A couple of years ago, I received a request from a reader asking if I would write an article about all the symptoms experienced by a Neuroendocrine Cancer patient and how to sort out what is and what isn’t associated with NETs.

Although I chuckled and raised eyebrows at the request, inside I was genuinely humbled that someone thought I was capable of achieving this herculean task.  I actually gave it quite a bit of thought to the point of compiling a matrix of types of NET, main symptoms, cross-referenced with the symptoms of the most common reported comorbidities. After it started to look like it might be bigger than the Empire State Building, I came to the conclusion that it’s an almost impossible task for a wee Scottish guy with less common disease.   I also started to suspect that even the world’s top NET experts would not attempt it either.

Here’s a picture of my work to date:

I have, however, dabbled in attempts to work out my own problems over the past few years and I can give you a golden rule to follow – “Not everything is connected to NETs”. NETs can present with a ‘syndrome’ – a bunch of symptoms normally caused by excessive hormone secretion, some of which are particularly vague and can sometimes continue to cause issues after treatment and beyond – it’s a real witch’s brew of symptoms.  They can also cause non-tumour, non-syndromic issues pertaining to treatment side effects, some of which look very similar to syndromic issues and issues caused by tumour growth.  

In my article “Neuroendocrine Cancer Syndromes – early signs of a late diagnosis”, I focused on the key symptoms experienced pre-diagnosis and then discussed how you might go about sorting out the symptoms from main side effects post-treatment (another regular conundrum for most).  On a similar subject, you might want to check out my 5 E’s blog for (so-called) carcinoid syndrome. I also compiled an article about the source of flushing and diarrhea given there were many differential diagnoses and not just syndromes.  For those of you still looking for a diagnosis, please read this article. 

NETs vs Other Illnesses

Adding another jigsaw piece to the issues with cancer and side effects – common comorbidities (many of an endocrine nature) can arise simultaneously. Is it connected with NETs being just another illness to manage alongside?  All of these factors can make it really difficult to determine the source of the symptoms.  I’m always conscious that the majority of NET patients are in their 5th decade onward and at an age where things start to go wrong quite naturally due to ‘time’ and ‘wear and tear’.

Here’s one classic example of this problem, I can see many people on forums also have diabetes (an endocrine disease). In the United States alone, nearly 7 million people have undiagnosed diabetes, according to the American Diabetes Association.  I can also see from the news in UK, that this is becoming a much bigger deal too – a report published in Feb 2018 claims that diagnoses have doubled in 20 years.  I’ve used the diabetes link as an example, there will be many other very common factors at play, e.g. hypothyroidism which is an age and gender related issue.  The number of people I see in my group with acid reflux is another area of concern given the crossover with certain types of NETs which have this presentation (although the NET potential is much much much less than regular acid reflux disease).

It is certainly possible that many of the problems people face might just be an as yet undiagnosed/underlying condition, unconnected with NETs. To quote the great Dr Eric Liu, “even NET Patients get regular illnesses”.  Working it out is rather difficult though. Sometimes pragmatism and patient detective work is required. 

Syndromes vs Side Effects of Treatment

On forums where most people have a diagnosis and are undergoing treatment, there is regular discussion and Q&As about the source of symptoms, i.e. are they a result of a functioning syndrome (i.e. a consequence of cancer) or something else?  For example, some people complain they still have (so-called) carcinoid syndrome diarrhea after bowel surgery………that needs some careful thought and understanding before coming to what might just be the wrong conclusion, particularly if all tumour and hormonal markers are normal.  I’ve lost count of the number of times someone has asked about a symptom on a forum and got 50 different answers. One of the reasons why forums can be good at frightening rather than frighteningly good.  Personally, I never compare myself to strangers on the internet. I just hope most people are using the forums as ‘sounding boards’ and are simultaneously addressing these very complex issues with their doctors when they are genuinely concerned.  I try to help people deal with these issues in my own private Facebook group, which according to my members, is frighteningly good!  Join here if you’re not already there. 

I really feel for anyone who is going through a difficult diagnosis or has been diagnosed and then continues to have numerous problems after initial treatment.  I also admit I have a little bit of sympathy for primary and secondary care medical staff on the basis this is just one of over 200 types of cancer, many of which have wide age groupings adding to the complexity and difficulty. Moreover, many of the symptoms experienced by NET patients on analysis look very similar to everyday illnesses and other ailments. And if that wasn’t demanding enough for doctors, many patients present with already established and diagnosed comorbidities (other illnesses) which add another level of complexity. These difficulties can then continue throughout treatment. It can be a real challenge and I’m sure even Doctors can be totally flummoxed on occasion by patient presentations.

Summary

It is extremely difficult to “sort out the symptoms” when faced with multiple locations/tumour sub-types, multiple treatments causing multiple side effects, multiple side effects causing multiple symptoms, multiple comorbidities with symptoms similar to cancer syndromes, and treatment side effects (and vice versa).  This disease can be very individual and what happens to one might not happen to another. Although we hope doctors generally take a holistic view when treating NET patients, I have a view that sometimes focusing in on a particular symptom might occasionally be a more effective route (the bottom-up approach – pun not intended!).  When eating an elephant, take one bite at a time!  It’s useful to know about the range of tumour markers and hormone markers – read more here.

One thing I have learned  ……educate yourself to the best of your abilities.  This will help you to better advocate for yourself.  Improvements are possible.

Neuroendocrine Cancer is a very difficult jigsaw and you sometimes need to look very hard for the missing piece!  The ‘missing piece’ can be variable and very individual, i.e. a NET specialist, access to a particular treatment, or even just more support or access to support information that works. 

Try my group.