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Neuroendocrine Cancer – shh! Can you hear it?


sshh - can you hear it?

shh! – can you hear it? I didn’t.

The sooner any cancer can be correctly diagnosed, the better chances of a complete cure for the person concerned.  However, some cancers are in the ‘difficult to diagnose’ category.  Neuroendocrine Tumours (NETs) is in this category due to the vague symptoms which may be mistaken for other diseases and routine illnesses. This is one of the reasons there have been many lengthy diagnostic delays.  In many cases, it can be very quiet leading to diagnosis at very advanced stages.

In some cases it can be a little bit noisy. For example, the most common misdiagnosis appears to be Irritable Bowel Syndrome (IBS), asthma, or menopause.  Patients complain of abdominal pain, wheezing, shortness of breath, diarrhea, flushing, palpitations and a whole host of other minor issues.  There are even extreme cases where patients have been told they may have a mental illness following constant visits to their local doctors. These cases can lead to months or even years of delay from the onset of symptoms, with around half of patients diagnosed at an advanced stage of disease and metastases at initial presentation.

I’m not totally up to speed on what happens overseas, but in the UK, you normally only have 10 minutes (5 in some scenarios) to see a doctor (although my own experience is that many ignore that rule and if they sense a big issue).  No matter how hard we push, this can sometimes be insufficient to diagnose or even suspect NET cancer (or indeed many other cancers).  A NET Cancer diagnosis is more likely to be as a result of a number of visits where a picture can emerge and even then, a referral to a ‘symptom’ specialist may not necessary lead to an immediate discovery of a NET cancer.

There is no harm in targeting GP/PCP but they are more likely to be following instincts by referring due to symptoms rather than in the game of diagnosing obscure cancers which look like other things. I’m a big believer in primary care being the trigger for ‘something‘ which will hopefully be figured out at secondary care where you are more likely to get access to scans etc. In fact there is data to suggest that ‘symptom specialist’ frequently refer patients back to primary care, indicating the education at secondary care level may be a better focus for NET cancer awareness.

NET Cancer is dangerous despite it’s normally indolent course.  It has a propensity to metastasize meaning that the chance of a curative scenario is vastly decreased.  There is new data confirming the incidence of NET Cancer is on the increase and it’s no longer rare –I’m certain this is due to increased awareness, more efficient diagnostic tools and better reporting methods, e.g. Lung and Pancreatic NETs now being properly reported as NETs rather than Lung and Pancreatic Cancer respectively, particularly at Grade 3.

However, it’s probably true to say the term ‘silent cancer’ or ‘quiet cancer’ is apt even in those who are fortunate to be diagnosed at an early stage.  I mean, how do you detect something that is silent?  Anyone who is diagnosed with NET Cancer on the first visit to any medical professional is extremely lucky!  I suspect this is the same for many ‘difficult to diagnose’ cancers.  

Neuroendocrine Cancer – shh! can you hear it? 

By the way, Neuroendocrine Cancer hates awareness so share share share!

Thanks for reading

Ronny

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Awareness, Awareness, Awareness


awareness-road-sign

When Tony Blair swept to power in 1997, he said:  “Ask me my three main priorities for government and I tell you education, education, and education”.  His approach of repeated word emphasis has been copied and recycled by many others replacing the words with something to suit their own message.  I’m now guilty of similar plagiarism!

NET Cancer is rare and as a consequence has a small community of sufferers and specialists. It does not get the same levels of publicity, funding and research that the bigger patient population and more common cancers receive.  It therefore needs ‘team work’ to send a bigger and more powerful awareness message.  Thus why the World NET Community formed in Berlin in March 2010.  This is a group of NET cancer patient organisations from countries as far-flung as North America, Australia/Far East and Europe.  Their common aim is to raise awareness of NET cancers.  Efforts are  focussed around World NET Cancer Awareness Day, which is held on 10th November.  Check out this link for more info: http://www.netcancerday.org

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10th November

One of the key aims of my blog is to spread awareness of NET Cancer and I’m very pleased to be part of the ‘worldwide team’ doing my bit to help. I started blogging in Apr this year mainly to support a sponsored walk but it has turned into something more permanent.  I start to twitch if I haven’t blogged for more than a week 🙂  I’m now fast approaching my first 10,000 hits which is beyond all my expectations.  My blog statistics package also lets me know my posts have been read in 56 countries indicating NET Cancer is truly an international disease.  Check out the long list below to see how your country is doing!

