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Linear EUS: Rectal NET T1

A 49 years old female with abdominal pains and distention. Colonoscopy revealed that a small (5 x 7 mm) anal canal nodule proved on biopsy to be Low-grade NET, referred for EUS that showed a submucosal nodule not extending to the Muscularis Propria layer (the internal anal sphincter). About Management:- The vast majority of rectal NETs are asymptomatic and found incidentally on endoscopy that is performed for another reason, However, size correlates closely with the likelihood of metastases. Tumors smaller than 1 cm are rarely metastatic. Observation alone results in inferior outcomes, even for small tumors less than 1 cm. Treatment options for localized rectal NETs include: A- Conventional endoscopic resection (standard polypectomy or EMR). B- Advanced endoscopic resection (ESD, transanal endoscopic microsurgery (TEM), cap-assisted EMR), transanal surgical resection. C- Radical resection (low anterior resection (LAR), abdominoperineal resection (APR). Tumors smaller than 1 cm and confined to the mucosa or submucosa (T1) can generally be treated by standard endoscopic resection, greater likelihood of negative resection margins may be achievable with more advanced endoscopic techniques including ESD. Size below 1cm and low rate of Mets (Rectal EUS and FNA for definite diagnosis and G classification is sufficient) NET below 1cm:- I- T1 and G1or 2 resected endoscopically better by ESD. II- T1 and G3 better to open surgical resection.