Small Intestine Neuroendocrine Tumours: “No other cancer really looks like this”

Translate

It’s known that Neuroendocrine Cancer is quite different in many ways from other cancers, notwithstanding the misnomer term carcinoid which is thankfully being slowly moved out of terminology.  As a few examples:

  • It’s a wide spectrum heterogeneous cancer group with indolent isolated small tumours at one end all the way across to extremely aggressive metastatic cases at the other end.
  • It’s a cancer type that can be syndromically functional or non-functional to add to diagnostic and management challenges.
  • It’s a cancer that can appear almost anywhere in the human body.

One of it’s less well-known traits is the ability to produce multiple primary tumours.  Most people might be thinking of Multiple Endocrine Neoplasia at this point (a syndrome that predisposes the patient to multiple primary tumours in different organs).  However, I also mean multi-focal (multicentric), i.e. more than one primary in the same organ.  And that is the focus of this post in regards Small Intestine NETs where this is a common occurrence (one Swedish study put that at 40%).   

This new study from Sweden has appeared twice in the last month, one giving a highly technical summary of the genome mapping to a small group of tumours. The other gives a higher-level summary.  

The conclusion from this small study is astonishing in that it would appear multifocal primary NETs in the small intestine are capable of producing their own metastases.  I personally don’t believe that changes anything in terms of therapy, but it does reinforce the need for a full check during surgery, something known in surgical terms as “running the bowel” which can be done for different reasons depending on the scenario but in cases of small intestine NETs is important as many of these cases can have multifocal tumours (multiple primaries).  

See the abstract below:

Let’s start with the overview as that is what most of you will be looking for.  There’s also some technical stuff in this overview but genome mapping is a highly technical subject not understood by many.

Concrete clinical question 

“When we remove neuroendocrine tumors in the small intestine, we often find many tumors in the same place, which is unusual. No other cancer really looks like this,” says Erik Elias, an endocrine surgeon at Sahlgrenska University Hospital and a post-doctoral researcher at the University of Gothenburg. “The cancer is also unusual because known driver mutations are largely absent.”

Surprising answer

“The result was both unambiguous and surprising. The intestinal tumors had developed independently. Yet the metastases were clearly related and could be traced back to a specific bowel tumor.”

Erik Elias and Erik Larsson Lekholm in fornt of hospital.
Erik Elias and Erik Larsson Lekholm. Photo: Elin Lindström

Multiple tumors without kinship occur simultaneously in the small intestine | University of Gothenburg (gu.se)

Citing information:

Elias, E., Ardalan, A., Lindberg, M. et al. Independent somatic evolution underlies clustered neuroendocrine tumors in the human small intestine. Nat Commun 12, 6367 (2021). https://doi.org/10.1038/s41467-021-26581-5

Click this link to read full article:

Independent somatic evolution underlies clustered neuroendocrine tumors in the human small intestine | Nature Communications

Click picture to read more

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.   

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.

Thanks for reading.

Ronny

I’m also active on Facebook. Like this page.
I’m also active on this Facebook page. Follow this page.
Also like this awareness page on Facebook. 

Sign up for my newsletters – Click Here

Disclaimer

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!)

Check out my Glossary of Terms – click here

patients included

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

 
 
 
Facebook
Twitter
Pinterest
WhatsApp
Email

A spotlight on Chromogranin A

What is Chromogranin A? Chromogranin A (CgA) is an acidic protein released along with catecholamines from chromaffin cells and nerve terminals. This statement alone might

Read More »

Neuroendocrine Cancer: Catch them early, not late!

Diagnosing Neuroendocrine Neoplasms (NENs). It’s no secret that Neuroendocrine Neoplasms (NENs) can be difficult to diagnose, particularly well differentiated slow growing types (NETs) which can

Read More »

A spotlight on Rectal Neuroendocrine Neoplasms

What are Rectal NENs Rectal Neuroendocrine Neoplasms (NENs) (rNENs) account for approximately 1-2% of all primary cancers in the rectum.  The other main cancer types

Read More »
Clinical Trial

Clinical Trial: Novel Somatostatin Receptor Subtype 2 Antagonist Labelled With Terbium-161 (161Tb-DOTA-LM3) (Beta plus)

A new clinical trial post. What is Terbium-161 (161Tb-DOTA-LM3) (Beta plus). Terbium-161 is a radioactive substance.  DOTA-LM3 is a novel somatostatin antagonist targeted using somatostatin

Read More »

Repeat after me: Maria Menounos has Neuroendocrine Cancer

Like many people from outside USA, I don’t really know anything about Maria Menounos.  For those in the same boat, let me confirm she is

Read More »

Summary of April 2023 on RonnyAllan.NET

Summary of RonnyAllan.NET website activity in April 2023 The top 10 most read posts in April are included below as the main product of this summary

Read More »

A spotlight on 5-HIAA

Background. It’s important to note that not every type of Neuroendocrine Neoplasm will get the same tests due to the heterogenous nature of this cancer type.

Read More »

The NET Detectives

The NET Detectives is an awareness post. Detecting NETs In general, it’s probably true to say that Neuroendocrine Tumours (NETs) are difficult to diagnose. Some

Read More »

Low FODMAPs – The NET Effect

Background Many people with NET have had issues prior to diagnosis and then continue to have similar issues after. For some it will be either

Read More »

3 thoughts on “Small Intestine Neuroendocrine Tumours: “No other cancer really looks like this”

  • I recall asking how many tumours were found in the Small Bowel. The surgeon replied there were too many to count but we removed the affected length plus a clear % at each end. The tumours had already metastasised to the liver, lymph node and the mesentery. What was fascinating was the primaries being G1 and the metastases at G2.

    • it would have been an interesting correlation, but I did note that there was even one patient where they spotted the same signature in different metastases from the same primary tumour!

    • Joani Wicklund

      Admittedly much of this was way over my head. I will say how grateful I was for an astute surgeon. I presented with a pretty typical NET on imaging, but when they got in there they also found a second tumor in the Ileum and the 3 multifocal mesenteric tumor deposits that were .03 cm, .08 cm, and 1 cm. The correlation between the two nets (Jejunum and Ileum which were completely separate) and the tumor deposits is confusing to me.

I love comments - feel free!

%d bloggers like this: