Tumor imaging and treatment monitoring in patients with neuroendocrine tumors

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Neuroendocrine tumors are a heterogeneous group of rare tumors which arise from cells of the (neuro)endocrine system. These cells are located throughout the body and are capable of secreting biologically active amines, peptides and hormones. They can be divided into cell types that form localized glands (for example the adrenal medulla and the paraganglia) and cells that are dispersed throughiout the entire body in other organs: the diffuse neuroendocrine system. Tumors originating from the chromaffin cells of the adrenal medulla are classified as pheochromocytoma, while tumors of the sympathetic and parasympathetic paraganglia are called paraganglioma. Neuroendocrine tumors that arise from the diffuse neuroendocrine system are mainly localized in the intestine, pancreas and lung, although they can originate in other organs as well. Intestinal neuroendocrine tumors are most commonly found in the small intestine, followed by the rectum and appendix. Neuroendocrine tumors that arise from the pancreas are called islet cell tumors. The World Health Organisation (WHO) categorizes neuroendocrine tumors based on histological features. The main categories defined by this classification system are well differentiated neuroendocrine tumors, welldifferentiated neuroendocrine tumors of uncertain behavior, welldifferentiated neuroendocrine carcinoma and poorly differentiated neuroendocrine carcinomas. In this thesis the term carcinoid tumor is used to describe the well-differentiated neuroendocrine tumor of the gastrointestinal tract.

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