Initial imaging and tests; what to expect after initial NETs diagnosis

Posted by prairiezebra @prairiezebra, Jul 21, 2025

Context:

I've known about my NETs diagnosis for less than 2 weeks. A very small NET was discovered during a routine colon cancer screening colonoscopy; my first colonoscopy ever! The doctor that performed the colonoscopy found two small polyps; one of which turned out to be a NET. He consulted with our local oncologist (who sees patients at our community medical center in rural Minnesota once per week). The oncologist said I could either wait 6 months and do another colonoscopy to get the remaining margins (and, I guess, see what growth there might be if any) OR I could have a procedure sooner to have the margins removed.

Rectal colon polyp, biopsy -
Well differentiated neuroendocrine tumor, WHO grade 1 (G1).
Greatest contiguous measurement at least 2 mm.
Margins involved.
Mitoses < 2 per 2 mm2 and Ki67 index < 3%.
Immunohistochemical staining (Synaptophysin, Chromogranin A, Ki-67) performed. Tumor is positive for synaptophysin. Chromogranin stains negatively. Occasional cells stain positive for Ki67.

I am planning to have a procedure to remove the margins next week, to meet with the oncologist the following week, and have an initial consultation at Mayo in MN in early September (unless an earlier appointment becomes available).

I had been having a variety of vague symptoms that I was guessing were perimenopause (I'm 47) or stress (frequent loose stool). I would occasionally have blood in my stool, but I thought maybe just hemorrhoids or something. My menstrual cycle is a little off, but not too bad -- some other changes I noticed that I thought were perimenopause (occasional hot flashes). My vision has been worse, and I've had more headaches and a couple of aural migraines (new to me). I also had a cold or some other virus last summer that I just couldn't shake (was pretty severe and lasted about a month, I still feel like I get winded more easily than I used to). I masked all year at work because I seemed to get COVID once a semester when I didn't, and that cold/virus from the summer really wiped me out. I'm now wondering if some of my symptoms could be NETs. The tumor was so small, I don't know if it would be likely to cause symptoms in its presence or relieve symptoms with its absence in any meaningful or noticeable way.

My initial appointment includes some bloodwork and CT Chest/Abdomen/Pelvis Multi Exam. I feel concerned/scared that there may be more NETs elsewhere, and I'm curious if it's normal to not include a PET scan. I don't know if my other symptoms would indicate call for a PET scan, or what other things might suggest that a PET scan would be useful or not useful. I wonder if I didn't say enough about those other symptoms in the lead up to the appointment. I feel like I'm being a little bit of a hypochondriac or attributing *any* symptoms to NETs that *might possibly* be from NETs (but might certainly just be normal for getting a bit older, gaining a little weight, being under stress, etc.)

In addition, I was off my thyroid medicine for 3 weeks to check if my body still needed it... and turns out it definitely does. I've been on that medication for hypothyroidism for 20 years, but a few years ago it was suggested that maybe my body has started doing some thyroid stuff on its own again... it was never a convenient time to try going off meds until this summer when I just happened to have a gap between most recent refill and time for annual physical (well, slightly delayed... hence the gap in refill).

That is a long message.

Question/request:

I'm wondering if people would be willing to share what kinds of things happened at their first appointments after diagnosis for anyone whose NETs journey started with the incidental finding of a tumor in some kind of routine screening such as a colonoscopy. My tumor was just so small... but I'm still feeling very afraid that it might be a metastasis *from* somewhere else even if this tumor itself was not looking particularly aggressive. I don't want to miss anything in this initial set of scans/tests. It seems like this could be the best case scenario of a tiny NET that can be removed and then we just monitor. Have others had that experience? Or, have others thought they *might* have that experience based on initial findings, but then some particular test caught some sneaky NETs elsewhere? Basically, if they are there, I just want to know. Did anyone *not* initially have a PET scan, but then bloodwork or CT scans led to a later PET scan?

I feel a lot better knowing the appointment is on the horizon with whatever tests the Mayo team thought made sense. I don't want to miss something because I didn't share enough about my many little seemingly disparate symptoms.

Interested in more discussions like this? Go to the Neuroendocrine Tumors (NETs) Support Group.

To be honest, I am still waiting for the referral and appointment to the doctors. Yes, I belive the doctors will do further examinations since doctors in Taiwan consider it as needed. I think there's no disagree for this. Recently, I receive the colonoscopy pictures from the hospital I underwent the surgery at Taiwan. I do hope these pictures which show the tumor images will largely help the doctors in the US to diagnose for me. Last thing I am worried about is the medical expense. Even that I have the UCSHIP, I do think I need to pay a lot from all those these medical examinations or medications.

