Dustin Diamond (January 7, 1977 – February 1, 2021)

I’m behind the curve on this one after being ahead on celebrities such as Steve Jobs, Aretha Franklin, Wilko Johnson and Olivia Williams. But in my defence, Dustin Diamond was not that well known in UK. I noticed his name mentioned in relation to “Neuroendocrine” in early 2023. I set about searching and it didn’t take me long to make a connection. BUT …. this is much more complex than the cases above despite the misinformation which followed in all of these cases due to the use of anatomy to name cancers. This appears to be a common issue, particularly as it is the language used by doctors and the press to simplify the complexity to which I refer above; and will outline below.

Who is Dustin Diamond

Dustin Neil Diamond (January 7, 1977 – February 1, 2021) was an American actor and stand-up comedian, best known for his role as Samuel “Screech” Powers throughout the Saved by the Bell franchise. In early January 2021, Diamond was diagnosed with extensive stage (ES) small cell carcinoma of the lung, a disease formally known as Small Cell Lung Cancer (SCLC). He completed one round of chemotherapy in Florida, but died from the disease on February 1, 2021, at age 44.

What is Small Cell Lung Cancer (SCLC)?

SCLC is a highly aggressive cancer of the lung which accounts for approximately 15% of bronchial carcinomas. At the time of diagnosis, approximately 30% of patients with SCLC will have tumours confined to the hemithorax of origin, the mediastinum, or the supraclavicular lymph nodes. These patients are designated as having limited-stage disease (LD). Patients with tumours that have spread beyond the supraclavicular areas are said to have extensive-stage disease (ED).

SCLC is more responsive to chemotherapy and radiation therapy than other cell types of lung cancer; however, a curative approach is difficult to achieve because SCLC has a greater tendency to be widely disseminated by the time of diagnosis. Immunotherapy to successfully treat SCLC remains elusive. As an example of incidence and prevalence, the overall incidence and mortality rates of SCLC in the United States have decreased during the past few decades. This aligns with falls in smoking, but not all cancers of the lung are caused by smoking. In fact, Dustin Diamond was recorded as a non-smoker.

Estimated new cases and deaths from lung cancer (SCLC and non-small cell lung cancer (NSCLC) combined) in the United States in 2022:

- New cases: 236,740.
- Deaths: 130,180.

SCLC vs Neuroendocrine Carcinoma of Lung Origin

The World Health Organisation (WHO) categorises SCLC as a Neuroendocrine Carcinoma (NEC). Reference: WHO Classification of Tumours, Thoracic Tumours, 5th Edition. Travis WD, Al Dayel FH, Bubendorf L, Chung JH, Rekhtman N and Scagliotti G. Tumours of the lung. SCLC vs Neuroendocrine Carcinoma (NEC) As you can see from these numbers, the incidence is relatively high, but prevalence is lower than many other cancers given the aggressive course of this disease. Approximately 15% of all cancers of the lung are SCLC. From that, you can see that SCLC as a Neuroendocrine Carcinoma would be the most common type of NEN and the lung would be the most common primary location at 35,511 cases of SCLC in 2022. However, it’s complicated. Some SCLC cases are multiple cell, e.g. SCLC combined with a NSCLC component, most often adenocarcinoma or squamous cell carcinoma. A case revealing foci of both SCLC and adenocarcinoma would therefore be termed “combined SCLC and adenocarcinoma.” SCLC may also be combined with LCNEC and is classified under the term “combined SCLC and LCNEC.” It is estimated to affect up to 25% of cases. I could not find any statistics to indicate if the Neuroendocrine element was the dominant cell type in mixed cell cases. Unlike the term used in Gastroenteropancreatic NENs (GEPNENs) – Mixed Neuroendocrine Non-Neuroendocrine Neoplasms (MINEN), the Thoracic committee decided to call them “combined” suffixed with the cell types in the examples indicated above. Getting accurate statistics for the Neuroendocrine component of SCLC is difficult but taking the worst case of 25% “combined” would still make the numbers of SCLC (NEC) the most common type of NEN and the lung would remain the most common primary site for NENs. In many countries, SCLC is not treated by NEC specialists, rather Thoracic or Lung Multidisciplinary Teams (MDTs) tend to manage these patients. Additionally, some countries (UK is one example) do not even include SCLC in their Neuroendocrine Neoplasm (NEN) epidemiological data. Many other countries are similar, for example when you look at US statistics, it is patently obvious that SCLC is not included. I’m quite confident this situation would be replicated in many other countries.

So, did Dustin Diamond have Lung Cancer or Neuroendocrine Carcinoma?

One thing I have learned over the years is that doctors are trained to talk about cancer in anatomical terms, this is to the disadvantage to Neuroendocrine Neoplasms in terms of celebrity publicity when they get ill or die and it makes the news. If you do an internet search on Dustin Diamond, you will find many instances of “Lung Cancer” but also many instances of “Small Cell Carcinoma” of lung origin. But based on morphology, there is at least a 75% chance that he had something which could equally be called a Neuroendocrine Carcinoma.

References Used:

1. BBC News Report – click here
2. TMZ News Report – click here
3. Moffatt News – click here
4. Small Cell Lung Cancer Treatment (PDQ®)–Health Professional Version –c lick here
5. The 2021 WHO Classification of Lung Tumors: Impact of Advances Since 2015 – Journal of Thoracic Oncology (jto.org) – click here

See my detailed blog post on Lung Neuroendocrine Neoplasms

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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Thanks for reading. Ronny