Fighting neuroendocrine cancer takes guts- pancreatic cancer vs Neuroendocrine cancer

1. They are totally different cancers despite an anatomical relationship.  Although they can share a similar presentation, they can have different signs, different treatments, and vastly different prognostic outcomes. Anyone looking for useful information on either needs to be very careful on interpretation, they could end up with very bad advice and in some situations, become more concerned than they should be. (particularly with the prognostics).

2.Both Pancreatic Cancer and Neuroendocrine Cancer are diseases that need maximum publicity, both types of cancer have their own unique situations, thus why the awareness messages can be so vastly different. It’s really important, therefore, that publicity surrounding famous patients be attributed to the correct cancer type in order that the advocate organisations and supporters can gain maximum benefit to forward their causes. Unfortunately, thanks to doctors and media, this very often doesn’t work out in favour of Neuroendocrine Cancer due to the Human Anatomy of Neuroendocrine Cancer (this problem goes beyond the pancreas).

The pancreas is an organ that sits behind the stomach. It's shaped a bit like a fish with a wide head, a tapering body, and a narrow, pointed tail. In adults it's about 6 inches (15 centimeters) long but less than 2 inches (5 centimeters) wide.

The head of the pancreas is on the right side of the abdomen (belly), behind where the stomach meets the duodenum (the first part of the small intestine).

The body of the pancreas is behind the stomach.

The tail of the pancreas is on the left side of the abdomen next to the spleen.

Pancreatic neuroendocrine tumors, known as PNET, are also called islet cell tumors. They are a type of neuroendocrine cancer that starts in the pancreas. There are different kinds of PNET. Some PNET make and release different hormones. They also vary in size and how fast they grow.

PNET are different from other types of pancreatic cancer, because they form from neuroendocrine cells in your pancreas. Neuroendocrine cells are part of your body’s normal “control system.” When your brain and nervous system send messages, neuroendocrine cells release hormones and other chemical messengers to control bodily functions, like digestion, reproduction, airflow to the lungs, and responses to stress or injury.   

There are many subtypes of PNET; most are slow growing, but some may be aggressive.

The most common type of pancreatic cancer, adenocarcinoma of the pancreas, starts when exocrine cells in the pancreas start to grow out of control. Most of the pancreas is made up of exocrine cells which form the exocrine glands and ducts. The exocrine glands make pancreatic enzymes that are released into the intestines to help you digest foods (especially fats). The enzymes are released into tiny tubes called ducts which eventually empty into the pancreatic duct. The pancreatic duct merges with the common bile duct (the duct that carries bile from the liver), and empties into the duodenum (the first part of the small intestine) at the ampulla of Vater.

Endocrine cells make up a smaller percentage of the cells in the pancreas. These cells make important hormones like insulin and glucagon (which help control blood sugar levels), and release them directly into the blood. Pancreatic neuroendocrine tumors start in the endocrine cells. See Pancreatic Neuroendocrine Tumor for more about this type.

A neuroendocrine tumor (NET) begins in the specialized cells of the body’s neuroendocrine system. These cells have traits of both hormone-producing endocrine cells and nerve cells. They are found throughout the body’s organs and help control many of the body’s functions. Hormones are chemical substances that are carried through the bloodstream to have a specific effect on the activity of other organs or cells in the body. Most NETs take years to develop and grow slowly. However, some NETs can be fast-growing. See the Grades section to learn more.

NETs can begin in any part of the body, including:

Gastrointestinal (GI) tract. NETs develop most commonly in the GI tract, specifically in the large intestine (20%), small intestine (19%), and appendix (4%). The GI tract plays a central role in digesting foods and liquid and in processing waste. GI tract NETs used to be called carcinoid tumors. Learn more about NET of the GI tract.

Lung. The lung is the second most common location of NETs. About 30% of NETs occur in the bronchial system, which carries air to the lungs. Lung NETs also used to be called carcinoid tumors. Learn more about NET of the lung.

Pancreas. Approximately 7% of NETs can develop in the pancreas, a pear-shaped gland located in the abdomen between the stomach and the spine. Pancreas NETs used to be called islet cell tumors. Learn more about NET of the pancreas.

