of treatments for NECs. However, I’m one fan of genetic sequencing and hopefully this new immunotherapy might be something to help.
Eric Liu, M.D.
NET Specialist and Surgeon
Chief Medical Advisor HNF