Neuroendocrine tumors (NETs) can occur in any organs where endocrine cells are normally present: in the gastrointestinal tract, lungs, thymus, kidneys, ovaries, prostate, mammary and thyroid glands, skin. Neuroendocrine cancer is rare with usually slowly growing tumors in which a significant deterioration in the quality of life of patients, even in the presence of metastases, occurs at a late stage of the disease.
The neuroendocrine system is represented by cells located in various organs: the digestive tract, thyroid gland, adrenal glands, respiratory tract, etc. These types of cells perform regulatory functions and are also able to synthesize biologically active substances, including hormones. Neuroendocrine tumors are classified as malignant (Merkel's cancer, neuroendocrine thyroid cancer) and mixed neoplasms, for example, pheochromocytomas or carcinoids, which have the potential for malignant transformation.
Neuroendocrine tumors are functional, in other words, they are characterized by the production of hormones. For example, pheochromocytoma produces large amounts of adrenaline and norepinephrine, leading to persistent arterial hypertension that can threaten the patient's life. Treatment of neuroendocrine cancer is mainly surgical but can also include chemotherapy. Cancer treatment is complemented by measures to normalize hormonal balance, as well as – if we are talking specifically about malignant neoplasms – chemotherapy and radiotherapy.
Neuroendocrine tumors (NETs) of the abdominal and retroperitoneal organs account for about 20% of all neoplasms of the gastrointestinal tract, pancreas, and other organs, and about 2% of all malignant neoplasms. Neuroendocrine cancer’s most frequent localization is the gastrointestinal tract (about 73.7% of cases) and the bronchopulmonary system (about 25.1% of cases). Within the gastrointestinal tract, neuroendocrine cancer is localized in the small intestine (about 28.7% of cases), the appendix (about 18.9% of cases), and the rectum (about 12.6% of cases). The overall 5-year survival rate of neuroendocrine cancer patients regardless of location is about 67.2 – 82%.
Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms originating from neuroendocrine cells of the embryonic intestine with biologically active properties. Neuroendocrine cancer can occur in any organs where endocrine cells are normally present. Thus, given such a wide range of NETs, your doctor of potentially any specialty can encounter NETs in the practice (however, it should be noted that in most cases, your doctor can be unfamiliar with neuroendocrine cancer).
Of course, the question arises about the incidence of NETs. More recently, it was believed, and the majority of doctors continue to have a stable idea that neuroendocrine cancer is a rare pathology. However, data from large population studies suggest the opposite.
The approximate incidence of neuroendocrine cancer is 5 per 100 thousand people per year. Considering that the majority of neuroendocrine tumors are characterized by relatively slow growth, the true incidence is much higher and amounts to approximately 35 per 100 thousand people per year. Besides, the incidence of neuroendocrine cancer is growing significantly faster than other types of cancer. Of great interest is the fact that neuroendocrine tumors of the gastrointestinal tract are more common than cancers of the stomach and pancreas (pancreas) combined. Such a significant increase in the frequency of occurrence can probably be explained, firstly, by the improvement of diagnostic methods, in particular, endoscopic, and, secondly, by the availability of high-precision imaging methods, such as computed and magnetic resonance imaging. Considering that in the future there will be improvements in diagnostic methods, as well as their widespread introduction, it can be expected that neuroendocrine cancer will be detected even more often.
For neuroendocrine cancer, a completely different clinical course is typical, in particular, the rate of progression and response to therapy. However, there is no doubt that the earlier the diagnosis is made, the more effective the treatment will be.
This important fact is proved by data on the survival rate of patients with neuroendocrine cancer, depending on the prevalence of the disease.
So, the obligatory participation of the therapist in the diagnosis of neuroendocrine cancer is primarily since the clinical picture of NET corresponds to diseases from completely different disciplines. In addition to specific clinical syndromes, for example, Cushing's syndrome or acromegaly, caused by hypersecretion of cortisol and growth hormone, respectively, in most cases there are non-specific symptoms.
So, the following clinical manifestations are most common for neuroendocrine cancer:
- Hot flashes
- Damage to heart valves
- Bronchoconstriction syndrome
Rarely discussed syndromes in this cancer are:
- Diabetes, metabolic syndrome, non-alcoholic fatty liver disease
- Arterial hypertension
- Pigmentation, arthropathy
- Ulcerative lesion, rash
- Mental disorders
Thus, the manifestation of NET symptoms often mimics a large number of different diseases common in the general population, the diagnosis, and treatment of which are performed by a primary care physician – your doctor. The natural development of NET is accompanied by the so-called carcinoid syndrome.
For about 10–12 years, patients with this type of NETs are diagnosed with irritable bowel syndrome, and at the time of establishing an accurate diagnosis of NET, there is already a distant spread of the disease, while we remember that the patient's survival depends on the prevalence of the process. Thus, taking into account, first, the high prevalence of NETs, which is most likely to continue to increase; secondly, a polymorphic clinical picture of NETs, which is characterized by nonspecific and widespread symptoms and syndromes in the general population; thirdly, a more optimistic prognosis with early diagnosis of NETs and prescription of therapy, your doctor plays an initiating role in the treatment of NET, the importance of which cannot be overestimated.