Insulinomas

These tumors release insulin, a hormone that lowers sugar levels in your blood. They may cause the following symptoms:

• Low blood sugar

• Nervousness

• Excess sweating

• Blurred vision

• Confusion

Glucagonomas

These tumors release glucagon, a hormone that raises sugar levels in your blood. They may cause the following symptoms:

• Diabetes (elevated blood sugar)

• Rash

• Weight loss

Gastrinomas

These tumors release gastrin, a hormone that signals your stomach to produce digestive acids and enzymes. They may cause the following symptoms:

• Ulcers

• Abdominal pain

• Diarrhea

• Heartburn

• VIPomas

These tumors release vasoactive intestinal peptide, a substance that stimulates the release of water and electrolytes in your intestines. They may cause the following symptoms:

• Watery diarrhea

Abdominal pain and cramping

Dehydration

Somatostatinomas

These tumors release somatostatin, a hormone that stops the release of other hormones, including gastrin, insulin, and glucagon. They may cause the following symptoms:

• Diabetes (elevated blood sugar)

• Diarrhea

• Weight loss

• Nonfunctional neuroendocrine tumors

Neuroendocrine tumors that do not release hormones are called "nonfunctional." These tumors in your pancreas may cause the following symptoms:

• Abdominal pain and cramping

• Weight loss

NETs can also begin in other organs. In about 15% of cases, a primary site cannot be found. Sometimes, NETs may develop in or on the adrenal glands. These rare types of NETs are called pheochromocytoma and paraganglioma. Other types of tumors that begin in hormone-producing cells are also described in their own sections on Cancer.Net, including thyroid cancer, adrenal gland tumors, and pituitary gland tumors.

A tumor begins when the DNA of healthy cells is damaged, causing the cells to change and grow out of control, forming a mass. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body if it is not found early and treated. A benign tumor means the tumor can grow but will not spread. A benign tumor usually can be removed without it causing much harm.

It is difficult to tell if pheochromocytoma and paraganglioma are benign or malignant, even after surgically removing the tumor and examining it under a microscope. The only sure way to know if a pheochromocytoma or paraganglioma is malignant is if it has spread, called metastasis, or if it comes back, called a recurrence.

Pheochromocytomas and paragangliomas are considered a subset of a group of tumors called neuroendocrine tumors (NETs). A NET begins in the specialized cells of the body’s neuroendocrine system. These cells have traits of both hormone-producing endocrine cells and nerve cells. They are found throughout the body’s organs and help control many of the body’s functions. Hormones are chemical substances that are carried through the bloodstream to have a specific effect on the activity of other organs or cells in the body. All NETs have the potential to become metastatic. Most NETs take years to develop and grow slowly. However, some NETs can be fast-growing. 

A pheochromocytoma is a rare NET of the adrenal glands. The body has 2 of these small, yellowish glands. One is on top of each kidney. Adrenal glands have 2 main parts that function separately: the outer adrenal cortex and the inner adrenal medulla. Each part produces a different set of hormones.

A pheochromocytoma begins in the chromaffin cells of the adrenal medulla. The cells release hormones called catecholamines during times of stress. Adrenaline and noradrenaline, which increase blood pressure and heart rate, are 2 of those catecholamines. A pheochromocytoma can cause uncontrolled surges of extra adrenaline and noradrenaline into the blood. Even though an estimated 90% of pheochromocytomas remain localized to the area they began, these hormone surges can still lead to life-threatening health problems, such as a stroke, heart attack, hemorrhage, or sudden death.

Most people develop a pheochromocytoma in 1 adrenal gland. Some people develop a tumor in both glands. There can also be multiple tumors in a gland. Pheochromocytomas usually grow slowly.

A pheochromocytoma is called a primary adrenal gland tumor because it starts inside an adrenal gland.

A paraganglioma is a rare NET that develops from the same type of cells that pheochromocytomas do. However, paragangliomas form outside the adrenal glands. These tumors are also called extra-adrenal paragangliomas. The majority of paragangliomas form in the abdomen. They can also form in other parts of the body, including near the carotid artery, along nerve pathways in the head and neck, and in the chest, heart, abdomen, pelvis, and bladder. Paragangliomas are less common than pheochromocytomas. An estimated 60% remain localized and 40% may spread, though that cannot be determined at the time of diagnosis or from the pathology evaluation  Paragangliomas are typically slow growing.

Maintain a healthy lifestyle

• Your doctor may suggest some things you can do to help make living with a NET as comfortable as possible.