I’m also helping to spread awareness through my associations with PLANETS Charity: http://www.planetscharity.org and NET Patient Foundation: http://www.netpatientfoundation.org  In fact, I’ll be representing the latter at the NET Patient Foundation event on Tuesday 4th November in the UK Parliament.  This event aims to increase awareness amongst parliamentarians about NET cancers and the challenges to timely diagnoses – in short we are taking our fight for greater awareness directly to the heart of the UK government!

I’m also a ‘tweeter’ which is such a fantastic tool for spreading awareness if used properly.  I run my own personal site and also administer the PLANETS Charity account.  If you want to follow both of these accounts please link here:

https://twitter.com/RonnyAllan1

https://twitter.com/PLANETSCHARITY

Please also follow my colleagues in NET Patient Foundation: https://twitter.com/netpatientfound

If you want to help spread awareness of Neuroendocrine Cancer, please follow my blog and share across your own social media systems.  If you want to receive an email when a new post is published, click on the follow button (this is a system generated message and your email will not be used by me for any other purpose).  In addition to WordPress (the blog tool), I also post on Facebook, Twitter, Google+ and StumbleUpon.

Finally, please look at the list of blog hits by country:

Ronny

 

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Horrible Hormones


Until I was diagnosed with metastatic Neuroendocrine Cancer, I didn’t have a clue about hormones – it’s one of those things you just take for granted. However, hormones are vital to human health (male and female) and it’s only when things go wrong you suddenly appreciate how important they are ……..like a lot of other things in life I suppose! The presence of over-secreting hormones (often called peptides throughout) is useful to aid diagnosis albeit it often means the tumours have metastasized. It’s also a frequent indication that the person has an associated NET syndrome.

This is a really complex area and to understand the hormone problems associated with Neuroendocrine Cancer, you need to have a basic knowledge of the endocrine and neuroendocrine systems.  I’ve no intention of explaining that (!) – other than the following high level summary:

  • Glands in the endocrine system use the bloodstream to monitor the body’s internal environment and to communicate with each other through substances called hormones, which are released into the bloodstream.  Endocrine glands include; Pituitary, Hypothalmus, Thymus, Pineal, Testes, Ovaries Thyroid, Adrenal, Parathyroid, Pancreas.
  • A Hormone is a chemical that is made by specialist cells, usually within an endocrine gland, and it is released into the bloodstream to send a message to another part of the body. It is often referred to as a ‘chemical messenger’. In the human body, hormones are used for two types of communication. The first is for communication between two endocrine glands, where one gland releases a hormone which stimulates another target gland to change the levels of hormones that it is releasing. The second is between an endocrine gland and a target organ, for example when the pancreas releases insulin which causes muscle and fat cells to take up glucose from the bloodstream. Hormones affect many physiological activities including growth, metabolism, appetite, puberty and fertility.
  • The Endocrine system. The complex interplay between the glands, hormones and other target organs is referred to as the endocrine system.
  • The Neuroendocrine System. The diffuse neuroendocrine system is made up of neuroendocrine cells scattered throughout the body.  These cells receive neuronal input and, as a consequence of this input, release hormones to the blood. In this way they bring about an integration between the nervous system and the endocrine system (i.e. Neuroendocrine).  A complex area but one example of what this means is the adrenal gland releasing adrenaline to the blood when the body prepares for the ‘fight or flight’ response in times of stress, ie, for vigorous and/or sudden action.

