Episode 27: What to Know About Neuroendocrine Tumor Liver Metastases

What do you call NETs in the liver? How often do NETs spread? What causes NETs to spread? How do you determine if surgery is an option? Dr. Xavier Keutgen from University of Chicago brings clarity to NET tumors found in the liver and describes how surgery fits in with other treatments for metastatic NETs.

ABOUT DR. XAVIER KEUTGEN

Xavier M. Keutgen MD is a board-certified, double-fellowship trained surgeon who specializes in the treatment of gastro-entero-pancreatic neuroendocrine tumors and neoplasms of the thyroid-, parathyroid- and adrenal glands. A native from Belgium, Dr. Keutgen graduated magna cum laude from the University of Heidelberg Medical School in Germany and completed a general surgery residency and surgical oncology research fellowship at New York Presbyterian Hospital-Weill Cornell Medical Center.  He then completed a hepato-pancreato-biliary fellowship at the University Hospital of Zurich in Switzerland as well as an endocrine oncology and surgery fellowship at the National Cancer Institute, National Institutes of Health (NIH) in Bethesda, Maryland. Dr. Keutgen currently serves as the director of the Neuroendocrine Tumor Program, director of the Endocrine Research Program and co-director of the Von Hippel-Lindau Clinical Care Program at the University of Chicago Medicine.

Throughout his career Dr. Keutgen has developed a particular interest in clinical, translational and basic science research. His laboratory specializes in investigating the role of radiation therapy and DNA damage repair in pancreatic, lung and small bowel neuroendocrine tumors, discovering new actionable molecular targets for neuroendocrine tumors, and elucidating new mechanisms of drug delivery for endocrine malignancies.

TOP TEN QUESTIONS 

1. What is liver NETs? How often do NETs spread? Is it expected that NETs will eventually spread?
2. If the primary tumor was already removed, do you now call this liver NET or do you still refer to it by the primary site of origin – and why? How is this different from liver cancer?
3. What causes NETs to spread? Is there anything that is done to cause NET tumors to spread? Is there anything that can be done to keep them from spreading?
4. How do you determine if surgery is an option? What is involved in evaluating metastases? What scans or labs are needed?
5. How do you decide what the “tumor burden” is?
6. How do you weigh the grade or ki67?  How do you weigh tumor size? Is there a cut-off for tumor size or the number of tumors that is too much to operate?
7. How does one decide between surgery versus other options? How often can surgery or other treatments be done? How safe is liver surgery?
8. How do you approach surgery for someone with liver tumors who also has tumors in the tail versus the head of the pancreas?
9. When someone has had a Whipple surgery and later is found to have tumors in the liver, what are the options?
10. What advances in the field are you most excited about? 

For more information, visit LACNETS.org.