Don’t believe the hype – Neuroendocrine Cancer Myths debunked

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OPINION

There’s a lot of inaccurate and out of date information out there. Some is just a lack of understanding, some caused by out of date websites, often as a result of patient forum myth spreading. Some can only be described as propaganda. Some of it even comes from doctors and NET advocate organisations. 

Myth 1: All Neuroendocrine Tumours are benign

Not true. By any scientific definition, the word ‘tumour’ means ‘an abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumours may be benign (not cancerous), or malignant (cancerous)’. Sure, some NETs will be benign but a tumours which spreads away from the primary site cannot be benign by any scientific definition. However, since the World Health Organisation (WHO) 2010 classification for digestive systems, the situation has been based on the concept that all NETs have malignant potential, and therefore abandoned the division into benign and malignant NETs and tumours of uncertain malignant potential. This has been reinforced in the 2017 Endocrine update to include clarification for endocrine organ types of NET including Pheochromocytoma and subsequently (and more forcefully) in the 2019 Digestive Systems update. Read more here. The word ‘Carcinoid’ is inextricably linked with this issue – read here why we need to stop using the term to help fight the benign myth.

Kunz His belief these tumors did not metastisize

Myth 2: Neuroendocrine Tumours is a terminal condition

Not true. By any definition of the word terminal in a medical diagnostic context, most NET patients have a good prognostic outlook, even those with metastatic and incurable variants of the disease. Read more here.

being_there_front
Graphic courtesy of Ellie McDowell

Myth 3: Carcinoid is another word for Neuroendocrine Tumours

Not true. Carcinoid is a very old term and was phased out years ago. Carcinoid is not mentioned in the latest WHO Classification schemes for Neuroendocrine Neoplasms (a term covering Neuroendocrine Tumours and Neuroendocrine Carcinoma). Unfortunately, the problem is exacerbated by organisations and individuals who still use the word. Also, those who use the following terms:

  • “Carcinoid Neuroendocrine”,
  • “Neuroendocrine Carcinoid”,
  • “Carcinoid and Neuroendocrine”,
  • “Neuroendocrine and Carcinoid”,
  • “Carcinoid NETs” or “CNET”

These are all contextually incorrect and misleading terms (not to mention the bad grammar). ENETS, NANETS and NCCN publications are gradually phasing the word out except in relation to Carcinoid Syndrome (and even then, there could be easy solutions for this). Doctors (including some NET specialists) and patient organisations need to catch up. Read more here and here.

Myth 4: All NET patients get ‘carcinoid syndrome’

Not true. Firstly, many NETs are non-functional; and secondly, carcinoid syndrome is only one of a number of “NET Syndromes” and is only associated with serotonin-secreting NETs.  However, the issue is further confused by those who use the word ‘Carcinoid‘ to incorrectly refer to all NETs and use Carcinoid Syndrome to refer to all NET Syndromes. Read more here.

Myth 5: Neuroendocrine Neoplasms are rare

Not true. As a collective grouping of cancers, this is no longer accurate. Read more here. Also, check out my post about the “Invisible NET Patient Population“.

Myth 6a: Steve Jobs had Pancreatic Cancer

Not true. Steve Jobs had a Neuroendocrine Tumour of the Pancreas. Ditto for a few other famous names. Read more here.

steve jobs 2010
The last few years have reminded me that life is fragile

Myth 6b: Aretha Franklin had Pancreatic Cancer

Not true. Aretha Franklin had a Neuroendocrine Tumour of the Pancreas. Ditto for a few other famous names. Read more here.

Myth 7: I’m not getting chemotherapy, I must be doing OK?

Not true. For some cancers or some sub-types of cancers, although it remains an option in certain scenarios, chemotherapy is not particularly effective, e.g. some types of Neuroendocrine Cancer (NETs). In general, well-differentiated NETs do not normally show a high degree of sensitivity to chemotherapy, although some primary locations fare better than others. However, many of the treatments for NETs are somewhat harsh, have long-term consequences, and have no visible effects. NET patients are often said to “look well” but that doesn’t mean they are not struggling behind the scenes or under the surface. Read more here. P.S. Afinitor (Everolimus), Sutent (Sunitinib) are not chemo – Read more here.

chemotherapy-hand-and-arm

Myth 8: All diarrhea is caused by carcinoid syndrome

Not true. It could be one of the other syndromes or tumor types or a side effect of your treatment. Check out this post.

NETCancer Diarrhea Jigsaw

Myth 9: NET is a ‘good cancer’

Not true. Simply, no cancer is good. Some are statistically worse than others in prognostic terms, that’s true…… but living with NETs is very often not a walk in the park. However, no one cancer is better to get than any other – they’re all bad. Read more here.