Hormones – the NET Effect

At least one or more hormones will be involved at various sites and even within certain syndromes, the dominant and offending hormone may differ between anatomical tumour sites. For example, NETs of the small intestine, lung or appendix (and one or two other places) may overproduce serotonin and other hormones which can cause a characteristic collection of symptoms currently called carcinoid syndrome.   The key symptoms are flushing, diarrhea and general abdominal pain, loss of appetite, fast heart rate and shortness of breath and wheezing. The main symptom for me was facial flushing and this was instrumental in my eventual diagnosis. The fact that I was syndromic at the point of diagnosis made it easier to discover, albeit the trigger for the investigation was a fairly innocuous event.  Other types of NETs are also affected by the overproduction of hormones including Insulinomas, Gastrinomas, Glucagonomas,VIPomas and Somatostatinomas and others.  These can cause syndromes which are associated with each type of NET.  For more on syndromes –Read Here.

So are hormones ‘horrible’ as my title indicates? 

Absolutely not, they are essential to the normal function of the human body.  For example if you didn’t have any of the hormone Serotonin in your system, you would become extremely ill.  On the other hand, if your glands start secreting too much of certain hormones, your body could become dysfunctional and in some scenarios, this situation could become life threatening.  So hormones are good as long as the balance is correct. NET patients with an oversecreting tumor may be classed as “functional”. However, many NET patients are deemed to be “non-functioning” with normal hormone levels. Regardless of their status, hormones really get a bad press in the NET Cancer community!

Location Location Location

It’s accurate to say that the type and amount of hormone secretion differs between locations or sites of the functional tumor and this can also create different effects.

For example, serotonin secreting tumors tend to be associated with carcinoid syndrome which tends to be associated with midgut NETs and this is normally the case. Many texts will also tell you that a syndrome only occurs at a metastatic stage.  Both are a good rule of thumb but both are technically incorrect. For example, in the bronchus or ovary you can have a form of carcinoid syndrome without liver metastasis (tends to be described as atypical carcinoid syndrome). It’s also possible to see serotonin secreting tumors in places such as the pancreas (although what you would call that type of NET is open for debate).

For example – Foregut NETs (gastric and bronchial) lack the enzyme aromatic amino decarboxylase that converts 5-HTP (5-Hydroxytryptophan – a precursor to serotonin) to serotonin (5-HT); such tumours produce 5-HTP and histamine instead of serotonin.

For example – Hindgut NETs (transverse, descending colon and rectum) cannot convert tryptophan to serotonin and other metabolites and therefore rarely cause carcinoid syndrome even if they metastasise to the liver.

Let’s look at the key NET hormones

Serotonin

I used the example of Serotonin above because it is the most cited problem with NET Cancer although it does tend to be most prevalent in midgut tumors. Serotonin is a monoamine neurotransmitter synthesized from Tryptophan, one of the eight essential amino acids (defined as those that cannot be made in the body and therefore must be obtained from food or supplements). About 90% of serotonin produced in the body is found in the enterochromaffin cells of the gastrointestinal (GI) tract where it is used mainly to regulate intestinal movements amongst other functions. The remainder is synthesized in the central nervous system where it mainly regulates mood, appetite, and sleep. Please note there is no transfer of serotonin across the blood-brain barrier.

Alterations in tryptophan metabolism may account for many symptoms that accompany carcinoid syndrome. Serotonin in particular is the most likely cause of many features of carcinoid syndrome as it stimulates intestinal motility and secretion and inhibits intestinal absorption. Serotonin may also stimulate fibroblast growth and fibrogenesis and may thus account for peritoneal and valvular fibrosis encountered in such tumours; serotonin, however, it is said not to be associated with flushing. The diversion of tryptophan to serotonin may lead to tryptophan deficiency as it becomes unavailable for nicotinic acid synthesis, and is associated with reduced protein synthesis and hypoalbuminaemia; this may lead to the development of pellagra (skin rash, glossitis, stomatitis, confusion/dementia).

