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Neuroendocrine Cancer About

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Pancreatic neuroendocrine tumors are becoming more common (the bad news) and also more treatable (the good news).

Pancreatic cancer is a dreaded and especially deadly type of cancer. About 44,000 Americans will be diagnosed with pancreatic cancer this year, accounting for approximately 3% of all cancer diagnoses. Unless some dramatic breakthroughs in treatment occur, fewer than 3,000 will be alive in five years.

Steve Jobs fared better than many with pancreatic cancer. The charismatic co-founder of Apple died on Oct. 5, 2011, almost exactly eight years after his cancer was discovered incidentally on a CT scan of his kidneys (the pancreas is near the left kidney). According to the best-selling biography of Jobs that was published shortly after his death, his urologist had urged him to get the scan because of kidney stones he'd had several years earlier.

But some cancer specialists would say Jobs didn't have pancreatic cancer at all — at least not in the way it is usually described. He had a rare form of cancer called a neuroendocrine tumor. They do occur in the pancreas, but two-thirds of neuroendocrine tumors develop elsewhere in the body. Neuroendocrine tumors and the kind of cancer that typically affects the pancreas arise from different types of cells, have different symptoms, and are treated differently. People can lead relatively normal lives for several years with pancreatic neuroendocrine tumors, even if they've metastasized outside the pancreas. Only several thousand cases are diagnosed each year in the United States, although the number has been increasing.

The FDA approved two new drugs for pancreatic neuroendocrine tumors in 2011, sunitinib (Sutent) and everolimus (Afinitor), which disrupt molecular-level signaling within cancerous cells and work in a much more targeted way than conventional chemotherapy.

Cancer specialists see sunitinib, everolimus, and drugs like them as the new wave of cancer therapy. Sunitinib and everolimus are not mentioned by name in the Jobs biography, but molecular targeted therapy is, so it's a reasonable guess that he might have taken one of those drugs near the end of his life.
A gland in the middle of things

Oblong and tapered at one end, the pancreas invites creaturely comparisons: a small eyeless squid, perhaps, with neither long tentacles in front nor a fin in back. The animal imagery is encouraged by the anatomical division into a head, body, and tail.

Part of the reason pancreatic cancer is so perilous is that the pancreas is so close and interconnected to many other structures. Branches of major arteries and veins serve the organ. The head looks like it is nuzzling the small intestine and is grooved to accommodate the common bile duct that connects the liver to the small intestine. The body lies up against the aorta, and the tail looks like it's invading the personal space of the spleen and the left kidney.

Functionally, the pancreas is a gland — a body part that secretes. But it's an unusual, dual-purpose gland, producing digestive fluids and enzymes that are secreted into the small intestine and insulin and other hormones that are secreted into the bloodstream.

Dr. Matthew H. Kulke, a physician at Harvard-affiliated Dana-Farber Cancer Institute in Boston who specializes in pancreatic neuroendocrine tumors, explained in an interview that pancreatic cancer has traditionally been viewed in this context, with the common type coming from the cells that produce the digestive juices, and neuroendocrine tumors arising from the islet cells responsible for insulin and other hormones. This is still the dominant view, although Dr. Kulke said the evidence is shifting, and both types may originate from stem cells.
No known risk factors

Smoking, diabetes, and inflammation of the pancreas (pancreatitis) have been implicated as risk factors for the more common type of pancreatic cancer. Nothing similar has been identified for pancreatic neuroendocrine tumors. Some cases are probably caused by inherited genes and, in particular, mutations in a tumor suppressor gene called menin. But the evidence so far is that genetic inheritance accounts for only a small percentage (perhaps 5%) of cases.

The reasons for the increasing number of cases of pancreatic neuroendocrine cancer are difficult to pin down. A definitive diagnosis requires a biopsy. In the past, biopsies weren't done as often as they are now, so some neuroendocrine tumors were probably lumped in with other pancreatic cancers.

