Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2023) 96 P27 | DOI: 10.1530/endoabs.96.P27

UKINETS2023 Poster Presentations Section (27 abstracts)

Which cancer? Clinical decision making in a case of concurrent metastatic neuroendocrine tumour and breast cancer

ST Williams 1, 2, 3, AJ Hodgson 3, C Marshall 2, 3, A Munir 1, 3 & J Wadsley1,2,3

1Department of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom; 2Weston Park Cancer Centre, Sheffield, United Kingdom; 3Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Broomhill, Sheffield, United Kingdom

Background: Neuroendocrine tumours (NETs) are a heterogenous group of malignancies that frequently metastasise to other organs. Both breast cancer and NETs have a predilection for liver, lymphatic and bone metastases. We report the investigations and management of a patient with concurrent small bowel NET and breast cancer.

Case: 66 year-old female. Presented with 2 years of abdominal pain, diarrhea and flushing. Octreotide scintigraphy and biochemical investigations diagnosed metastatic small bowel NET with carcinoid syndrome. After 1 year somatostatin analogue therapy, surveillance imaging showed evidence of disease progression. Pre-Lutathera biopsy: Ki-67 1-2 %, Grade 1 NET. Underwent small bowel resection and anastomoses following obstruction. Surgical histology: Ki-67 4-5 %, Grade 2 NET. Three years following NET diagnosis, the patient-identified a breast lump. Triple assessment: Grade 1 invasive tubular carcinoma, ER 8/8, HER2 negative. Subsequently underwent wide local excision, sentinel lymph node biopsy and hormonal treatment. Subsequent NET surveillance imaging: Enlarging liver metastases while stable disease elsewhere. Biopsy of liver metastases: Ki-67 10 %, Grade 2 NET. Excludes metastatic breast cancer. MDT advised liver metastasectomy in view of oligoprogression.

Discussion points: (1) Treatment strategy was dependent upon correct metastases characterisation. (2) Successive biopsies showed increasingly aggressive NET features across 5 years. (3) Surgery can be an appropriate option, especially if one lesion is behaving more aggressively.

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