Neuroendocrine tumours

Our research


Patient-Reported Burden of a Neuroendocrine Tumor (NET) Diagnosis: Results From the First Global Survey of Patients With NETs.

  • Singh S, Granberg D, Wolin E, Warner R, Sissons M, Kolarova T, Goldstein G, Pavel M, Öberg K, Leyden J.
  • J Glob Oncol. 2016 Jun 8;3(1):43-53.
  • Summary: This global patient-reported survey demonstrates the considerable burden of NETs with regard to symptoms, work and daily life, and health care resource use, and highlights considerable unmet needs. Further intervention is required to improve the patient experience among those with NETs.

Neglected conditions: Neuroendocrine tumours.

  • Hallet J, Singh S, Law CH.
  • CMAJ. 2014 Apr 1;186(6):452.
  • Summary: Letter from members of the Susan Leslie Clinic for Neuroendocrine Tumours to the Canadian Medical Association Journal, outlining the importance of caring for NETs and improving research opportunities.

Multidisciplinary reference centers: the care of neuroendocrine tumors.

  • Singh S, Law C.
  • J Oncol Pract. 2010 Nov;6(6):e11-6
  • Summary: Discussion regarding the benefits of multidisciplinary clinics dedicated to NETs, including a report of the experience in implementing the Susan Leslie Clinic for Neuroendocrine Tumours.

Patient experiences of having a neuroendocrine tumour: a qualitative study.

  • Feinberg Y, Law C, Singh S, Wright FC.
  • Eur J Oncol Nurs. 2013 Oct;17(5):541-5.
  • Summary: Results of patient interviews aimed at understanding the patient experience of having a NET. Patients identified “no clear pathway” in the care for NETs. Four themes pertaining to this issue were identified: difficulty in obtaining a diagnosis, difficulty in finding appropriate information about NETs from physicians, difficulty finding treatment centres with knowledge of NETs, and difficulty finding disease specific support. Satisfaction with a specialized care centre and side-effects of treatments were the major factors modifying patients’ experiences. As a conclusion, a multidisciplinary specialized clinic for NETs is recommended.


The North American Neuroendocrine Tumor Society Consensus Guidelines for Surveillance and Medical Management of Midgut Neuroendocrine Tumors.

  • Strosberg JR, Halfdanarson TR, Bellizzi AM, Chan JA, Dillon JS, Heaney AP, Kunz PL, O'Dorisio TM, Salem R, Segelov E, Howe JR, Pommier RF, Brendtro K, Bashir MA, Singh S, Soulen MC, Tang L, Zacks JS, Yao JC, Bergsland EK.
  • Pancreas. 2017 Jul;46(6):707-714.
  • Summary: Updated North American guidelines for the medical management of midgut NETs, incorporating new knowledge from the CLARINET, RADIANT-2, RADIANT-4, NETTER-1 and TELESTAR trials.

Diagnosis and management of gastrointestinal neuroendocrine tumors: An evidence-based Canadian consensus.

  • Singh S, Asa SL, Dey C, Kennecke H, Laidley D, Law C, Asmis T, Chan D, Ezzat S, Goodwin R, Mete O, Pasieka J, Rivera J, Wong R, Segelov E, Rayson D.
  • Cancer Treat Rev. 2016;47:32-45
  • Summary: Updated Canadian recommendations for the diagnosis and care of gastrointestinal NETs.

Consensus Recommendations for the Diagnosis and Management of Pancreatic Neuroendocrine Tumors: Guidelines from a Canadian National Expert Group.

  • Singh S, Dey C, Kennecke H, Kocha W, Maroun J, Metrakos P, Mukhtar T, Pasieka J, Rayson D, Rowsell C, Sideris L, Wong R, Law C.
  • Ann Surg Oncol. 2015 Aug;22(8):2685-99.
  • Summary: Canadian recommendations for the diagnosis and care of pancreatic NETs.


Patterns and Drivers of Costs for Neuroendocrine Tumor Care: A Comparative Population-Based Analysis.

  • Hallet J, Law CHL, Cheung M, Mittmann N, Liu N, Fischer HD, Singh S
  • Ann Surg Oncol. 2017 [EPub ahead of print]
  • Summary: This study defined costs associated with care of NETs and compared them to costs of care for colon cancers. It reported that NETs represent a potential important health care burden. The costs patterns for NETs were unique and differed from those of colon cancer. Socio-economic status and primary NET site influenced the costs of care at different points in the treatment journey. This information can be used to inform resource allocation tailored to needs of NETs patients.

Escalated-dose somatostatin analogues for antiproliferative effect in GEPNETS: a systematic review.

  • Chan DL, Ferone D, Albertelli M, Pavlakis N, Segelov E,Singh S.
  • Endocrine. 2017. [Epub ahead of print]
  • Summary: This study reviewed the evidence supporting increasing the dose of somatostatin analogues in the treatment of gastro-entero-pancreatic NETs. It concluded that dose increase is well-tolerated. While it can achieve good tumor control, tumor response is more rare. It highlighted the need for prospective studies investigating the role of dose escalation of somatostatin analogs in the treatment of metastatic NETs.

Prognostic and predictive biomarkers in neuroendocrine tumours.