The incidental finding on a CT scan, as experienced by Jobs, has become increasingly common (of all cancers, not just pancreatic neuroendocrine tumors), so more detection in this age of high-resolution medical imaging may be the reason for some of the increase. But the possibility that there's been a true increase in the number of these types of tumors can't be ruled out, either.
Typing cancer

Cancer is identified not only by its location but by the type of cells it originated from — its lineage, so to speak. Sarcomas, for example, come from bone, muscle, and various kinds of connective tissue. Carcinomas, the most common type of cancer, arise from epithelial cells that line various parts of the body.

Most pancreatic cancer is adenocarcinoma, cancer that originates from ductal tissue. Neuroendocrine tumors affect cells that produce hormones. The pancreas is a common site for neuroendocrine tumors, but they also develop in the small intestine, appendix, and other parts of the body, where they are known as carcinoid tumors.
Removing the tumor

Pancreatic neuroendocrine cancer can be removed surgically. Usually enough of the pancreas and insulin-producing islet cells are left behind so the patient doesn't become diabetic.

Large tumors may indicate that the cancer has spread outside the pancreas, but that isn't always the case. "We've recommended resection of large, 10-centimeter tumors, with no metastasis, and the patients have done great," Dr. Kulke told us. Generally speaking, surgery is not done if the cancer has already metastasized outside the pancreas, because the procedure would probably do little to alter the course of the disease.

Much has been made about Jobs delaying surgery for nine months as he tried alternative treatments and a strict vegan diet (Jobs was on and off vegan and fruit diets throughout his adult life). Any judgment about whether the delay made a significant difference would require more detailed knowledge of his case. It is possible that the cancer had already spread, perhaps undetected, outside his pancreas by the time Jobs was diagnosed, in which case the timing of the surgery would have been of little consequence.
Taming hormones

Between 10% and 30% of pancreatic neuroendocrine tumors result in excess secretion of insulin or, depending on the particular type of islet cells involved, other hormones. If too much insulin is pumped out, blood sugar levels can plummet. Extra gastrin, a hormone that stimulates the stomach, can lead to stomach ulcers. Surplus glucagon can make blood sugar levels go up. In the past, people

Neuroendocrine Cancer

Sign Ribbon cells Horoscope Symbol Tattoos Research Zodiac Sign Ribbon Tattoos  

Neuroendocrine Cancer

Sign Ribbon cells Horoscope Symbol Tattoos Research Zodiac Sign Ribbon Tattoos 

Neuroendocrine Cancer

Sign Ribbon cells Horoscope Symbol Tattoos Research Zodiac Sign Ribbon Tattoos 

Neuroendocrine Cancer

Sign Ribbon cells Horoscope Symbol Tattoos Research Zodiac Sign Ribbon Tattoos 

Neuroendocrine Cancer

Sign Ribbon cells Horoscope Symbol Tattoos Research Zodiac Sign Ribbon Tattoo

Neuroendocrine Cancer

Sign Ribbon cells Horoscope Symbol Tattoos Research Zodiac Sign Ribbon Tattoos 

Neuroendocrine Cancer

Sign Ribbon cells Horoscope Symbol Tattoos Research Zodiac Sign Ribbon Tattoos 

                                                                                     

Neuroendocrine Cancer

Sign Ribbon cells Horoscope Symbol Tattoos Research Zodiac Sign Ribbon Tattoos 

Neuroendocrine Cancer

Sign Ribbon cells Horoscope Symbol Tattoos Research Zodiac Sign Ribbon Tattoos 

Neuroendocrine Cancer

Sign Ribbon cells Horoscope Symbol Tattoos Research Zodiac Sign Ribbon Tattoos 

Neuroendocrine Cancer

Sign Ribbon cells Horoscope Symbol Tattoos Research Zodiac Sign Ribbon Tattoos  

with pancreatic neuroendocrine tumors died from these hormonal excesses, not the cancer itself. Now a class of medications called somatostatin analogs can be used to effectively control hormone secretion. Somatostatin analogs may also slow the growth of the tumors themselves