Surgical intervention is typically the first basic step in treating brain tumours, especially when the tumour is accessible and operable.

A craniotomy involves removing a portion of the skull to access the brain and excise the tumour.

The goal is to remove as much of the tumour as possible while ensuring patient safety, which can alleviate symptoms and improve the effectiveness of subsequent treatments.

However, complete removal may not be feasible if the tumour is located near critical brain regions.

Radiotherapy uses high-energy beams, such as X-rays or protons, to target and kill cancer cells. External beam radiation is the most common form, in which the radiation is directed at the tumour from outside the body.

This treatment can be used post-surgery to eliminate any remaining cancer cells or as a primary treatment when surgery is not an option.

Proton therapy is an advanced form of radiation that uses protons instead of X-rays. This method allows for more precise tumour targeting, minimizing damage to surrounding healthy tissue. It is particularly beneficial for treating tumours located near sensitive areas of the brain and is associated with fewer side effects compared to traditional radiation therapy.

Chemotherapy involves the use of drugs to destroy cancer cells.

It is often combined with surgery and radiotherapy.

Although chemotherapy can be effective, it may cause side effects such as nausea, fatigue, and an increased susceptibility to infections.

All these 3 standard brain cancer treatment options has its own advantages and limitations, and the choice of therapy depends on the type, size, and location of the tumour, as well as the patient's overall health.

A neuroendocrine tumour, or NET, is a quite rare neoplasm that can develop in any body regions where the hormone-producing cells are present. Tumours that develop from the neuroendocrine cells preserve the ability to produce hormones and respond to the impulses from the autonomic nervous system. In addition to the unusual and variable clinical picture due to the hormone overproduction, NETs can develop features of malignant neoplasms, invade healthy tissues and requiring active therapy.

Pathophysiology and causes of neuroendocrine tumours

There are neuroendocrine tumours unites heterogeneous neoplasms that arise from the lungs, adrenal glands, appendix, rectum, pancreas, and other organs of the digestive tract. Their common feature is combining properties of hormone-producing cells and nerve cells. Neuroendocrine tumours are able to accept electric signals from the nervous system and discharge hormones into the bloodstream in response to such stimuli. Pathohistological of such tumours depends on the type of the progenitor cell.

Types of neuroendocrine tumours

Neuroendocrine tumours are quite rare neoplasms that arise from the specialized cells of the neuroendocrine system. The neuroendocrine system is present in many organ systems, as it controls and coordinates a number of the body’s functions. NETs are usually considered malignant neoplasms, despite many of them growing slowly and needing years to develop.

Depending on the growth speed, tendency to metastasize, and invading neighbouring organs, all NETs can be divided into benign and malignant ones. Benign or non-cancerous tumours grow slowly and manifest themselves mainly with unexplainable hormonal changes. Malignant or cancerous ones tend to spread through the organism, invade nearby organs and cause local and hormonal symptoms.

We find no links that neuroendocrine cancer hereditary nature, therefore, parents with this condition may give birth to healthy children. However, must be noted that certain hereditary conditions are associated with higher risks of NET development. Thus, in the presence of MEN-1, MEN-2, etc., attention should be paid to NET screening.

The majority of NET tumours are sporadic. This means that they are not transmitted from parents to children but arise as newly onset conditions. Nevertheless, few hereditary syndromes increase the chances of developing microcarcinoma. These are multiple endocrine neoplasia Type 1, multiple endocrine neoplasia Type 2, neurofibromatosis, von Hippel-Lindau syndrome, and tuberous sclerosis.

Neuroendocrine tumour classification depends on the localization and hormonal activity. Following these criteria the following tumour types are distinguished:

Gastroenteropancreatic neuroendocrine tumours are most often found at age 50-60 by accident (during surgical interventions for other reasons). This is connected with the absence of acute and specific clinical manifestations. Gastroenteropancreatic neuroendocrine tumours include the following subtypes:

1. Appendiceal neoplasms are typically found postoperatively, during the histological examination of the removed during appendectomy tissue specimens. Appendiceal neoplasms are benign and rarely cause carcinoid syndrome (in less than 1% of cases).
2. Gastric neoplasms may be associated with chronic atrophic gastritis, Zollinger-Ellison syndrome, MEN-1, or sporadic. These are usually the sporadic tumors that actively produce histamine and serotonin, causing an atypical carcinoid syndrome.
3. Colorectal neoplasms are divided into small-cell and moderately differentiated carcinomas. The first ones are somewhat similar to small-cell lung cancer and require chemotherapy. The second ones resemble large-cell lung carcinoma and are successfully treated surgically.
4. Pancreatic neoplasms originate from the diverse cells of pancreatic islets.

Due to the diversity of secreted hormones, the pancreatic NETs are divided into numerous subtypes:

• Insulinoma is a beta-cell neoplasm that is capable of excessive insulin secretion. This is the most widespread pancreatic NET.
• Gastrinoma typically arises in the pancreas or duodenum and is responsible for the development of Zollinger-Ellison syndrome or peptic ulcers against the background of high gastrin levels.
• VIPoma is a component of MEN-1 syndrome. VIPoma autonomously and uncontrollably synthesizes the vasoactive intestinal peptide.
• Somatostatinoma is the rarest pancreatic NET. High levels of hormone somatostatin suppress the work of the gastrointestinal tract, and the diagnosis is easily confirmed by the elevated somatostatin blood levels.
• Pancreatic polypeptide-secreting tumour is a rather common NET type, although it is not associated with any clinical syndrome. Non-specific symptoms, like abdominal pain or jaundice, may be associated with the tumor presence.

Pheochromocytoma is a benign neoplasm that arises from the adrenal gland. This is a rather common condition characterized by the excessive secretion of catecholamines and is often found in young patients with arterial hypertension. On the contrary, adrenal cancer is a malignant pathology that tends to metastasize to distant body parts.



Merkel cell carcinoma is a rare skin malignant neoplasm that arises on the head, neck, or face. The condition is typically diagnosed in older people, as well as in people with weak immunity. The tumour may be superficial or may spread deeper, beyond the skin.



Tumours of the genitourinary tract appear in kidneys and bladder, ovaries and cervix uteri (women), prostate, and testicles (men). Due to the weak hormonal activity, they are rarely diagnosed (except for testicular and ovarian ones).

Pulmonary tumours comprise typical and atypical carcinoids, large cell neuroendocrine carcinoma, and small-cell lung carcinoma. The pathologies are listed in order of aggressiveness increasing and prognosis worsening. It should be noted that pulmonary and endocrine neuro cancer has the same cell of origin as small cell lung cancer.



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