• Light exercise: Mild activity, such as walking, is best and can help reduce stress

• Get a good night's sleep: Get plenty of sleep and take naps when you can

• Avoid stress: Make time for yourself to do things you enjoy and keep a positive attitude

 

Continue your daily routine

Your family members and caregivers will be there for you throughout this journey. Don't be afraid to ask them for help. They can help you with daily activities and also help you cope with your feelings. They understand that the most important thing is for them to be there for you.

Your loved ones can help:

• Provide emotional support

• Take notes and ask questions at your doctor appointments

• Keep track of your appointments and paperwork

Let the people in your life know how you feel and what you are going through. Asking them to be more involved can help you continue your regular routines.

Shoes

 As you get ill and had to have special food, 

Daily weather somber mood

Or a mood of merriment

Hopeful survival is an achievement

Within disagreements, bereavements 

There is positive movement

The inner part moodily, sullenly thoughtful 

Sarcastic, doubtful 

In the dark gloom those stinking humanity

Who cares about their vanity?

With dignity like a person coolly

The fierce and rude brings forth, a winning streak

Life is a vast and big cliff inspiring me to climb to the peak

Climbing alone, enjoy it.

I have my old miserable handed down muddy pair of boots

It's all about mistrust, narcissism, and disputes

The favorite shoes wore out, clothes wore out,

Had to stay in a house with windows broken; 

Wall is a disgrace;

The man and the woman bring brutality to the place

It seemed as if no sooner there was a little money in the money box but the huge evil spirit with a big appetite came and ate it up.

Hey, " Listen, boy, you're just your spouse's pup"

Magic and the Magician

From the Cosmos 

Makes me realize everything is not a chaos

With a disgraceful old pair of shoes

’his great dirty feet, without wipin’ ’is shoes.’

When you take a stroll in heaven's high paradise

Learn how to walk through doors because not having dirty feet, that's nice

You probably don’t have one, so pack my shoes

 And I’ll take you with me and wonderfully fit you into one of mine.

I bring you my passionate rhyme.

And you never realized the time.

 Time eateth all things

A marionette on strings

Life is reserved for foolish things

Yet I find my spirit sings

Life is a fairy story

Steeped in light and color of the glory

Domed vast roof of the universe

I hear the Creator's verse

In my tattered shoes

Endless thoughts, endless dreams, endless blues

‘I don’t mind admitting I’m down-hearted'

Blue and down-hearted

Back where all started …

"When I was just a little girl

I asked my mother, what will I be"

Futures not us to see said she

Quick-witted, talkative showing how you feel about people 

In the way that your witty communication with them. 

Being sympathetic, encouraging quick-witted, talkative, 

Showing how you feel about people

 In the way that you communicate with them, being sympathetic while encouraging

Cheerfully understanding

Content eating on good times

 Enlightening to ignoring bad periods

Live my slice of my life

A world ended trudging across life

Wearing my shoes

So much you'd deduce

Want me to tie the laces?

Fighting the incurable illness, people require money

 

The neuroendocrine system,Neuroendocrine cells are like nerve cells in some ways and like hormone-making endocrine cells in other ways.  Cells in this system don't form actual organs. Instead, they are scattered throughout other organs like the esophagus, stomach, pancreas, intestines, and lungs.

Neuroendocrine cells (sometimes just called endocrine cells) in the pancreas are found in small clusters called islets (or islets of Langerhans). These islets make important hormones like insulin and glucagon (which help control blood sugar levels), and release them directly into the blood.

Functioning neuroendocrine tumors are characterized by inappropriate release of biologically active polypeptides or amines causing the typical clinical presentation.

Therefore, determination of the “hypersecreted” hormone or amine is mandatory.

Both Pancreatic Cancer and Neuroendocrine Cancer are diseases that need maximum publicity, both types of cancer have their own unique situations, thus why the awareness messages can be so vastly different. It’s really important, therefore, that publicity surrounding famous patients be attributed to the correct cancer type in order that the advocate organisations and supporters can gain maximum benefit to forward their causes. Unfortunately, thanks to doctors and media, this very often doesn’t work out in favour of Neuroendocrine Cancer due to the Human Anatomy of Neuroendocrine Cancer.

Neuroendocrine neoplasms (NENs) display variable behaviors based on origin and grade. We assumed that both tumor origin and the location of metastasis may play a role in survival.

Site of metastasis plays an important role in survival of metastatic NEN patients independent of commonly described prognostic factors and should be considered in survival estimates.