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My husband, Ron, had his first tumor discovered after a routine colonoscopy in 1995. Of the 11 lymph nodes taken, 7 were malignant. At that time, there was very little information on this rare cancer. At the beginning he was scanned every 3 months as well as given a 5HIAA test which were often abnormal. After 2 or 3 years, scans and oncology appointments went to once a year. At 10 years he and the doctor decided he wouldn't need to be seen every year. December 30, 2022 (28 years later) he was rediagnosed. At that time, he had a colonoscopy, a biopsy, a PET scan and blood tests. Tumors are throughout his skull and entire body. He was put on Lanriotide every 28 days. We began going to Mayo Rochester on a regular basis. He remained stable for 3 1/2 years. This year (31 years later) we learned that his tumors are increasing. He just finished his 2nd PRRT treatment. With the number of tumors he has, our prayer is for stabilization. We are very thankful for the research that has been done over the years -- basically in 1995 we were just sent home with a good luck wish. He actually had an incident in 1998 that would have been better if we had insisted on a CT scan. If that had shown what was happening, we would have connected with Mayo and he would have been put on Lanriotide sooner. Hopefully Ron's story gives you hope as you move forward into this journey. They continue to tell us that at 82, he will not die from the tumors as his are obviously nonagressive. We have found the sharing of information on Mayo Connect to be very helpful especially since he started PRRT. I would encourage you to be sure you are working with a NETS specialist and let us all know on Mayo Connect how you are doing. Good luck to you!!

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31 years and still going strong! Wow, I can only dream. I'm at the 7 year mark since first seen on a CT. Best of luck to you guys!

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Profile picture for rkklinger @rkklinger

My husband, Ron, had his first tumor discovered after a routine colonoscopy in 1995. Of the 11 lymph nodes taken, 7 were malignant. At that time, there was very little information on this rare cancer. At the beginning he was scanned every 3 months as well as given a 5HIAA test which were often abnormal. After 2 or 3 years, scans and oncology appointments went to once a year. At 10 years he and the doctor decided he wouldn't need to be seen every year. December 30, 2022 (28 years later) he was rediagnosed. At that time, he had a colonoscopy, a biopsy, a PET scan and blood tests. Tumors are throughout his skull and entire body. He was put on Lanriotide every 28 days. We began going to Mayo Rochester on a regular basis. He remained stable for 3 1/2 years. This year (31 years later) we learned that his tumors are increasing. He just finished his 2nd PRRT treatment. With the number of tumors he has, our prayer is for stabilization. We are very thankful for the research that has been done over the years -- basically in 1995 we were just sent home with a good luck wish. He actually had an incident in 1998 that would have been better if we had insisted on a CT scan. If that had shown what was happening, we would have connected with Mayo and he would have been put on Lanriotide sooner. Hopefully Ron's story gives you hope as you move forward into this journey. They continue to tell us that at 82, he will not die from the tumors as his are obviously nonagressive. We have found the sharing of information on Mayo Connect to be very helpful especially since he started PRRT. I would encourage you to be sure you are working with a NETS specialist and let us all know on Mayo Connect how you are doing. Good luck to you!!

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@rkklinger
I appreciate you sharing about Ron's NET diagnosis. I can certainly relate to his story. I was diagnosed with my first NET during a routine upper endoscopy (I had a history of ulcers and GERD). After that diagnosis and surgery, I had routine endoscopies for several years. Another NET was found two years later. Nine years later, I was also told that I didn't need any more follow-up testing, as they were sure there would be no recurrence. For some reason, I didn't believe it. I'm grateful that I persisted, as 11 years after my second surgery, another NET was found in the same location as the first two.

Being persistent and advocating for your care is not always easy (nor popular), but it is important!

You are right that this is a great forum to learn from others with this rare cancer. You are also correct about all the new advances and treatments, such as PRRT, that are now available.

We are better together as we share and learn from each other.

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Take a deep breath and don't over think things right away. First make sure your oncologist is well versed in NET'S and how many patients with NET'S have they treated. This is a rare Cancer. If they are, educate yourself about it the best you can, so you can ask the best questions while getting the correct care. If they aren't well versed, then fine someone who is because you want to get the right treatment now. I am 16mo post op for Pan NET with liver involvement and doing well on Lanriotide. I wish you the same.

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