Serotonin is also thought to be responsible for ‘right sided’ heart disease (Carcinoid Heart Disease). It is thought that high levels of serotonin in the blood stream damages the heart, leading to lesions which cause fibrosis, particularly of the heart valves. This generally affects the right side of the heart when liver metastases are present. The left side of the heart is usually not affected because the lungs can break down serotonin. Right sided heart failure symptoms include swelling (edema) in the extremities and enlargement of the heart.

Whilst serotonin can be measured directly in the blood, it’s said to be more accurate to measure 5HIAA (the output of serotonin) via blood or urine.

Tachykinins

Tackykinins include Substance P, Neurokinin A, Neuropeptide K and others. They are active in the enterochromaffin cells of the GI tract but can also be found in lung, appendiceal and ovarian NETs, and also in Medullary Thyroid Carcinoma and Pheochromocytomas. They are thought to be involved in flushing and diarrhea in midgut NETs. The most common tachykinin is Substance P, which is a potent vasodilator (substances which open up blood vessels). Telangiectasias are collections of tiny blood vessels which can develop superficially on the faces of people who have had NETs for several years. They are most commonly found on the nose or upper lip and are purplish in color. They are thought to be due to chronic vasodilatation.

Histamine

Histamine is a hormone that is chemically similar to the hormones serotonin, epinephrine, and norepinephrine. After being made, the hormone is stored in a number of cells (e.g., mast cells, basophils, enterochromaffin cells). Normally, there is a low level of histamine circulating in the body. However (and as we all know!), the release of histamine can be triggered by an event such as an insect bite. Histamine causes the inconvenient redness, swelling and itching associated with the bite. For those with severe allergies, the sudden and more generalized release of histamine can be fatal (e.g., anaphylactic shock). Mast cell histamine has an important role in the reaction of the immune system to the presence of a compound to which the body has developed an allergy. When released from mast cells in a reaction to a material to which the immune system is allergic, the hormone causes blood vessels to increase in diameter (e.g., vasodilation) and to become more permeable to the passage of fluid across the vessel wall. These effects are apparent as a runny nose, sneezing, and watery eyes. Other symptoms can include itching, burning and swelling in the skin, headaches, plugged sinuses, stomach cramps, and diarrhea. Histamine can also be released into the lungs, where it causes the air passages to become constricted rather than dilated. This response occurs in an attempt to keep the offending allergenic particles from being inhaled. Unfortunately, this also makes breathing difficult. An example of such an effect of histamine occurs in asthma. Histamine has also been shown to function as a neurotransmitter (a chemical that facilitates the transmission of impulses from one neural cell to an adjacent neural cell).

In cases of an extreme allergic reaction, adrenaline is administered to eliminate histamine from the body. For minor allergic reactions, symptoms can sometimes be lessened by the use of antihistamines that block the binding of histamine to a receptor molecule.  Histamine is thought to be involved with certain types and locations of NET, including Lung and foregut NETs where they can cause pulmonary obstruction, atypical flush and hormone syndromes.

Histamine, another amine produced by certain NETs (particularly foregut), may be associated with an atypical flushing and pruritus; increased histamine production may account for the increased frequency of duodenal ulcers observed in these tumours.

Kallikrein

Kallikrein is a potent vasodilator and may account for the flushing and increased intestinal mobility.

Prostaglandins

Although prostaglandins are overproduced in midgut tumours, their role in the development of the symptoms of carcinoid syndrome is not well established but triggering peristalsis is mentioned in some texts.

Bradykinin

Bradykinin acts as a blood vessel dilator. Dilation of blood vessels can lead to a rapid heartbeat (tachycardia) and a drop in blood pressure (hypotension). Dilation of blood vessels may also be responsible for the flushing associated with carcinoid syndrome.

