Abdominal pain, diarrhea, and stomach ulcers are seemingly common minor problems that most people may not take seriously, but these may also be symptoms of gastroenteropancreatic neuroendocrine tumors. The incidence of neuroendocrine tumors (NET) has increased fivefold in the past 30 years, and it is also the second most common tumor in the digestive system. The public should be more aware of it to avoid delay in diagnosis and treatment.
Chen Lin, a specialist in internal oncology, said that NET originates from the neuroendocrine cells of the human endocrine system, which secrete hormones to control multiple bodily functions. These cells are distributed throughout the body, so NETs can also occur in different parts, and in the case of Hong Kong, the disease is more common in the rectum (42%) or the pancreas (24%).
Symptoms vary
NET can be divided into functional and non-functional categories. Surgery specialist Liao Yuhua explained, “The former symptoms depend on which organs NET occurs in. For example, in the digestive system, it may affect glucagon/insulin and cause hyper/hypoglycemia; if it affects gastrin, it can cause peptic gastric ulcer; affect blood vessels Active intestinal peptide may have symptoms of diarrhea and electrolyte imbalance. If it occurs in the respiratory system, or there are problems such as dyspnea and asthma; if it is in the cardiovascular system, it may cause flushing, fast or slow heartbeat, and low blood pressure; The tumor gradually becomes larger, and it can also compress nearby tissues and cause abdominal pain, back pain, etc.” Non-functional NETs are asymptomatic or very mild, and problems such as weight loss, bleeding, and abdominal pain usually occur after 5 to 7 years, but the tumor may have already diffusion.
Interdisciplinary diagnosis
Due to the variability of symptoms and lack of uniqueness, the detection, diagnosis, and treatment of NET often require interdisciplinary discussions, including oncology, surgery, and endocrinology. Liao Yuhua pointed out, “If the NET can be completely removed by surgery and can achieve a radical effect, but if it cannot be removed or can only be partially removed, drug therapy or radiotherapy should be considered to control the disease.” Chen Lin continued, “Currently, first-line treatment can The use of somatostatin analogs or targeted drugs, the former can improve symptoms caused by excessive hormone secretion and delay tumor growth; In vivo, targeted radionuclide therapy (PRRT) can be considered.”
delay deterioration
The principle of PRRT is to combine targeted peptides and radionuclides. The targeted peptides will bind and integrate into tumor cells, and the radionuclides will emit radiation in tumor cells to kill cancer cells. Among several PRRT drugs, one of them has been shown to reduce the risk of disease progression or death by 80% in the study; during the 30-month study period, the median progression-free survival was not reached, that is, more than half of the patients did not have disease progression. Chen Lin said, “The course of treatment generally requires 4 treatments, once every 8 weeks. Because the drug contains radioactive substances, the patient needs to be hospitalized for 1 to 3 days for each treatment.”
stable condition
Mr. Liu, 61 years old this year, was diagnosed with pancreatic neuroendocrine tumor in 2014 and developed symptoms of high blood pressure and asthma. Because the tumor had spread to the liver, targeted drugs were used to control the disease. However, the disease had repeated several years and his life was at one point. Fortunately, he was saved by electrotherapy, blood transfusion and surgery to remove the bleeding site. In 2017, he was converted to receive PRRT treatment, and his condition was finally stabilized. He is now taking somatostatin analogs as maintenance therapy, and his condition is good.
Chen Lin finally reminded that if you continue to experience abdominal distension, diarrhea, weight loss, sudden flushing, ear heat, etc., you should seek medical treatment and evaluation as soon as possible to avoid delaying the disease.
Originally published on AM730 https://www.am730.com.hk/health/small problems do not ignore-beware of neuroendocrine tumors/322752