However, it is clear that currently, at least, there is not one level that can be agreed upon to determine good and poor prognosis tumours. It is imperative therefore that biomarkers such as Ca19-9 are interpreted in a multi-disciplinary team setting where the patient’s status, such as the relationship of the Ca19-9 to pre-operative stenting and concurrent disease processes, is clear when clinical decisions are being made. In such a setting

it is likely to be a much more powerful tool. Finally, given the vogue for consensus statements, it would be appropriate timing for such a conference to evaluate Ca19-9 and its role in pancreatic cancer and to set cut of values for Ca19-9 against which Inhibitors,research,lifescience,medical future studies can be compared. Such a process for carcinoembryonic antigen levels in pancreatic cystic lesions lead to the Sendai guidelines (9) adopting a CEA level of ≥192 ng/mL as that for determining if a cyst deemed positive for CEA or not. Inhibitors,research,lifescience,medical Such a process for Ca19-9 would, within a short period of time, through audit processes, allow confirmation that

such guideline values were correct and would Inhibitors,research,lifescience,medical aid all clinicians managing pancreatic cancer. Footnotes No potential conflict of interest.
This single centre, retrospective study was under taken at the South Tyneside District Hospital (STDH), South Shields, United Kingdom, between the period January 1999 to January 2009. The study was approved by the Trust audit and research committee. The hospital histopathology database was searched using the keywords ‘carcinoid’ and ‘neuroendocrine tumour’ to obtain a list of patients eligible for inclusion in the study. Only those patients with carcinoids arising from the gastrointestinal

tract were included Inhibitors,research,lifescience,medical in the study. Using Inhibitors,research,lifescience,medical a pre-designed proforma, data including demographic information, presenting complaints, diagnostic methods, surgical procedures, histopathology and follow-up were extracted from the hospital case records and where necessary from contact with the patient’s general practitioner. The data was transferred onto Microsoft Excelspreadsheet (Microsoft Corporation, Redmond, Washington, USA) and analysed using the statistical program SPSS version 15 (SPSS, INCB018424 Chicago, Illinois, USA). An important part of the study was to critically review the current evidence on the Dacomitinib management of GICTs and thus, a systematic literature search of PubMed, Ovid and Cochrane was performed for keywords “gastrointestinal carcinoids and gastrointestinal neuro-endocrine tumours”. Relevant publications were reviewed and compared with our results at STDH in order to generate conclusions and recommendations for the management of GICTs within the confines of small district hospitals. Results At STDH which is a small hospital providing healthcare services to a population of about 160,000, a total of 35 patients (17 males, 18 females; mean age 62±15.