Calcitonin

Calcitonin is a hormone that is produced in humans by the parafollicular cells (commonly known as C-cells) of the thyroid gland. Calcitonin is involved in helping to regulate levels of calcium and phosphate in the blood, opposing the action of parathyroid hormone. This means that it acts to reduce calcium levels in the blood. This hormone tends to involve Medullary Thyroid Carcinoma and Hyperparathyroidism in connection to those with Multiple Endocrine Neoplasia. Worth also pointing out the existence of Calcitonin Gene-Related Peptide (CGRP) which is a member of the calcitonin family of peptides and a potent vasodilator.

Corticotrophin (ACTH)

Adrenocorticotropic hormone (ATCH) is made in the corticotroph cells of the anterior pituitary gland. It is secreted in several intermittent pulses during the day into the bloodstream and transported around the body. Like cortisol, levels of ATCH are generally high in the morning when we wake up and fall throughout the day. This is called a diurnal rhythm. Once ACTH reaches the adrenal glands, it binds on to receptors causing the adrenal glands to secrete more cortisol, resulting in higher levels of cortisol in the blood. It also increases production of the chemical compounds that trigger an increase in other hormones such as adrenaline and noradrenaline. If too much is released, The effects of too much ATCH are mainly due to the increase in cortisol levels which result. Higher than normal levels of ATCHe may be due to:

  • Cushing’s disease – this is the most common cause of increased ATCH. It is caused by a tumor in the pituitary gland (PitNET), which produces excess amounts of ATCH. (Please note, Cushing’s disease is just one of the numerous causes of Cushing’s syndrome).
  • A tumour outside the pituitary gland, producing ATCH (also called ectopic ATCH). With NETs, this is normally a pNET or Lung NET.

Adrenaline

Adrenaline and noradrenline are two separate but related hormones and neurotransmitters. They are produced in the medulla of the adrenal glands and in some neurons of the central nervous system. They are released into the bloodstream and serve as chemical mediators, and also convey the nerve impulses to various organs. Adrenaline has many different actions depending on the type of cells it is acting upon.  However, the overall effect of adrenaline is to prepare the body for the ‘fight or flight’ response in times of stress, i.e. for vigorous and/or sudden action. Key actions of adrenaline include increasing the heart rate, increasing blood pressure, expanding the air passages of the lungs, enlarging the pupil in the eye (see photo), redistributing blood to the muscles and altering the body’s metabolism, so as to maximise blood glucose levels (primarily for the brain). A closely related hormone, noradrenaline, is released mainly from the nerve endings of the sympathetic nervous system (as well as in relatively small amounts from the adrenal medulla). There is a continuous low-level of activity of the sympathetic nervous system resulting in release of noradrenaline into the circulation, but adrenaline release is only increased at times of acute stress.  This hormone is normally related to adrenal gland and extra adrenal NETs such as Pheochromocytoma and Paraganglioma.  Like serotonin secreting tumours, adrenal secreting tumours convert the offending hormone into something which comes out in urine. In fact, this is measured (amongst other tests) by 24 hour urine test very similar to 5HIAA (with its own diet and drug restrictions).  It’s known as 24-hour urinary catacholamines and metanephrines.  Worth noting that adrenaline is also known as Epinephrine (one of the 5 E’s of Carcinoid Syndrome)

Gastrin

Gastrin is a hormone that is produced by ‘G’ cells in the lining of the stomach and upper small intestine. During a meal, gastrin stimulates the stomach to release gastric acid. This allows the stomach to break down proteins swallowed as food and absorb certain vitamins. It also acts as a disinfectant and kills most of the bacteria that enter the stomach with food, minimising the risk of infection within the gut. Gastrin also stimulates growth of the stomach lining and increases the muscle contractions of the gut to aid digestion. Excess gastrin could indicate a NET known as a Gastric NET (stomach) or a pNET known as Gastrinoma.

