NET Cancer Questions: Lung Neuroendocrine Tumors with Robert Ramirez, OD

NET Cancer Questions: Lung Neuroendocrine Tumors with Robert Ramirez, OD


Neuroendocrine tumors are cancers that
can occur throughout the body. Um, generally we don’t understand
why people get these cancers. There’s certain sort of genetic
syndromes, but they’re rare. Um, normally they occur sporadically. In the majority of times they tend to
start out somewhere in the abdomen. So I see him in the small intestine,
pancreas, colon, rectum, uh, but up to about 25, 30% of the
time they start out in the lung. And in many times when
they start out in the lung, they can be asymptomatic. So patients can get
diagnosed because they get a, they get a scan for
another reason. You know, maybe they have some sort of abdominal
problem and they get a scan of the abdomen and it picks up, uh, it picks up something at the
bottom of the lung and then they go on this journey to this
diagnosis. Uh, the other, you know, one of the other ways they get picked up, diagnosed is through symptoms.
And the symptoms can vary. Um, you know, they sort
of mimic our normal, so our non small cell or
our small cell lung cancer. They can go from shortness of
breath or cough or wheezing. Sometimes people can cough up blood. Uh,
weight loss can come along with this. If the cancer is spread,
uh, spreads to the bone, sometimes people get bone
pain associated with this. But this is all, the symptoms
really vary from patient to patient. It’s a very good question. So,
neuroendocrine cancers of the lung vary in terms of degrees of
aggressiveness. So they represent, when we look at the
totality of lung cancer, um, this represents probably
about 20% of all lung cancers. But when we start talking
about some of the, some of the lower grade tumors and
things that we’re gonna talk about today, the typical and atypical carcinoid tumors, this only represents
about 2% of lung cancers. Um, so they, we break them into degrees of
aggressiveness. So from very, very indolent tumors to
very, very aggressive, uh, and they’re classified that way. So, the fastest growing tumors that we see, the neuroendocrine tumors that we see
are something called small cell lung cancer. Uh, we see this primarily in patients who
have a long smoking history and it tends to be a very aggressive lung
cancer. Take it down a notch, underneath that is large cell
neuroendocrine carcinoma. So not as aggressive, but still
a very aggressive lung cancer. And then when we come down even further, we see something called an
atypical carcinoid tumor. And then down further to the, to the more indolent tumors
is a typical carcinoid. So, if you look at the literature,
the percentage is very low. Some series say 2%, some people say 10%. In my experience, you know, patients may have this a little
more often than that, uh, but the majority of these cancers
are what we call nonfunctional. So they’re not secreting hormones that
produce this syndrome. You can certainly, you know, it’s not just
carcinoid syndrome, but they can produce other types
of hormones as well that produce, can cause something called
Cushing’s or acromegaly. Uh, so there’s other types of hormones
that we look for. Um, but the, the actual percentages are
minimal. Um, but I think, I think it’s somewhat evolving as well. So I see them and I’m seeing
more and more like this. Uh, I dunno if there’s a, you
know, certainly, you know, breast cancer being very common. You know, we see this, especially since, you know, many times with the carcinoid
tumors, this can be a very, a long course of disease. So, you know,
we see this more and more. So I think, I think finding out, you know,
I think the biggest thing is, you know, if you have lung cancer and now all of
a sudden you have a nodule, you know, they do a biopsy to make sure this is
not metastatic disease from the original cancer. But if it’s a carcinoid tumor, you know, you treat it as such, with
definitive treatment. If it’s metastatic, well then, then you treat it as a
metastatic disease. But, but as far as, we certainly do see neuroendocrine tumors
happen with other types of cancers, not just breast cancer, but all
different types of cancers I see. The biggest thing that I see that is a
problem is people not understanding this disease and not just, not patients, but physicians. And I think, I think patients need to be their own
best advocate about this. You know, I see many patients that have come
through and they get told “Oh, you had a benign tumor, we took it out.
You don’t need anything else.” Well, that’s absolute wrong thing. Um,
you know, seek out other opinions. Um, you know, we collaborate with
people from around the country, around the world, and provide
a roadmap for care. You know, your doctors are not going to
be upset at you, if you say, “can I go get another opinion?”
If they are upset at you, well then maybe you should go get
another opinion anyway. Um, you know, so get your specialty
opinions, you know, from your neuroendocrine centers and you know, we’re not stealing any of their patients. You know, sometimes that’s a
fear from other docs saying, “Oh, they’re gonna steal. You’re gonna steal
my patients.” We work with them. Um, you know, we provide a roadmap for care, for them and 99% of the time they
are very happy because they’re, they may get, they may have two patients with the
carcinoid tumor in their entire practice. They see lung and breast and
colon cancer all day long. And then twice a year someone with
carcinoid comes in and they’re more than happy to say, go to the expert, but come
back to me and you get your injections, you get your other treatment. But
a few times a year, you go and see, you go and see the specialist. So
that’s the big thing, you know, this is your disease. And at the end of the day, you know, I
think taking control of it and really, you know, being your own patient
advocate really goes a long way.

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