November 10, 2017
November 10 is the awareness day for neuroendocrine tumour (NET) cancer – a rare form of cancer that arises from cells of the hormonal (endocrine) and nervous systems. NET cancers take many forms and while it most often occurs in the gastro-intestinal system, it also frequently presents in the pancreas and lungs and many other sites within the body.
At LHSC, a number of clinical care areas are involved in treating patients with this type of cancer – including surgery, transplant, interventional radiology, medical oncology, nuclear medicine, and pathology. The teams use their collective expertise as members of a tumour board, where they work together to review patient cases to determine the best course of treatment.
“With NETs, there isn’t one standard treatment protocol that we can look to because they take so many forms,” says Dr. David Laidley, nuclear medicine physician at LHSC. “There are a number of different clinical areas that can offer therapies, so we work together as a group to determine which combination and order of treatments are most likely to maximize outcomes. Sometimes that might be surgery followed by chemotherapy, and others it might be a liver-directed therapy followed by a transplant.”
As a tertiary and quaternary acute care centre that offers advanced levels of medicine and surgical procedures which are highly specialized, and home of the London Regional Cancer Program, and one of Canada’s largest transplant programs, LHSC has a history of excellence in treating this type of cancer. London has also been a leader in providing systemic chemotherapy and radiation to NET patients and has been using peptide receptor radionuclide therapy (PRRT) for many years with encouraging results.
Dr. Laidley notes, “London is in a unique position when working with patients with NETs. Within the local hospital system, we have the full range of medical experts that can provide many different types of therapies and treatments for these patients. This in turn, helps to make the overall care journey for these patients easier as the transitions between care providers in each specialty are smoother because we’re already working together.”
In addition to our local in-house expertise, the team ensures they are continuing to improve treatment care for patients by participating in community education and research. LHSC is an active partner with the national patient advocacy organization Carcinoid-NeuroEndocrine Tumour Society of Canada (CNETS), helping to connect patients with important community-based resources and build awareness for the disease. Further, physicians at LHSC are collaborating with other NET experts in Ontario through various clinical trials, as well creating partnerships with international clinicians and scientists involved in the Commonwealth Neuroendocrine Tumour Group (CommNETS).
While NET cancers are curable by surgery if caught early, there is currently not a standard early screening protocol as there is with other more prevalent types of cancers. Additionally, with a lack of symptoms or very subtle symptoms like reddening of the face or heart palpitations that are easily mistaken for other health concerns, the disease itself is often difficult to diagnose. Most patients are not diagnosed with NET cancer until they are at a later stage where the cancer has spread to other areas.
“Despite the fact that most patients aren’t diagnosed until a later stage of this rare form of cancer, with the range of surgeries and treatments available today, people are still going on to live for many years with a good quality of life,” says Dr. Laidley. “The range of therapies has come such a long way over the past decade and I believe we’ll continue to see rapid improvements over this next decade. We’re constantly working to improve outcomes for our patients through research and awareness.”