Insulin

Insulin is a hormone made by the pancreas. Here, insulin is released into the bloodstream by specialised cells called beta cells found in areas of the pancreas called islets of Langerhams. It is a hormone essential for us to live and has many effects on the whole body, mainly in controlling how the body uses carbohydrate and fat found in food. Insulin allows cells in the muscles, liver and fat (adipose tissue) to take up sugar (glucose) that has been absorbed into the bloodstream from food. This provides energy to the cells. This glucose can also be converted into fat to provide energy when glucose levels are too low. In addition, insulin has several other metabolic effects (such as stopping the breakdown of protein and fat).  Excess insulin could indicate a pNET known as Insulinoma.

Vasoactive Intestinal Peptide (VIP) 

VIP is a hormone that stimulates the secretion and inhibits the absorption of sodium, chloride, potassium and water within the small intestine and increases bowel motility. These actions lead to a secretory diarrhea, hypokalemia (low potassium), and dehydration. Too much Vasoactive Intestinal Peptide (VIP) causes Watery Diarrhea, Hypokalemia (potassium deficiency), and Achlorhydria (absence of hydrochloric acid in gastric secretions). The VIPoma syndrome is also commonly called Verner-Morrison syndrome, pancreatic cholera syndrome, or the WDHA syndrome. Excess VIP could indicate a pNET known as VIPoma.

Somatostatin

Somatostatin is a hormone produced by many tissues in the body, principally in the nervous and digestive systems. It regulates a wide variety of physiological functions and inhibits the secretion of other hormones, the activity of the gastrointestinal tract and the rapid reproduction of normal and tumour cells. Somatostatin may also act as a neurotransmitter in the nervous system. Excess somatostatin could indicate a pNET known a Somatostatinoma.

Glucagon

Glucagon is a hormone that is involved in controlling blood sugar (glucose) levels. It is secreted into the bloodstream by the alpha cells, found in the islets of Langerhans, in the pancreas. The glucagon-secreting alpha cells surround a core of insulin-secreting beta cells, which reflects the close relationship between the two hormones. Glucagon’s role in the body is to prevent blood glucose levels dropping too low. Excess glucagon could indicate a pNET known as Glucagonoma.

Pancreatic Polypeptide (PP)

A pancreatic polypeptide is a polypeptide hormone secreted by the pancreatic polypeptide (PP) cells of the islets of Langerhans in the endocrine portion of the pancreas. Its release is triggered in humans by protein-rich meals, fasting, exercise, and acute hypoglycemia and is inhibited by somatostatin and intravenous glucose. The exact biological role of pancreatic polypeptide remains uncertain. Excess PP could indicate a pNET known as PPoma.

Working out which hormones are being over-secreted?

Clearly the presenting symptoms will give doctors a clue to the oversecreting hormone (see list above). Excessive secretions or high levels of hormones and other substances can be measured in a number of ways. For example:

Well known tests for the most common types of NET include 5-Hydroxyindoleacetic Acid (5-HIAA) 24 hour urine test which is also measured by a blood draw. Note: – tumor markers can be measured simultanously e.g. Chromogranin A (CgA) blood test and/or Pancreastatin as there can very often be a correlation between tumour mass and tumour secreting activity. CgA / Pancreastatin is a blood test which measures a protein found in many NET tumour cells. Thes marker tests are normally associated with tumour mass rather than tumour functionality.

By measuring the level of 5-HIAA in the urine or blood, healthcare providers can calculate the amount of serotonin in the body (5-HIAA is a by-product of serotonin).  5-HIAA test is the most common biochemical test for carcinoid syndrome or the degree of how ‘functional’ tumours are.  If you’ve understood the text above, you can now see why there are dietary and drug restrictions in place prior to the test.

There are other tests for other hormones and there is a common test which measured the main hormones seen in NETs. It may be called different things in different countries, but in UK, it’s known as a ‘Fasting Gut Hormone Profile’.

Scratching the surface here so for a comprehensive list of marker tests for all NETs, have a read here.