  • Chan DL, Clarke SJ, Diakos CI, Roach PJ, Bailey DL,Singh S, Pavlakis N.
  • Crit Rev Oncol Hematol. 2017 May;113:268-282
  • Summary: This study reviewed the current use of biomarkers, blood markers, and functional imaging in prognosis and therapy planning for NETs.

Principles of diagnosis and management of neuroendocrine tumours.

  • Raphael MJ, Chan DL, Law C, Singh S.
  • CMAJ. 2017 Mar 13;189(10):E398-E404
  • Summary: This study summarizes the diagnostic process and management for NETs.

Everolimus in the management of metastatic neuroendocrine tumours.

  • Chan DL, Segelov E,Singh S.
  • Therap Adv Gastroenterol. 2017 Jan;10(1):132-141.
  • Summary: This study reviews progresses and evidence supporting the use of everolimus in the treatment of NETs, and highlights directions for future research to improve care.

Everolimus in Neuroendocrine Tumors of the Gastrointestinal Tract and Unknown Primary.

  • Singh S, Carnaghi C, Buzzoni R, Pommier RF, Raderer M, Tomasek J, Lahner H, Valle JW, Voi M, Bubuteishvili-Pacaud L, Lincy J, Wolin E, Okita N, Libutti SK, Oh DY, Kulke M, Strosberg J, Yao JC, Pavel ME, Fazio N; RAD001 in Advanced Neuroendocrine Tumors, Fourth Trial (RADIANT-4) Study Group.
  • Neuroendocrinology. 2017 [Epub ahead of print]

Rural-urban disparities in incidence and outcomes of neuroendocrine tumors: A population-based analysis of 6271 cases.

  • Hallet J, Law CH, Karanicolas PJ, Saskin R, Liu N, Singh S.
  • Cancer. 2015 Jul 1;121(13):2214-21.
  • Summary: This study looked at all patients with NETs in the province of Ontario to assess whether or not living a rural area impacted outcomes of NETs. Of 6,271 patients diagnosed with NETs from 1994 to 2011, 13.5% resided in rural areas (population < 10,000 and outside the commuting zone of a metropolitan area). NETs were more commonly diagnosed in rural areas (3.01 NETs per 100,000 people per year) than in urban areas (2.82 per 100,000 people per year). Patients living in rural areas had worse cancer recurrence and survival. This indicated the need to focus on access to care for all patients with NETs to improve outcomes.

Exploring the rising incidence of neuroendocrine tumors: a population-based analysis of epidemiology, metastatic presentation, and outcomes.

  • Hallet J, Law CH, Cukier M, Saskin R, Liu N, Singh S.
  • Cancer. 2015 Feb 15;121(4):589-9
  • Summary: This study looked at all patients with NETs in the province of Ontario from 1994 to 2009. The incidence of NETs increased over the study period, from 2.48 to 5.86 per 100,000 people per year, while the proportion of metastases at the time of diagnosis decreased from 29% to 13%. This is the first study indicating that the increase in incidence of NETs may be related to increased detection. It also revealed that socio-economic status and rural living impacted survival, in addition to tumor characteristics.

Hepatic parenchymal preserving technique in the management of diffuse bilateral neuroendocrine tumour liver metastases: a feasible approach.

  • Nadler A, Cukier M, Milot L, Singh S, Law CH.
  • Can J Surg. 2014 Apr;57(2):E2-8.
  • Summary: This study described the early results of the hepatic parenchymal preserving resection technique used at Sunnybrook Health Sciences Centre for surgery of NETs liver metastases. This technique aims at resecting the smallest amount of liver parenchyma to maintain the liver function and allow for additional liver directed therapies in the future, if needed. The study included patients operated for diffuse NET liver metastases involving both lobed of the liver. Symptomatic and hormonal (reduction in 5HIAA levels) response was observed for over a year in 75% of patients. Radiology assessments showed that the liver parenchyma was effectively preserved in all cases.

Ki-67 is a reliable pathological grading marker for neuroendocrine tumors.

  • Nadler A, Cukier M, Rowsell C, Kamali S, Feinberg Y, Singh S, Law CH.
  • Virchows Arch. 2013 May;462(5):501-5
  • Summary: This study assessed the reliability of Ki-67 index measurement for NETs between institutions. It showed that Ki-67 results were highly reproducible, and that therefore Ki-67 is a reliable tool in assessing patients with NETs.

Chromogranin A: a sensitive biomarker for the detection and post-treatment monitoring of gastroenteropancreatic neuroendocrine tumors.

  • Singh S, Law C.
  • Expert Rev Gastroenterol Hepatol. 2012 Jun;6(3):313-34.
  • Summary: This study reviewed the use of chromogranin A as a tumor marker for gastrointestinal and pancreatic NETs.

Radionuclide therapy in neuroendocrine tumours: a systematic review.

  • Gulenchyn KY, Yao X, Asa SL, Singh S, Law C.
  • Clin Oncol (R Coll Radiol). 2012 May;24(4):294-308.
  • Summary: This study reviewed the use of peptide receptor radionuclide therapy (PRRT) for advanced NETs, as of the date of publication in 2012.