The Impact of Neuroendocrine Tumor Heterogeneity During Disease Progression

Clinical Pearls

David S. Klimstra, MD, chair, Department of Pathology, Memorial Sloan Kettering Cancer Center, discusses the impact of tumor heterogeneity during disease progression. This was the topic of a talk given by Oliver G. McDonald, MD, PhD, from Vanderbilt University Medical Center, at the 2014 NANETS Symposium.

• There is tumor heterogeneity in NET biology between the primary and metastases and/or between sites of metastases. The genetics of this heterogeneity is not yet understood.
• There is clonal evolution in the development of metastases.
• The epigenetic evolution of a tumor is site-specific. This is slightly discouraging, because shutting off the driving gene could be much more difficult if the driving pathway has been modified in metastatic sites.