Treatment for Over-secreting Hormones – i.e. Inhibitors

Of course, reducing tumour bulk through surgery should technically reduce over-secretion. Clearly there will be exceptions to this rule of thumb. One of the key treatment breakthroughs for many NET cancer patients, is the use of ‘Somatostatin Analogues’ mainly branded as Octreotide (Sandostatin) or Lanreotide (Somatuline). Patients will normally be prescribed these drugs if they are displaying these symptoms but some people may be more avid to the drug than others and this may influence future use and dosages. This is another complex area but I’ll try to describe the importance here in basic terms. Somatostatin is a naturally occurring protein in the human body. It is an inhibitor of various hormones secreted from the endocrine system (some of which were listed above) and it binds with high affinity to the five somatostatin receptors found on secretory endocrine cells. NETs have membranes covered with receptors for somatostatin. However, the naturally occurring Somatostatin has limited clinical use due to its short half-life (<3 min). Therefore, specific somatostatin analogues (synthetic versions) have been developed that bind to tumours and block hormone release. Thus why Octreotide and Lanreotide do a good job of slowing down hormone production, including many of the gut hormones controlling emptying of the stomach and bowel.  It also slows down the release of hormones made by the pancreas, including insulin and digestive enzymes – so there can be side effects including fat malabsorption. It’s also why somatostatin analogues are used in radioactive scans (e.g. Octreoscan, Ga68 PET) as the mix of radioactivity and these drugs binds to the tumours making them ‘light up’ and show on the gamma camera pictures.   If you can see it, you can detect it!

Other than the effects of curative or cytoreductive surgery, some NETs may have very specialist drugs for inhibiting the less known hormone types.

Worth also noting that oversecreting hormones can contribute to a phenomenon known as Carcinoid Crisis – read more here.  For catacholamine secreting tumors (Pheochromocytoma/Paraganglioma), this may be known as Intraoperative Hypertensive Crisis

 

Thanks for reading

 

Ronny

I’m also active on Facebook.  Like my page for even more news.  I’m also building up this site here: Ronny Allan

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Remember ….. in the war on Neuroendocrine Cancer, let’s not forget to win the battle for better quality of life!

A Commitment to Fight Cancer


Steve Davis and the Author

Steve Davis and the Author

I was a spectator at the Bournemouth marathon on Sunday 5 Oct 2014.  I was there to shout for my old army friend, Steve Davis, who was running 26.2 miles for PLANETS Charity.  When Steve found out I was living with Neuroendocrine Cancer, he immediately volunteered his services to help raise funds. Steve is a runner but when you are ’50 something’, running a marathon is no easy feat – not easy on your feet either 🙂

I had seen excerpts of marathons on television but this was my first time as a spectator at a live event.  One thing that struck me was the sheer number of people who were running for good causes. The usual big names were there (Cancer Research, Macmillan, etc) but there were dozens of smaller charities also represented including PLANETS ( http://www.planetscharity.org )  Sure, there were many ‘professionals’ and the ‘fitness types’ who were there because they run marathons as a sport/pastime – but they were vastly outnumbered by people who were running to make a statement and to raise money for their chosen charities.

The ‘statement makers’ were big, small, tall, short, long hair, short hair and some with no hair.  To me some of them did not look like they would be able to run 26.2 miles.  However, their presence there meant they had made the commitment.  If you want to witness the meaning of pride, determination, relief and happiness all bundled into one, simply go and look at the faces of people as they cross the finish point of a marathon. If you also want to be moved, go to a live marathon.  I saw a blind man running who was attached to a ‘guide’ and I saw ladies who had clearly just undergone (or were undergoing) chemotherapy.  Many people had the names of family and friends emblazoned on their running tops and the one which made me frantically ‘blink’ was a lady who had clearly lost a child through some illness.

I think all cancer patients and those who have been touched by this terrible disease will join me in thanking everybody who steps up and commits their time and effort to make money for charities all over the world.  It is really very much appreciated.

I found the whole day quite humbling and my emotions were certainly tweaked.

 

Ronny

follow me here: https://twitter.com/RonnyAllan1

 

 

 

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