Gallium-68-DOTA-NOC PET/CT appears to be a highly sensitive and specific modality for the detection of gastroenteropancreatic NET. It is better than conventional imaging for the evaluation of gastroenteropancreatic NETs and can have a significant impact on patient management.

The adoption of receptor imaging techniques such as radiolabeled octreotide or Gallium Dotatate PET/CT scans, which can identify occult metastatic disease is not uniform or consistent between practices.

Neuroendocrine tumours frequently metastasize to the liver. Although generally slowly progressing, hepatic metastases are the major cause of carcinoid syndrome and ultimately lead to liver dysfunction, cardiac insufficiency and finally death.

Platelet serotonin and chromogranin A are useful biomarkers for detection and follow-up of neuroendocrine tumour. Helical computed tomography and somatostatin receptors are the most sensitive diagnostic modalities.

Surgical debulking is an accepted approach for reducing hormonal symptoms and to establish better conditions for medical treatment, but is frequently impossible due to the extent of disease.

Carcinoids are neuroendocrine tumours that arise from neoplastic proliferation of enterochromaffin or Kulchitsky cells. In 1963, carcinoids were classified according to their embryologic site of origin as foregut carcinoids (respiratory tract, stomach, duodenum, biliary system and pancreas), midgut carcinoids (small intestine, appendix, cecum, and proximal colon), and hindgut carcinoids (distal colon and rectum). According to the WHO classification in 2000, distinction was made between well-differentiated neuroendocrine tumours (benign behaviour or uncertain malignant potential.

Neuroendocrine tumours of the small intestine produce large quantities of serotonin (5-hydroxytryptamine), reflected in raised levels of platelet serotonin and a high urinary excretion of 5-hydroxyindoleacetic acid (5-HIAA) . The platelet serotonin concentration is more sensitive in the detection of carcinoid tumours than urinary 5-HIAA, particularly in tumours with relatively low serotonin production. Circulating free serotonin is removed very rapidly and effectively by the liver. In contrast to urinary 5-HIAA, platelet serotonin is not affected by a serotonin-containing diet. Hence platelet serotonin is the most discriminating marker for detection of most neuroendocrine tumours. However, in hindgut carcinoids, hydroxylase and decarboxylase are absent and no serotonin is produced.

Plasma chromogranin A (CgA) has been claimed to be the most sensitive and specific marker of tumour volume. CgA is a precursor for several peptides and is stored in secretory granules of neuroendocrine tissue . Circulating CgA allows early detection of persistent or recurrent neuroendocrine tumours.

Your symptoms may depend on where your tumor is growing and what kind it is. They show a spectrum of behaviors and this makes their treatment challenging. Some exhibit an indolent, slow growth pattern, while others parallel the more aggressive, rapidly spreading tumors such as small cell lung cancer (SCLC); in between there are neoplasms of intermediate malignant potential.

In general, well- differentiated tumors progress slowly and surveillance may be the best approach in some cases, whereas poorly differentiated neoplasms require urgent aggressive chemotherapy and are associated with markedly shorter survival. Tumors of small bowel origin tend to have a better prognosis compared to NENs originating in the pancreas. The effect of other factors such as age, race, predictability, performance status or even marital status  has similarly been examined in several publications. Most medical decisions nowadays consider tumor of origin, staging, but also tumor differentiation.

While it is generally accepted that stage IV (presence of metastasis) portends a poor prognosis for most neoplasms including NENs, there is no consensus on the gravity and importance of metastatic sites, or how they interplay with the primary tumor site when it comes to survival estimates. It has been shown for example that the incidence of certain types of NETs has increased and that the survival of patients has improved over time . This has been partially attributed to treatments such as somatostatin analogues (time to progression prolonged by 8 months), targeted therapies such as everolimus  and sunitinib (progression free survival benefit of about 5 months for both), and hopefully pazopanib or peptide receptor radionuclide therapy (PRRT)  in the future. With the latest iteration, the SEER database was enriched to include details of general metastatic sites, including lung, liver, bone and brain. This presents a unique opportunity to study the behavior of metastatic neuroendocrine tumors across a range of sites and histologies. We sought to explore the behavior of NENs with regards to the site of origin and metastatic areas and hypothesized that the site of metastasis will carry different prognostic significance depending on tumor grade and tissue of origin.

When completely removing the tumor is not possible, "debulking surgery" is sometimes recommended. Debulking surgery removes as much of the tumor as possible and may provide some relief from symptoms, but it generally does not cure a NET.

