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When you look at how cancer is classified and broken down, you can see why Neuroendocrine Neoplasm (the overarching term for Neuroendocrine Tumour and Neuroendocrine Carcinoma) often appears unlisted in certain websites and in certain clinical publications and press releases. Moreover, it robs awareness and funding for Neuroendocrine Cancer organisations, particularly when celebrities are involved in incorrect labelling.
Below, I wanted to cover why that sometimes happens but also why that is undeservedly detrimental to Neuroendocrine Cancer awareness.
From a histological standpoint, there are hundreds of different cancers, which are grouped into six major categories:
- Mixed Types
You may be like me and wondering where Neuroendocrine Tumours fit into these 6 types? Clearly, they must be somewhere inside Carcinoma …… and that must refer back to the Oberndorfer “Carcinoma-like” term, something which is translated from “Carcinoid“. As Carcinoid has been erased from the vast majority of WHO Cancer Classification ‘blue books’, let’s also hope they will address these classification and categorisation issues soon.
In the vast majority of cancer epidemiological papers, it’s clear that cancers are classified in two ways: by the type of tissue in which the cancer originates (histological type) and by primary site, or the location in the body where the cancer first developed.
When you look at the official cancer classification systems at World Health Organisation (WHO) level, something which all healthcare professionals should be using, you can see that there is no single area where all Neuroendocrine Neoplasms (NENs) are listed (it’s being talked about though). Instead, you will find Lung NENs in the Thoracic section, Pancreatic NENs in the Endocrine section, Gut NENs in the Digestive Systems section, Ovarian NENs in the Female Reproductive Organs; and so on. You can now see why doctors often refer to NETs by their primary site nomenclature (e.g. a NET of pancreatic origin is sometimes called “pancreatic cancer”).
However ……. the interpretation of the latest versions of the WHO books above is really important. e.g in the 2019 Digestive Systems book…. “Tumors of the Pancreas” following by subsections separating out Neuroendocrine Neoplasms.
In the 2017 Endocrine Organs book ….. “Neoplasms of the Neuroendocrine Pancreas” and I am posting that extract below (please note that Pancreatic Cancer comes from the ‘Exocrine’ Pancreas):
When you look at both the 2017 Endocrine Organs and the 2019 Digestive System version, you can see trends in definition e.g. they do not call them Pancreatic Cancer; they are called Neuroendocrine Neoplasms/Tumours/Carcinomas. So, it should prevent the wrong label but in practice this is not working.
The lost awareness of Neuroendocrine Cancer
Almost every day I see something in my news feed about Neuroendocrine Cancer …. an article, a tweet, a blog post, a subscription, an alert of some kind. Certain ones catch my eye and then something in the detail leads me to disappointment at the realisation I can’t share the information because of a major flaw in the content. Sometimes it’s just the use of ancient and rather stupid awareness methods, other times it’s the incorrect use of the outdated term “Carcinoid”. A common flaw is the failure to recognise that Neuroendocrine Neoplasms (Carcinomas and Tumors) can be found in numerous sites in the human anatomy. The latest article I read about Steve Jobs was a good read until I noticed it was actually about Pancreatic Cancer and inferred that a pancreatic NET was a subtype of Pancreatic Cancer. I spend a lot of time supporting Pancreatic Cancer because they really need the support, but we do too. In 2016, the death of Aretha Franklin, did not really help Neuroendocrine Cancer in an awareness sense. Although some ground was made up via my blog site and help and invention from NET Research Foundation, the sheer extent of the publicity this great lady got is now ingrained in the bowels of the online media and it’s difficult to undo. The 2023 case of Maria Menounos is a classic example – click here.
There are huge differences between Pancreatic Cancer and Neuroendocrine Cancer with a pancreatic primary – click here to read more.
Of course, there is a trend with famous NET patients being labelled with something else and I outlined this issue in my post “The Human Anatomy of Neuroendocrine Cancer” which already has over 50,000 hits. We need to keep clawing back some of that lost awareness. And we need to continue to emphasise that Neuroendocrine Cancer is NOT a type of another cancer PERIOD. Click here and share please!
I once told a story in a post called “Neuroendocrine – what’s that?“, about my own experience in communicating the details of my condition. To cut a long story short, as soon as I mention my primary site was in the ‘intestine’, people assume I have some kind of bowel cancer. Cue – a careful explanation which doubles up as awareness.
Our situation is not helped by many ‘big hitter’ cancer organisations, who mostly tend to list cancers by anatomical site, nearly always in alphabetical order. Many of them then add Neuroendocrine Tumors of the Pancreas, Lung, Appendix, to the description for Pancreatic, Lung and Appendiceal Cancer sections respectively, i.e. inferring that they are subtypes of those cancers. I get the reason for the anatomical listing, but system-wide cancers also need to be included, i.e. Neuroendocrine disease should be listed as an entity under N. Which bit of the phrase “Neuroendocrine tumors can occur anywhere in the body” is not understood! It is cancer in its own right, with its own medical coding, its own classification system, its own specialists and specialist centres, its own awareness. It’s not a type of another cancer! Please list it under N !!!
This issue causes us to lose awareness everywhere we look. Read a story about an outstanding awareness campaign featuring a Neuroendocrine Carcinoma patient – click here.
My name is Ronny Allan and I have a Neuroendocrine Cancer with a Small Intestinal Primary. I do not have Bowel Cancer!
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