Neuroendocrine neoplasms are a diverse group of tumors arising from neuroendocrine cells. The treatment pathway depends on whether the disease is a well-differentiated neuroendocrine tumor (NET) or a more aggressive neuroendocrine carcinoma (NEC), the primary site, grade and Ki-67 index, hormone activity, disease extent, receptor expression, previous treatment and the patient's overall condition. NCT Heidelberg describes specialist NET care as a multidisciplinary pathway involving medical oncology, endocrinology, gastroenterology, surgery, nuclear medicine, pathology, radiology and radiation oncology.
NET and NEC are not the same disease pathway
NCT Heidelberg distinguishes well-differentiated NETs from neuroendocrine carcinomas because their biology, growth rate and treatment can differ substantially. International referrals should include the original pathology, tumor grade and Ki-67 index rather than using 'neuroendocrine cancer' as the only diagnosis.
Treatment selection is multidisciplinary
Heidelberg states that existing records are reviewed, additional tests are arranged when needed and cases are discussed in a specialist tumor board. Depending on the case, the team can involve surgery, diagnostic and interventional radiology, endocrinology, medical oncology, nuclear medicine, pathology and radiation oncology.
The treatment toolbox depends on tumor biology
For selected well-differentiated NETs, German specialist centers describe surgery, somatostatin analogues, targeted medicines, chemotherapy, liver-directed treatment and peptide receptor radionuclide therapy among possible approaches. NECs are biologically more aggressive and more often require systemic chemotherapy. These options are not interchangeable and should be sequenced according to the exact diagnosis and disease course.
Somatostatin-receptor imaging can change the pathway
For suitable NETs, Ga-68 DOTATATE or DOTATOC PET/CT can show somatostatin-receptor expression. Heidelberg and Ulm link receptor imaging with theranostic decision-making, including assessment for PRRT when the disease is receptor-positive and the wider clinical criteria are met.
Records to send before travelling
A specialist NET review is much more useful when the receiving center can reconstruct the complete disease course.
- Pathology report with differentiation, grade and Ki-67
- Primary tumor site and staging summary
- Operative and histology reports
- Recent CT and MRI images in DICOM format
- Somatostatin-receptor PET/CT and report when available
- Previous systemic treatment and response
- Hormonal symptoms and relevant laboratory markers
- Current blood counts and kidney/liver function
- A clear question about surgery, systemic therapy, PRRT or second opinion
Plan the next step before booking travel
Ask whether the German center first needs remote record review, pathology re-review, additional imaging or a multidisciplinary consultation. For a rare tumor, the useful destination is the team that can answer the specific clinical question, not simply the most famous hospital or city.
Sources and review
This guide was last source-reviewed on 2026-08-30.
- Neuroendocrine tumors – diagnosis and treatment options — National Center for Tumor Diseases Heidelberg (NCT) ↗
- Treatment at NCT – multidisciplinary neuroendocrine tumor board — National Center for Tumor Diseases Heidelberg (NCT) ↗
- Neuroendocrine neoplasia of the gastrointestinal tract — Ulm University Hospital ↗
- Ga-68 DOTA-i-TATE diagnostics and nuclear-medicine pathway — Ulm University Hospital ↗