It is usually measured in matters of months and may reflect the virulence of the tumor, the severity of CNS dysfunction or the inability of most current therapies to cross the blood brain barrier. In our study, median survival was a mere 7 months and it is worth mentioning that single site brain metastases were more prominent in lung and “other” primary but uncommon in pancreas and small bowel.

The rate of brain metastasis was high. It is usually measured in matters of months and may reflect the virulence of the tumor, the severity of CNS dysfunction or the inability of most current therapies to cross the blood brain barrier.

Treatment options and recommendations depend on several factors, including:

• The primary site (where the NET originated)

• Whether the tumor is functional

• Stage (where the tumor is located in the body)

• Grade and degree of differentiation (how fast the cells are dividing)

• Pace of growth

• Somatostatin receptor status (whether the tumor is bright on 68Ga DOTATATE PET)

• Possible side effects

• The patient’s preferences and overall health

Site of metastasis plays an important role for survival in metastatic NEN patients and is probably reflective of variable tumor biology, even among NENs of similar origin and grade. 

A promising approach is the concept of somatostatin receptor (SSTR)-mediated chemo-or radiotherapy of SSTR-expressing metastatic carcinoid.

Mind over matter

 

Considering the unremitting misery of their lives on Earth, 

Nobody shall measure other's worth

The wonderful song painted by nature

View the charms of nature;

Grand in feature,

Is too beautiful and long

Throughout my life, I went singing along.

Stark or courageous or strong

The warrior 

beams divine,

In pain grace, smile, and shine

Always serves a greater purpose

Life is street entertainment and a mix of arts of circus

The Creator is the begetter of ingredients of life,

 Create a song composing  in verse

Frequently mentioned as “charity,” the word becomes from a Hebrew root meaning “righteousness” and “justice.” 

The Universe is rich and full in sound, as language or verse.

Imagine the despair which leads to suicide

 Yet 'despair' only reminds me of my 'hair'--and because  I have known despair I value  'hope' 

Makes me think of detergent or soap

Intelligence and adaptability of modern virus

Inspire us by transmitting from host to host

Some take it a step further.

To increase their number

Neuroendocrine tumors (NET) are a group of diverse neoplasms arising from cells of neuroendocrine origin. 

I strive to conquer my fundamental demons, 

Striving to stop the war within my mind

People who are kind.

These people are my heroes

When I am on the fringes of life

Person and experience of the person, and struggles to survive his ailment 

Makes Heroes, Victims, Martyrs, Warriors

Neuroendocrine tumors (NETs) are rare tumors that start in neuroendocrine cells. 

Not suffering r from others' dramas.

Most NETs develop slowly over some years. 

My old homes scenes of my childhood

Few fond memory appears 

They may not cause symptoms in the early stages. 

It’s not unusual for people to find that a NET has already Spread to another part of the body

None will treat you right, but get shoddy

 When they are diagnosed. 

Well not to worry, it's not what I supposed

The hypnotic clarity you realize they are ghosts

When cancer spreads to another part of the body, it is called metastasis. 

Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

Put yourself in my shoes... How do you think you would feel or react when you find yourself in my situation?

How do you think you'd react to death?

 Nausea and mortification came over them in waves

Being sick and tired of life

Life itself is contradictory only death is consistent

The warrior's keen wit, strong will, and sheer intelligence.

The ability of Mind over matter

Uses their willpower to rise above adversity.

Bask in uncertainty

Right knowledge enables to exist on the

brink of uncertainty.

Close to death right at the nick of time, survival for her is second nature

Controlling  a physical condition, problem, 

By using the mind is the ability to keep going

 Even when you feel tired

 Is a simple question of mind over matter.

Oh! What's the matter? What's the matter?

A useless clatter

I don't mind and you don't matter

Human existential angst - being aware that death is inevitable, 

but not knowing, at any given moment, exactly when or how it might occur!!!

A theoretical worry which you can never infer.

FDAapproved Belzutifan (Welireg) for the treatment of renal cell carcinoma (RCC), pancreatic neuroendocrine tumors (pNET) and hemangioblastomas (HB) in adult VHL patients. The medication is likely to be available for prescription in September 2021.

 

The VHL-associated cystic lesions are generally asymptomatic and do not require any treatment, unless they are indistinguishable from other cystic tumor types with malignant potential. Because pancreatic NET in VHL disease are non-functioning and have malignant potential, it is of clinical importance to find and diagnose these as early as possible.