Good-Bad

Myth 10: Every NET Patient was misdiagnosed for years

Not true. Many NET Patients are correctly diagnosed early on in their investigation and in a reasonable time.  Also, many are incidentally detected as an investigation leads to a scan or imaging – that is not a misdiagnosis.  This myth is perpetuated because of two things: firstly, on forums, the ratio of long-term misdiagnosis is high creating a false perception; and secondly, the method of capturing patient surveys is not extensive enough – again creating a false perception. In fact, the latest and largest database analysis from US indicates earlier diagnosis is improving, with more and more NETs being picked up at an early stage. Read more here.

if your doctors dont suspect something

Myth 11: Somatostatin Analogues are a type of Chemotherapy

Not true. Somatostatin Analogues (e.g. Octreotide and Lanreotide) are not chemotherapy, they are hormone inhibiting drugs. They are more biotherapy. As the drugs latch onto somatostatin receptors, they are more targeted than systemic. For the record, Everolimus (Afinitor) and Sunitinib (Sutent) are not chemotherapy either. Read more here.

chemo-or-not-chemo

Myth 12: Stuart Scott (ESPN) and Audrey Hepburn had Neuroendocrine Cancer.

Not true. This is a common misunderstanding within the community. They both had Pseudomyxoma Peritonei (PMP). Read more about PMP here.

Myth 13: I’ve been diagnosed with Neuroendocrine Tumours – my life is over

Not true. Many patients live a very long time and lead fairly normal lives with the right treatment and support. It’s difficult but I try not to use ‘I can’t’ too much. Read more here.

I CAN

Myth 14: There are only a handful of Neuroendocrine specialists in the world

Not true. There are many specialists in many countries. Get links to specialists by clicking here

find net specilaist and 10 qeusitons

Myth 15: The Ga68 PET scan is replacing the CT and MRI scan in routine surveillance for all NET Patients

Not true. It is actually replacing the Octreotide Scan for particular purposes, or will eventually. Read more by clicking here.

PET-CT-Scanner

Myth 16: All NET Patients are Zebras

Not true. They are in fact human beings and we should treat them as such. Please don’t call me a zebra, I and many others don’t appreciate it. Please don’t use the term on my social media sites, the comment or post will be removed. Sorry but I refuse to perpetuate this outdated dogma. Read why here:

hoofbeats

Myth 17: Multiple Endocrine Neoplasia (MEN) is a type of Neuroendocrine Tumour

Not true. Multiple Endocrine Neoplasia are syndromes and inherited disorders not tumours. You can actually have MEN and not have any tumours. However, these disorders can put people at more risk of developing Neuroendocrine or Endocrine Tumours. Read more here

genetics

Myth 18: Palliative Care means end of life or hospice care

Not true. Palliative care is specialized medical care that focuses on providing patients relief from pain and other symptoms of a serious illness. A multidisciplinary care team aims to improve quality of life for people who have serious or life-threatening illnesses, no matter the diagnosis or stage of disease. Read more here

The P word

Myth 19: Serotonin is found in foods

Not true. Serotonin is manufactured in the body. Read more here

brain-neurotransmitter-serotonin

Myth 20: NETs cannot be cured

Not true. If caught early enough, some NETs can be treated with curative intent (totally resected with margins) with little or no further follow up. It says this in ENETS and NANETS publications which are authored by our top specialists. If we can’t believe them, who can we believe? Read more here.

Myth 21: Pancreatic Enzyme Replacement Therapy (Creon etc) is only for pancreatic patients

Not true. It’s for any patient who is exhibiting exocrine pancreatic insufficiency. Read more here.

Myth 22: High Grade means Neuroendocrine Carcinoma 

Not true. Since 2017, Grade 3 (high grade) comprises well-differentiated tumours (NETs) and poorly differentiated tumours (Neuroendocrine Carcinomas or NEC). Only poorly differentiated tumours are carcinomas. Read more here.

High Grade

Myth 23: Chemo doesn’t work for NETs

Not entirely true. Chemo is commonly used on Grade 3 (high grade), particularly poorly differentiated. Also used in some grade 2 scenarios. Read more here.

Myth 24: “NET Cancer” is an official term

Not true. Aside from the ridiculous grammar “Neuroendocrine Tumour Cancer” is not the way to describe our cancer.  The correct terms can be found by reading here


 

More to follow no doubt

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For general cancer myths and the dangers of fake health news, please see my ARTICLE HERE

Disclaimer

I am not a doctor or any form of medical professional, practitioner or counsellor. None of the information on my website, or linked to my website(s), or conveyed by me on any social media or presentation, should be interpreted as medical advice given or advised by me.  Neither should any post or comment made by a follower or member of my private group be assumed to be medical advice, even if that person is a healthcare professional as they are not members of the private group or followers of my sites in any official capacity.  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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2 thoughts on “Don’t believe the hype – Neuroendocrine Cancer Myths debunked

  • Katrina Welch

    My sweet sister has a rare rash from her endocrine tumor & has been searching for answers that she hasnt been able to find. She is miserable & is hoping for any advise from someone who has experienced the same. When she is able to receive her chemo medication the rash subsides. Because of her low blood count & no chemo the rash has violently spread. She is in so much pain. Is there any sites, people or group that she can connect with to receive at least food for the mind? It would be GREATLY APPRECIATED!

    • Hi Katrina – a bit difficult to answer this questions without knowing where you are. What type fo Neuroendocrine Tumour does she have, where is the primary tumour located?

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