In the land of small tumours, there is still a lot of work to do!


I like reading the words of Dr Mark Lewis, an Oncologist and a Neuroendocrine Tumour (NET) patient himself (with MEN1).  He always delivers with “enthusiastic vigour”, a term he reduces to “brio” (which I had to google!)

His article as usual sets a scene and he has form for looking back in the history of NETs. I’m sure he does this as it can often illustrate just how much clinical progress has been made since way back then. And that is the purpose of the recent article entitled “Continuing the Odyssey in the Land of Small Tumors“.  He quotes from a 1987 article written by Dr Charles Moertel entitled “An Odyssey in the Land of Small Tumors” and I suspect he selected this article from Dr Moertel as he too writes with “brio”.

“Patients present in an almost surrealistic manner – a mix of tumor-related symptoms and signs, with bizarre and sometimes grotesque endocrine syndromes”

The article from 1987, when somatostatin analogues were starting to be used, must have been a hugely exciting time, perhaps more so than when peptide receptor radiotherapy (PRRT) became a thing in the 21st Century. After setting the scene using Dr Moeortel’s work, Dr Lewis then introduces a recent paper by well-known NET Specialist Dr Pamela Kunz and Dr Janie Zhang, a Hematology/Oncology Fellow at Yale-New Haven Hospital.  Dr Lewis introduces their work with “After more than three decades of interim research, the article in this issue by Zhang and Kunz provides a contemporary framework for approaching the titular small tumors, with updates on nomenclature, diagnostic workup, and management“.  Please note this review will focus on tumor control in NETs (i.e. not in Neuroendocrine Carcinomas).

In his own paper, Dr Lewis quite rightly points out the continued confusion whereby the classification of neuroendocrine tumors (NETs) has long been obfuscated by the etymology of the German word karzinoide, a misnomer if it is translated to mean that this cancer-like disease is uniformly benign. Clearly there’s still a lot of work to do to get rid of that obfuscation, the thoracic guys are still behind the curve.

As a patient himself, Dr Lewis also covers the issue of patient quality of life.  Clearly there’s a balance required making therapy decisions often tough for the physician and patient, particularly when the therapy may be different across the broad spectrum of NET types and primary locations. Another area where many unmet needs still remain.

And he approaches the tricky subject of therapy sequencing with the words “This risk-benefit calculus is crucial in caring for patients whose longevity can be measured in years, if not decades, and for whom therapeutic options have multiplied to the point that the sequence of their use must be considered“. Working out the best sequencing is difficult, particularly with so many factors involved not least the different types of NET and primary locations.  This is really a work in progress and perhaps will always be.

Both papers make for excellent reads and summaries of just how far we’ve come.  Clearly there’s still a long way to go!  I encourage you to read both recently published papers in this sequence:

1. Continuing the Odyssey in the Land of Small Tumors, Mark A. Lewis, MD, DOI: 10.1200/OP.21.00598 JCO Oncology Practice, published online October 15, 2021, PMID: 34652964 (click here)

2. Making Sense of a Complex Disease: A Practical Approach to Managing Neuroendocrine Tumors, Janie Y. Zhang MDPamela L. Kunz MD, DOI: 10.1200/OP.21.00240 JCO Oncology Practice, Published online October 15, 2021, PMID: 34652954 (click here)

And for those who, like Dr Mark Lewis and myself, like reading articles with “memorable brio”, you may also enjoy the 1987 work from Dr Moertel:

Moertel CGKarnofsky memorial lecture. An odyssey in the land of small tumors. J Clin Oncol 5:150215221987 Click this Link

General Clinical Trials Disclaimer

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided in the clinical trials document. It’s very important to check the trial inclusion and exclusion criteria before making any contact. 

Inclusion of any trial within this blog should not be taken as a recommendation by Ronny Allan. 


Subscribe to my newsletter

Thanks for reading.


I’m also active on Facebook. Like my page for even more news. Help me build up my new site here – click here and ‘Like’

Sign up for my newsletters – Click Here


My Diagnosis and Treatment History

Follow me on twitter

Check out my online presentations

Check out my WEGO Health Awards

Like my new awareness page – click here or on the photo.  (Like rather than follow please!)

Remember ….. in the war on Neuroendocrine Cancer, let’s not forget to win the battle for better quality of life!

patients included

Please Share this post for Neuroendocrine Cancer awareness and to help another patient


Neuroendocrine Cancer: Glossary of Terms

Welcome to my Neuroendocrine Cancer terms and definitions list providing a source of meanings for acronyms and medical terms, all sourced from top Neuroendocrine Cancer and

Read More »

Opinion: On Rare Cancer Day, what’s wrong with a bit of Neuroendocrine Cancer awareness?

On Rare Cancer Day, what’s wrong with a bit of Neuroendocrine Cancer awareness?  Well, there are three main things wrong with Neuroendocrine Cancer awareness: 1.

Read More »

Prospective Phase II Trial of Prognostication by 68Ga-NOTA-AE105 uPAR PET in Patients with Neuroendocrine Neoplasms: Implications for uPAR-Targeted Therapy

Summary A novel PET radiotracer can accurately assess the presence of a biomarker that indicates the level of tumor aggressiveness in neuroendocrine neoplasms (NENs). According

Read More »

Living with cancer: 5 tips for facing things you can’t control

I’m wired not to worry too much about something I cannot control.  For example, I automatically ignore any concerns about being inside an imaging device

Read More »

A Study of CF33-hNIS (VAXINIA), an Oncolytic Virus, as Monotherapy or in Combination With Pembrolizumab in Adults With Metastatic or Advanced Solid Tumors (MAST)

A Study of CF33-hNIS (VAXINIA), an Oncolytic Virus, as Monotherapy or in Combination With Pembrolizumab in Adults With Metastatic or Advanced Solid Tumors (MAST) Neuroendocrine

Read More »

Neuroendocrine Cancer: When you get years added to your life, it’s important to get life added to your years

Self Pity or Self Help?  I’m not one for wallowing in self-pity or accepting invites to pity parties.  It’s not my style. Things happen in

Read More »

Opinion: Neuroendocrine Cancer – remission, cancer-free, no evidence of disease

An opinion post Cure I once wrote an article called “Neuroendocrine Cancer – can it be cured“.  In that article, I covered the fact that

Read More »

Clinical Trial: Phase 1b/3 Targeted Alpha-Emitter PRRT RYZ101 (Ac225)

What is RYZ101? RYZ101 is an investigational targeted alpha-emitter radiopharmaceutical therapy, designed to deliver a highly potent radioisotope, Actinium-225 (Ac225), to tumors expressing SSTR2. RYZ101

Read More »

Lung nodules – something or nothing?

Background A focus on the issue of Lung nodules given I see these mentioned all the time in my online patient group, on many occasions

Read More »

I love comments - feel free!

%d bloggers like this: