Background: Neuroendocrine Tumors (NETs) are poorly understood malignancies. We sought to define epidemiologic characteristics and outcomes, and describe systemic, interventional and surgical therapies use for NETs. Methods: We conducted a population-based retrospective cohort study of all adult patients with NETs in Ontario from 1994 to 2009, linking propsective databases linked at the Institute of Clinical Evaluative Sciences. We looked at incidence, proportion of metastatic disease, overall survival (OS), and use of systemic therapy (ST), liver embolization (LE), and surgery. Results: We identified 5619 NET cases. Incidence of NETs increased from 2.48 to 5.86 per 100 000 per year over 15 years. Synchronous metastases were found in 20.8% and metachronous metastases in 38%. Incidence and metastases varied according to primary NET site. Around time of diagnosis (60 days pre/post diagnosis), 56.8% did not consult a surgeon and 97.2% did not see a medical oncologist. Initial primary site resection was performed in 63.9% broncho-pulomnary (BP), 57.1% gastrointestinal (GI) and 46.4% pancreas (PA) NETs (p <0.001). 53.7% of all liver metastases were resected. ST was used in 46% of PA, 23.2% GI and 25.4% BP NETs, and LE in 8.1% BP, 11.9% GI, and 19.2% PA NETs. 10-year OS was 42.8%, with independent predictors of worse OS being: advanced age, male gender, low socioeconomic status, rural living, and pancreas and small intestine sites. Conclusions: NETs incidence has markedly increased over 15 years, with outcomes disparities based on demographics, social, and tumor characteristics. Patterns of care for NETs were irregular and sporadic. Numerous NETs were not assessed by a surgeon or medical oncologist, indicating worrisome potential under treatment and non-optimal management. Future work is needed to define mechanisms explaining this portrait in order to improve outcomes through early diagnosis, more frequent surgical referrals and standardization of therapies.