In viral pandemics, most specifically
Covid-19, many patients with neuroendocrine
neoplasms (NENs), including phaeochromocytomas,
paragangliomas and medullary
thyroid carcinoma, may develop
Covid-19 in a mild or severe form, or be concerned about the influence of
viral infection relative to their anti-tumoral
therapy. In general, newly presenting patients should be assessed, and patients recently receiving
chemotherapy, targeted
therapy or
radionuclide therapy, or showing tumour growth, should be closely followed. For previously diagnosed patients, who have indolent disease, some delay in routine follow-up or treatment may not be problematic. However, patients developing acute secretory syndromes due to functional neuroendocrine
neoplasms (such as of the pancreas, intestine or lung), phaeochromocytomas and
paragangliomas, will require prompt treatment. Patients with life-threatening Covid-19-related symptoms should be urgently treated and long-term anti-tumoral treatments may be temporarily delayed. In patients with especially aggressive NENs, a careful judgement should be made regarding the severity of any
Covid-19 illness, tumour grade, and the
immunosuppressant effects of any planned
chemotherapy,
immunotherapy (e.g.
interferon-alpha), targeted
therapy or related treatment. In other cases, especially patients with completely resected NENs, or who are under surveillance for a
genetic disorder, a telephone or delayed consultation may be in order, balancing the risk of a delay against that of the possible development of
Covid-19.