Neuroendocrine tumours can be fatal!

Like most other cancers and tumours, neuroendocrine tumours remain silent until they reach an advanced stage; learn more about its symptoms and treatment.

The incidence of neuroendorcrine tumours (NET) has seen a five-fold increase in the last decade. From 1.05 per million in 1993-1997, it has rose to 5.15 per million in 2004-2007 globally. As per data from a group study by Surveillance, Epidemiology and Evaluation of Results (SEER), the analysis has shown an increase in various stages of the disease too.

NET received intense attention among Indians after veteran Bollywood actor Irrfan Khan was diagnosed with it. Steve Jobs, American entrepreneur and co-founder of Apple also succumbed to the same disease. Dr Geeta Nagasree N., senior consultant surgical oncologist explains these tumours which are prevalent but not reported due to their complex nature.

Q What is NET?
Neuroendocrine tumours are a group of tumours with a pathological range of benign to highly malignant and can be present anywhere in the body — the brain to the liver or gut. But despite their diverse presentation, they are characterised by some commonalities, that is they are characterised by cells which secrete certain hormones. The commonest of these tumours are found in the small intestine, lung and rectum. It can also co-exist with breast cancer and other gynaecological cancers.

Q Is NET easy to diagnose?
Diagnosis of NET is a cumbersome task. It requires clinical representation where the doctors opt for biochemical tests, radiological imaging, advanced nuclear imaging and other histological tests which are advanced in nature. When diagnosed, 50 per cent of the cases are already in their advanced stages. In nine out of 10 cases, it has been found that the patient comes for some other check-up and NET is detected. Liver is the organ from where the tumours start producing hormones and it usually gets detected there. There are many cases but the problem is that they do not come for tertiary care on time. There is a need for doctors at the primary level to be sensitised about this cancer..

Q What causes NET?
The exact cause is still not known but there are risk factors like family history of cancers of the pancreas, intestines or any other part of the endocrine system. Mutation of genes after a certain age is also one of the factors that causes NET.

Q What are the symptoms of NET?
In NET, the cancerous tumours secrete hormones once they are present in the liver. They release various active substances which cause symptoms like diarrhoea, vomiting, increased heart rate, high or low blood pressure. There is also swelling in the feet, bloated abdomen and liver enlargement. There can also be severe skin rashes and severe watery diarrhea. The non-cancerous tumours do not produce any hormones. But irritable bowel syndrome and recurrent diarrhea can occur due to these tumours.

Q Is the treatment effective? Does it have a relapse?
There is a debate in the medical fraternity about these tumours. Some of them state that they are slow-growing tumours while others state that they grow very fast. It all depends on which part of the endocrine system are these tumours present in. If it is found in the organs, then surgical removal is the first option. But if that is not the case, then other medical therapies are used.

The latest advances in treatment are allowing for targeted therapy of these tumours and the result has shown 30 to 40 per cent improvement. However, relapse is seen in other parts of the body as there are chances of multiple tumours at different levels. Hence the patient has to be followed up regularly.