Treatment of neuroendocrine cancer begins with diagnostics, during which the tumor is visualized, its size and localization are assessed, the histological type of tumor and the stage of cancer are established. Methods used in the diagnosis of neuroendocrine tumors include:
- Primary examination and consultation with your doctor
- Examination and consultation with an oncologist
- Detailed biochemical blood and urine tests to determine the concentration of hormones or other substances
- Blood test for chromogranin A
- PET-CT with somatostatin
- Computed tomography, magnetic resonance imaging
Biopsy and histopathological examination are necessary to establish whether the lesion is benign or malignant. Biopsy of neuroendocrine tumors is not always technically possible, and in such cases, the diagnosis is made based on indirect signs.
- Immunohistochemical analysis
Neuroendocrine tumors can have several specific characteristics: genetic characteristics, the presence of certain proteins in the cell membrane, etc.
Chemotherapy is commonly used to treat and manage neuroendocrine tumors (NETs). Your doctor may prescribe chemotherapy for certain reasons including:
- Control of symptoms caused by too much of certain hormones being released by a tumor (functional tumor)
- Slowing down of the growth and symptoms of cancer
- Destruction of neuroendocrine cancer cells
- Relieving the symptoms of neuroendocrine cancer (palliative therapy)
Your doctor will consider your personal needs to plan the chemotherapy, doses, and schedules of treatment. Your doctor may decide on a combination of different drugs or other treatments with chemotherapy.
Chemotherapy uses anticancer drugs to destroy cancer cells. It is usually only used to treat poorly differentiated neuroendocrine tumors when other treatments don’t work or can’t be used.
Chemotherapy may be a systemic therapy, which means that the drugs travel through the blood to reach and destroy cancer cells all over the body. Chemotherapy may also be local. Local chemotherapy is given to a specific area of the body. Chemoembolization can be used to deliver chemotherapy directly to metastatic tumors.
Your doctor will choose the chemotherapy drugs or their combination depending mainly on where cancer originated. Chemotherapy drugs used alone or in combination to treat NETs include:
- Capecitabine (Xeloda)
- Temozolomide (Temodal)
- Streptozotocin (Zanosar)
- 5-fluorouracil (Adrucil, 5-FU)
- Carboplatin (Paraplatin, Paraplatin AQ)
- Etoposide (Vepesid, VP-16)
- Doxorubicin (Adriamycin)
The overall goal of the treatment of neuroendocrine cancer is to remove the primary tumor and metastases.
In the case of widespread tumor processes, the presence of metastases and recurrence of NETs, cytoreductive methods are used to reduce the tumor mass before chemotherapy.
A promising area is the study of combination therapy with chemotherapy and targeted therapy.
For patients with inoperable and metastatic NETs, peptide receptor radionuclide therapy with somatostatin analogs is preferred. The effectiveness of chemotherapy drugs differs depending on the expression of different subtypes of somatostatin receptors by NET cells and the possibility of penetration of chemotherapy drugs into the tumor tissue. The response to treatment is determined using biochemical markers (chromogranin A) and imaging techniques (CT and MRI).
Thus, the use of chemotherapy for the treatment of neuroendocrine cancer allows your doctor to effectively control the hormonal syndrome of overproduction of regulatory peptides, significantly improving the quality of life of cancer patients.
Where can I undergo treatment with chemotherapy abroad?
Health tourism becomes more and more popular these days, as medicine abroad, often ensures a much better quality of treatment with chemotherapy.
The following European hospitals show the best success rates in the treatment of neuroendocrine tumors with chemotherapy:
- MediClin Robert Janker Clinic, Germany
- Medias Cancer, Clinic Burghausen, Germany
- Memorial Sisli Hospital Istanbul, Turkey
- Memorial Bahcelievler Hospital Istanbul, Turkey
- University Hospital Ulm, Germany
You can find more information about the European hospitals on the Booking Health website.
The cost of treatment with chemotherapy
The prices in European hospitals listed on Booking Health are relatively low. With Booking Health, you can undergo treatment of neuroendocrine tumors with chemotherapy at an affordable price.
The cost of treatment varies, as the price depends on the hospital, the specifics of the disease, and the complexity of its treatment.
The cost of treatment with chemotherapy in Germany is 6,949 – 9,893 EUR.
The cost of treatment with chemotherapy in Turkey is 3,766 – 3,896 EUR.
You might want to consider the cost of possible additional procedures and follow-up care. Therefore, the ultimate cost of treatment may differ from the initial price.
To make sure that the overall cost of treatment is suitable for you, contact us by leaving the request on the Booking Health website.
How can I undergo treatment with chemotherapy abroad?
It is not easy to self-organize any treatment abroad. It takes certain knowledge and expertise. Thus, it is safer, easier, and less stressful to use the services of a medical tourism agency.
As the largest and most transparent medical tourism agency in the world, Booking Health has up-to-date information about the treatment of neuroendocrine tumors with chemotherapy in the best European hospitals. We will help you select the right clinic taking into account your wishes for treatment.
We want to help you and take on all the troubles. You can be free of unnecessary stress, while Booking Health takes care of all organizational issues regarding the treatment. Our services aimed at you safely and successfully undergoing treatment of neuroendocrine tumors with chemotherapy.
Medical tourism can be easy!
All you need to do is to leave a request on the Booking Health website and our manager will contact you shortly.