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The Silent Disease – Neuroendocrine Cancer

NEUROENDOCRINE CANCER STARTS IN the neuroendocrine system, which is made up of cells that integrate the characteristics of traditional endocrine cells (or hormone-producing cells) and nerve ells. Neuroendocrine cells are found throughout the body in organs such as the thyroid, lungs, pancreas, urogenital tract and gastrointestinal tract. They perform specific functions, such as regulating the metabolic functions, electrolyte balances of the body and the digestive functions of the gastrointestinal tract.

Neuroendocrine tumours (NETs) are abnormal growths that often develop slowly. Tumours that start in the neuroendocrine system with rapid growth and spread quickly to other parts of your body are called neuroendocrine carcinomas. Neuroendocrine tumours occur most often in the digestive system, but could actually occur in the lungs, thyroid or other parts of the body.

NEUROENDOCRINE CANCER

The major challenge with neuroendocrine cancer is that it is often misdiagnosed as they could present in various ways. Some possible symptoms of neuroendocrine carcinoma, for example are:

  • Diarrhea
  • Recurrent abdominal pain
  • High blood sugars
  • Low blood sugars
  • Loss of appetite/weight loss
  • Wheezing
  • Hot Flushes
  • Sweating
  • Shortness of breath
  • Chest discomfort

Due to relatively slow growth and symptoms that can be vague and subtle, they are frequently diagnosed late. Many symptoms of neuroendocrine tumours are non-specific like diarrhoea, hot flushes or wheezes and these can be mistaken for other diseases like that of irritable bowel syndrome, menopause, anxiety, gastric ulcers and asthma amongst others. It may take an estimated five to seven years for the condition to be diagnosed correctly, by which time, the cancer have often spread to other organs.

Diagnosis may be achieved with new technologies available. New tumour markers, immune-histochemical markers and special scans using state of the art new molecular technology like that of Galium-68 PET scans make diagnosing and evaluating the extent of this cancer easier. This would be followed up with a biopsy to obtain tumour tissues for definitive identification of the subtype of neuroendocrine tumours.

The ability of science to develop minute single molecule that can bind to one precise marker on the neuroendocrine tumour cells like that of somatostatin receptor has allowed us to better pinpoint the location of the tumours and even effect the treatment of the disease. The Gallium labelled somatostatin like molecule allows us to locate the tumour and the Lutetium or Yttrium labelled somatostatin-like molecule allows us to treat the tumour.

This is a new molecularly targeted peptide linked radionuclide therapy called peptide receptor radionuclide therapy (PRRT). the systemic administration of a radiolabelled peptide designed to target with high affinity and specificity receptors overexpressed on tumours. The success rate is high, it benefits up to 80 per cent of patients with this disease.

With latest pharmacological bioengineering, many new therapeutic drugs directed at markers unique to the cancer cell are now available. This includes molecules directed at somatostatin receptor molecules, those directed at tumour blood vessels formation cascade (anti-angiogensis) and that of the sub-molecular level, intracellular processes in the tumour cells. The future outlook for treatment of neuroendocrine tumour is bright. 

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Mount Elizabeth Novena Hospital

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