Tumor types seen in VHL disease include hemangioblastomas in the CNS and retina, renal cell carcinoma, pheochromocytomas and pancreatic neuroendocrine tumors (NET). During their growth, these tumors impair the function of the primary organs and sometimes metastasize to distant organs, and thus are thought to have malignant potential.

VHL disease, NET, can be locally invasive and can metastasize, resulting in much higher clinical significance. NET occurs in 8%-17% of patients with VHL disease. 

Neuroendocrine neoplasms (NENs) are rare malignancies of the aerodigestive, genitourinary and integumentary systems. Their histologies vary from well-to-moderately differentiated neuroendocrine tumors (NETs) to poorly differentiated neuroendocrine carcinomas (NECs) and their natural history has been described in several publications. Most studies are limited due to the small number of cases, inconsistent follow-up or retrospective nature but it is clear, however, that the incidence of NENs is increasing  and that, at least for certain subtypes, survival might be improving.

NENs show a spectrum of behaviors and this makes their treatment challenging. Some exhibit an indolent, slow growth pattern, while others parallel the more aggressive, rapidly spreading tumors such as small cell lung cancer (SCLC); in between there are neoplasms of intermediate malignant potential. Research so far has identified stage, site of origin  and differentiation as well as proliferative indices (Ki-67, mitotic count) as important prognostic factors and multiple scores have been published, trying to predict survival in metastatic disease or recurrence after curative surgery . In general, well- differentiated tumors progress slowly and surveillance may be the best approach in some cases, whereas poorly differentiated neoplasms require urgent aggressive chemotherapy and are associated with markedly shorter survival. Tumors of small bowel origin tend to have a better prognosis compared to NENs originating in the pancreas. Most medical decisions nowadays consider tumor of origin, staging, but also tumor differentiation and mitotic indices (values that have formed the basis of the current grading system).

While it is generally accepted that stage IV (presence of metastasis) portends a poor prognosis for most neoplasms including NENs, there is no consensus on the gravity and importance of metastatic sites, or how they interplay with the primary tumor site when it comes to survival estimates. 

It has been shown for example that the incidence of certain types of NETs has increased and that the survival of patients has improved over time . This has been partially attributed to treatments such as somatostatin analogues (time to progression prolonged by 8 months), targeted therapies such as everolimus and sunitinib (progression free survival benefit of about 5 months for both), and hopefully pazopanib or peptide receptor radionuclide therapy (PRRT)  in the future. With the latest iteration, the SEER database was enriched to include details of general metastatic sites, including lung, liver, bone and brain. This presents a unique opportunity to study the behavior of metastatic neuroendocrine tumors across a range of sites and histologies. We sought to explore the behavior of NENs with regards to the site of origin and metastatic areas and hypothesized that the site of metastasis will carry different prognostic significance depending on tumor grade and tissue of origin.

It is of clinical importance to find and diagnose pancreatic NET in patients with VHL as early as possible. It is recommended that comprehensive surveillance for abdominal manifestations in VHL patients including pancreatic NET should start from the age of 15. In general, pancreatic NET with or without VHL disease show a slow growth phenotype and patients have a good prognosis. VHL patients at lower metastatic risk from pancreatic NET should be spared the risks of surgical resection.

Lung, liver, bone and brain metastases were observed in and 6% of metastatic patients respectively.

Pancreatic NETs that have not spread outside the pancreas should be completely removed, if possible, because these tumors are more likely to be cured with surgery. Sometimes, however, after the surgeon starts the operation it becomes clear that the cancer has grown too far to be completely taken out. The general metastatic sites, including lung, liver, bone and brain.

Site of metastasis plays an important role for survival in metastatic NEN patients and is probably reflective of variable tumor biology, even among NENs of similar origin and grade.

• Alex Trebek

• Steve Jobs

• John Hurt

• Alan Rickman

• Sally Ride

• She was one of America’s first female astronauts

Not naming the Hollywood actors and actresses but Indian 

• Irrfan Khan

lost their lives to neuroendocrine tumours.

On August 13, 2021, the US Food and Drug Administration (FDA) approved Belzutifan (Welireg) for the treatment of renal cell carcinoma (RCC), pancreatic neuroendocrine tumors (pNET) and hemangioblastomas (HB) in adult VHL patients. The medication is likely to be available for prescription in September 2021.