Slow-growing tumors present diagnostic and treatment challenges
By Dr. Philip DeSimone
The University of Kentucky's Markey Cancer Center has initiated the first regional multidisciplinary clinic dedicated to neuroendocrine tumors.
This is another significant "first" for Kentucky, as it will bring the experience and expertise of a variety of different medical specialists and support personnel to bear in the evaluation and treatment of these tumors. We are confident that our team-based approach, stressing individualized care, patient education and research, will result in better care for patients, improving both their prognosis and their quality of life.
Neuroendocrine tumors originate in the interfaces between the endocrine system and the nervous system, two distinct systems that regulate biological processes. The endocrine system is a complex network of glands throughout the body that secrete various hormones, which act as "chemical messengers." The nervous system fulfills a similar role, using electrical impulses to communicate.
Because they often are slow-growing and without symptoms, these tumors can go undetected for years. The most common site for neuroendocrine tumors is in the hormone-producing cells lining the small bowel. However, these tumors can also be found in the lungs, stomach, pancreas and rectum.
The indolent, or slow-growing, form of neuroendocrine tumors is called carcinoid, meaning "cancer-like." Carcinoid tumors were so named because they appeared to combine features of benign and malignant tumors. Although slow-growing, all carcinoids are now thought to have the potential to become malignant and spread to other parts of the body.
A minority of carcinoid patients will develop carcinoid syndrome, which results from the secretion by the tumor of larger-than-normal amounts of hormones such as serotonin. Symptoms of carcinoid syndrome include flushing, shortness of breath, palpitations and diarrhea. However, most carcinoid tumors do not produce symptoms and are discovered accidentally (for example, when a patient has surgery for an unrelated problem).
Because the overall incidence of neuroendocrine tumors is rare, they present some unique diagnostic and therapeutic challenges. The neuroendocrine tumor team at the Markey Cancer Center believes that these tumors must be addressed for each individual, stressing patient education, patient care and innovative research. The multidisciplinary, team-based treatment approach will incorporate chemotherapy, radiation therapy and interventional therapy (procedures done by radiologists).
Our team will be led by Dr. Mark Evers, director of the Markey Cancer Center. As a medical oncologist, I will be joining Dr. Mahesh Kudrimoti, radiation oncologist, in forming the core of the treatment team.
More information about gastrointestinal carcinoid tumors is available online from the National Cancer Institute at www.cancer.gov/cancertopics/types/ gastrointestinalcarcinoid.
For information regarding clinic appointments at the Markey Cancer Center, please contact Virginia Smithers at (859) 323-5275. For educational materials, please contact Judi Dunn at (859) 323-5016.
Dr. Philip DeSimone is a professor of medicine in the University of Kentucky College of Medicine and a medical oncologist at the Markey Cancer Center.