Duke’s neuroendocrine tumors (NET) program offers coordinated expertise, advanced diagnostics, and innovative therapies to personalize care plans. This includes treatment options not available at other centers, including innovative clinical trials for this rare cancer. 

“Neuroendocrine tumors can be tricky to diagnose and treat,” says Diane Reidy‑Lagunes, MD, chief of medical oncology at Duke Cancer Institute and physician vice president of cancer services for Duke Health. “The tumors can arise almost anywhere in the body, and because they are often slow-growing with vague symptoms, patients can go years before receiving the correct diagnosis.”

Reidy‑Lagunes has extensive experience leading neuroendocrine tumor programs. At Duke, she is supporting a robust collaborative model that brings experts together across disciplines to deliver leading-edge care.

“Duke is fortunate to have an incredible group of experts who truly care about helping patients with this disease,” she says. “Our team includes specialists in medical oncology, surgery, endocrinology, interventional radiology, nuclear medicine, pathology, and radiology. That comprehensive approach allows us to think carefully about which treatments are appropriate and, just as importantly, in what order.”

Treatment sequencing is a critical issue in neuroendocrine cancer care. Because the disease is relatively uncommon, data defining the optimal order of therapies is limited. “There’s often no single roadmap,” Reidy‑Lagunes says. “Part of Duke’s expertise is pulling in different specialties and collectively deciding on the right treatment strategy and timing for each patient.”
For some patients, surgery can successfully remove all visible disease. Others may benefit from careful surveillance if the tumor is slow-growing. Patients with metastatic disease often require combinations of systemic therapies, liver-directed procedures, or radiopharmaceutical treatments.

“About 90% of the time when this cancer spreads, it goes to the liver,” Reidy‑Lagunes says. “Having interventional radiology experts like Dr. Charles Kim allows us to offer treatments such as embolization and radioembolization that can control disease and preserve quality of life.”
Duke is also expanding its leadership in radiotheranostics, an emerging field that delivers targeted radiation directly to tumor cells. Nuclear medicine specialist Terence Wong, MD, works closely with the oncology team to deliver peptide receptor radionuclide therapy (PRRT), including lutetium-177-based treatments.

“These radioligand therapies represent one of the most exciting advances in the field,” Reidy‑Lagunes says. “We can deliver radiation in a highly targeted way, and we’re building one of the leading programs for these therapies in the Southeast.”

Duke’s research and clinical trials are expanding other treatment options for patients. The team is investigating novel targets such as DLL3 and other emerging approaches for rare cancers. Duke medical oncologist Michael Morse, MD, has over 25 years of experience in treating neuroendocrine tumors and leads several studies exploring innovative treatments for metastatic NETs and advanced bronchial NETs.

For referring physicians, Reidy‑Lagunes says early recognition of potential NET symptoms can make a significant difference. “If a patient has persistent, unexplained diarrhea, flushing, abdominal pain, or weight loss, it’s worth considering neuroendocrine tumors as part of the differential diagnosis.”

She also cautions against an overreliance on nonspecific biomarkers, including chromogranin A, which can lead to unnecessary workups. “This biomarker can be elevated because of medications or other factors. If clinicians are uncertain about a patient’s symptoms or test results, we’re happy to help guide the plan of care. Our goal is to partner with community physicians so patients can get the right diagnosis and access to the best care as early as possible.”