Exploring the Relationship between Obesity, Metabolic Syndrome and Neuroendocrine Neoplasms

Abstract

Obesity is a major burden for modern medicine, with many links to negative health outcomes, including the increased incidence of certain cancer types. Interestingly, some studies have supported the concept of an “Obesity Paradox”, where some cancer patients living with obesity have been shown to have a better prognosis than non-obese patients. Neuroendocrine neoplasms (NENs) are malignancies originating from neuroendocrine cells, in some cases retaining important functional properties with consequences for metabolism and nutritional status. In this review, we summarize the existing evidence demonstrating that obesity is both a risk factor for developing NENs as well as a good prognostic factor. We further identify the limitations of existing studies and further avenues of research that will be necessary to optimize the metabolic and nutritional status of patients living with NENs to ensure improved outcomes.

Management & surveillance of rectal neuroendocrine tumours: a single‐centre retrospective analysis

“…Most lesions are small (< 10 mm) and can be managed with endoscopic resection rather than requiring surgery. 1,2,4 The highest incidence is reported in people of Asian ethnicity, up to ten-times that reported in the Caucasian population. 5 rNETs should be separated from other gastrointestinal neuroendocrine tumours (colonic, pancreatic, small bowel, and appendiceal) in terms of behaviour, natural history and appropriate management.…”

“…Standard polypectomy without lifting may be insufficient due to the subepithelial origin of these lesions, there is evidence for advanced endoscopic techniques including endoscopic submucosal dissection (ESD) and cap-assisted mucosal resection. 1,2,4,[8][9][10][11][12][13][14][15][16] Post endoscopic excision of rNETs, ENETS underscores the importance of distinguishing lesions based on their pathological status; be it R0, indeterminate, or R1 (any margin, even a free margin <1 mm is defined as R0). They advise that every attempt should be made to render indeterminate or R1 resected lesions R0 to reduce recurrence risk and allow for follow-up based on the R0 resection category (i.e., no follow-up for lesions <10 mm without risk factors).…”

“…rNETs are commonly diagnosed between 50 and 60 years of age, often incidentally at screening colonoscopy. Most lesions are small (< 10 mm) and can be managed with endoscopic resection rather than requiring surgery 1,2,4 . The highest incidence is reported in people of Asian ethnicity, up to ten‐times that reported in the Caucasian population 5 …”

“…Lesion recognition and appropriate resection technique is required for successful excision. Standard polypectomy without lifting may be insufficient due to the subepithelial origin of these lesions, there is evidence for advanced endoscopic techniques including endoscopic submucosal dissection (ESD) and cap‐assisted mucosal resection 1,2,4,8–16 …”