TREATMENT OPTIONS AND FOLLOW UP
Over the past decades many treatment options for NETs have emerged. They should be used with a careful weighing of benefit and risk and applied to the appropriate variant of disease. Despite the fact that NETs are frequently diagnosed with metastatic disease and Stage IV, their slower rate of growth can still result in long survival times. Therefore, a scan showing widespread disease is not immediate cause for alarm; even widely metastatic disease can often be considered chronic disease. Clinical trials should not be overlooked as on option for any NET patient. In general, therapy can be divided into systemic and local treatments.
Despite its reputation as an indolent disease, NETs can be highly malignant and nearly all disease recurs. In some settings of local disease and complete resection, the patient may be cured; however, the more frequent situation is a disease-free period with subsequent distant recurrence. Therefore, close follow-up is imperative for early detection. There is no fixed protocol for followup in surveillance or restaging; it is done with a combination of biomarkers, cross-sectional scanning, and functional imaging. Depending on the tempo of disease, the evaluations can vary from every 3–24 months.