So, neuroendocrine tumours are a group of tumours in our body that consist of specific
cells which are called neuroendocrine cells. Those cells can be found forming glands such
as pituitary, adrenal parathyroids, but also can be distributed in many
organs and most commonly, they gut, the stomach, the pancreas; and this is where we can find
the majority of those tumours. Those tumours have got five main characteristics. First:
they are heterogeneous, which means that they consist of different cells that play different
roles, second: they are usually slow growing, third: they usually secrete hormones and therefore
can cause specific symptoms, fourth: they may have receptors of somatostatin which is
specific hormone on their surface, and finally, those tumours likely can be treated with more
than one option. In the past, those tumours were considered to be rare, but it's not the
case anymore, because recent studies have demonstrated that over the last 30 years,
the incidence of those tumours have substantially increased, whereas the instance of all other
cancers has remained stable. Those tumours can become more or less aggressive and I can
borrow the example of an old-fashioned Western: The Good the Bad and the Ugly to divide them
into slow growing tumours with some of them may never spread; and this is the Good group.
The Bad group are tumours which are still slow growing, but at some point, they'll spread
and the Ugly group are the tumours that became really aggressively and they look like other
cancers. The diagnosis of those tumours is based on a good historical examination by
the physician, also a blood test and urine test, third: on good quality imaging studies,
and finally, on biopsy.
Symptoms of neuroendocrine tumours can be variable. Patients can present with chronic
diarrhoea, which means diarrhoea for more than 4 weeks. Flashing, which means that their
face becomes red for few minutes. When patients can have chronic cramping pain, patients can
have ulcers in the stomach that are difficult to treat, patients can present with episodes
of low blood sugar, but also, patients may have no symptoms. In those cases, neuroendocrine
tumours can be revealed just incidentally.
The physician, when he's trying to make a diagnosis of neuroendocrine tumours, should
follow the steps of history clinical examination, but also use high quality imaging studies,
such as the Gallium 68 PET scan, which is most modern in imaging modality that someone
can use for neuroendocrine tumours and this is a whole-body scan and can pick up tumours
as small as 7 ml. Through that scan, tumours cannot be missed, but the tumours can be missed
only if the physician does not suspect them.
When we are three thing a patient with neuroendocrine tumour, we're following the four principles.
First of all, we are aiming to control the patient's symptoms and especially those who
are related to hormone secretion by the tumour. As soon as we achieve this, we discuss the
patient case with our surgical colleagues to see whether the can reset the primary tumour
or even when metastasis. If these is not possible then we try to find ways to delay the tumour
growth and even shrink the tumour, and the last not least is, we as physicians
try to improve and always maintain the patient's quality of life. For the first target, control
of patient's symptoms, we are lucky to have easy medications which are monthly hormonal
injection which can be given easily by the patient's GP, and some of them even by the
patient themselves. So those injections can control the hormonal symptoms of the tumour,
but also can delay the tumour growth. If this is not possible, the physician who treats
neuroendocrine tumours is lucky because he or she can choose from a variety of options
which can include the injections or dimension, chemotherapy, oral tablets that are inhibiting
the ability of the tumour to produce vessels, but also many treatments including radiation
treatment, internal and external.