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STANDARDIZED CARCINOID-ISLET CELL (NETS) PATIENT PROTOCOL FOR PRE-OPERATIVE, INTRA-OPERATIVE AND POST- OPERATIVE CARE
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Patients with Carcinoid/ Syndrome
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Patients with islet cell tumors
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PRE-OPERATIVE
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PRE-OPERATIVE
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- Serum Chromogranin A, Neurokinin A, pancreastatin, Substance- P, Octreotide levels (Sandostatin), Serotonin (prefer ISI 1-800-255-2873 or Quest)
- 5-HIAA 24 hr urine (keep on ice)-done locally.
- OCTREOSCAN 4hr planar images, 24 planar and SPECT images and later delayed films if possible fusion images are optimal.
- CT of Chest, Abdomen & Pelvis with oral and IV contrast (unless allergic) as baseline
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- OCTREOSCAN 4hr planar images, 24 planar and spect images and later delayed films if necessary
- CT of Chest, Abdomen & Pelvis as baseline
- Prefer ISI (1-800-255-2873) or Quest for the following peptide screening assays.
- Chromogranin- A
Gastrin
Glucagon
Insulin
C-peptide
VIP
Neurotensin
Ghrelin
Somatostatin (SRIF-14)
Motilin
PTH (Parathyroid hormone)
Growth Hormone
Insulin-like Growth Factor 1
Octreotide levels (Sandostatin) if patient is on this drug
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INTRA-OPERATIVE - PATHOLOGY
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INTRA-OPERATIVE - PATHOLOGY
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From tissues get slides stained for Chromogranin A, ki-67 and Factor VIII
Specifically we need to know:
The percent of tumor cells that are positive for CGA and ki-67.
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From tissues get slides stained for Chromogranin A, ki-67
Specifically we need to know
The percent of tumor cells that are positive for CGA and ki-67.
Neuron specific enolase, specific peptides (as identified by above assays) and synaptophysin staining should also be done.
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POST OP FOLLOW UP
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POST OP FOLLOW UP
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FIRST TWO YEARS
1. EVERY 3 MONTHS:
A. Serum CHROMOGRANIN A, pancreastatin (prefer Quest ot ISI). Others based on values that were elevated preoperatively on screening
B. 5-HIAA 24 hr urine (keep on ice)
2. EVERY 6 MONTHS
A. OCTREOSCAN 4 hr planar images, 24 planar and spect images and later delayed films if necessary
B. CT of Chest, Abdomen & Pelvis as baseline
C. Octreotide levels (Sandostatin levels)
STARTING YEAR 3
1. EVERY 6 MONTHS
A. Serum Chromogranin-A (prefer Quest or ISI)
B. 5-HIAA 24 hr urine (keep on ice)
C. Select lab tests for only high range peptides from initial peptide profile
2. EVERY YEAR, 6 months from CT scan
A. OCTREOSCAN 4 hr planar images, 24 planar and spect images and later delayed films if necessary
3. EVERY YEAR- 6 months from Octreoscan
CT of specific areas of tumors unless new symptoms or new lesions suspected
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FIRST TWO YEARS
1. EVERY 3 MONTHS
A. Labs for high range peptides identified in the initial ISLET CELL SCREENING ASSAYS
B. Octreotide levels (Sandostatin) if patient is on this drug
C. Chromogranin-A
2. EVERY 6 MONTHS
A. OCTREOSCAN 4 hr planar images, 24 planar and spect images and later delayed films if necessary
B. CT of Chest, Abdomen & Pelvis as baseline
C. Chromogranin-A
STARTING YEAR 3
1. EVERY 6 MONTHS
A. Labs for high range peptides from the ISLET CELL SCREENING ASSAYS
B. Octreotide levels if on drug
C. Chromogranin-A
2. EVERY YEAR-6 months from CT scans
A. OCTREOSCAN 4 hr planar images, 24 planar and spect images and later delayed films if necessary
3. EVERY YEAR-6 months from Octreoscan
A. CT of specific areas of tumors unless new symptoms or new lesions suspected
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