One of my daily alerts brought up this very interesting article published in the Journal of Gastrointestinal Oncology last month (June 2015). I personally found it fascinating. Moreover, it gave me some hope that specialists are out there looking for novel treatments to help with the difficult fight against Neuroendocrine Cancer.
This is an article about something generally described as “Intra-operative Chemotherapy”, i.e. the administration of chemo during surgery. This isn’t any old article – this is written by someone who is very well-known in Neuroendocrine Cancer circles – Dr. Yi-Zarn Wang.
March 2022: Note Dr Wang has a new post.
“I am now in Permian Basin-Odessa Midland Texas as the new Program Director of a new general surgery residency program. I have officially joined the faculty of Texas Tech University Health Sciences Center on October 1, 2021. I have privileges at TTUHSC and our two teaching hospitals. I’ve resumed seeing patients and operating. Thank you again for your unconditional support. My clinic number is 432–703–5555. Fax number 432- 335–1693. Amanda Mendoza will handle my patient appointment appointments. Her email is: email@example.com. Her phone number is 432–703–5555 then choose option one. Christina Rodriguez is my nurse.”
The general idea behind this isn’t exactly new as there’s also a procedure known as HIPEC (Hyperthermic Intraperitoneal Chemotherapy) or “chemo bath”. This is mostly used intra-operatively for people with advanced appendiceal cancers such as Pseudomyxoma Peritonei (PMP). It normally follows extreme surgery – you can read more about this in a blog I wrote at the beginning of the year entitled “The Mother of all Surgeries”.
However, this is both different and significant because it is targeted at midgut neuroendocrine tumour (NET) patients who are often diagnosed at an advanced stage with extensive mesenteric lymph node and liver metastasis. Despite extensive surgery which needs to be both aggressive and delicate, there can sometimes be small specks left behind which will not show up on any type scan, particularly in the mesentery area. It is possible these specks could eventually grow big enough to cause fresh metastasis or syndrome recurrence/worsening and then need further invasive treatment.
The treatment aims to eliminate potential tumour residuals in mesenteric lymph node dissection beds using a safe and local application of chemotherapy agent 5-fluorouracil (5-FU). The 5-FU is delivered via ‘intraoperative application’ of 5-FU saturated gelfoam strips secured into the mesenteric defect following the extensive lymphadenectomy. The term ‘Chinese dumpings’ is used to describe the 5-FU saturated gelfoam strips once they are in place in the treatment site. I understand from other research that they can also be used in liver surgery (anecdotal from a forum site).
The report concluded that those who were treated with the intra-operative 5-FU received less follow-up surgery than those who were not (the control group). However, it added that further studies were required to evaluate its effect on long-term survival.
So…. this form of intra-operative treatment is very interesting. Incidentally there is already a form of intra-operative treatment using radiotherapy (IORT) which is a similar concept but essentially still in its infancy. However, the first IORT machine of its kind in the UK was deployed in Jun 2016. I blogged about this here.
You can read the report in full here:
Adjuvant intraoperative post-dissectional tumor bed chemotherapy—A novel approach in treating midgut neuroendocrine tumors
p.s. If you get time, the introduction section of this article is a very powerful explanation of the problems and challenges faced by surgeons when presented with extensive abdominal neuroendocrine disease.
Dr Wang reminds me of my own surgeon, he would do surgeries no one else would do and innovation was there when necessary. He arranged for charity-funded intra-operative radiotherapy (IORT) to be provided some years ago. This is giving patients a blast of radiotherapy to nearby tissue during surgery to help get rid of cells and improve margins.
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Please also note that mention of a clinical service, trial/study or therapy does not constitute an endorsement of that service, trial/study or therapy by Ronny Allan, the information is provided for education and awareness purposes and/or related to Ronny Allan’s own patient experience. This element of the disclaimer includes any complementary medicine, non-prescription over the counter drugs and supplements such as vitamins and minerals.
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8 thoughts on “‘Chinese Dumplings’ and Neuroendocrine Cancer”
Thanks Ron for posting Dr Wang did the Whipple in 2014 and yes i had the dumplings done
I’ve often worried about my tumor coming back or a reoccurrence. Here’s the quick short story of what happend to me.
My name is Dana and I’m now 33 had my Appendix removed in January 2015 the surgery went well and I recovered fine. a few weeks after my surgery I went for the follow up that’s when I was told they found a 2.5 CM tumor that was cancerous. I left that appointment having no idea what a carcinoid tumar was later to find out I had Neuroendocrine cancer.
I’ve now had a right Hemicolectmy and 15 lymph nodes removed. one had cancer the rest were fine. My now cancer free treatment plan going forward is a yearly CT scan does everyone think this is the best way to monitor a reoccurrence?
Dana – you’ve come through on my blog site so probably only I will see this. Did you mean to post it in mt Facebook group ?
I prefer mince and dumplings lol xxxx
Me too 😁
Those dumplings look like guts.
Ha Ha, the white things are the ‘dumplings’
thanks! Check out this page if you’re not there yet https://www.facebook.com/NETCancerBlog