Help before nemesis

Creation of men who has anger and ego stuffed inside was a bad move of the Cosmic project

He who laughs longest

With a tattered body

Loves to study

Standing up to every test

Met the worst with her best

The diarrhea might tell you the truth 

Symptomatic brain metastases

With dismal prognosis

Early detection and treatment is advisable

Well, I say you can't indemnify

So medical men think about it detect and identify

Before there are more irredeemable losses.

Hah! They heard it for the first time and I am dealing with it mostly in brain in Irrfan Khan's case this is laudable 

The neuroendocrine system comprises a complex architecture of cells that are capable of producing neuroendocrine neoplasms (NENs) throughout the body. These cells are found diffusely throughout different organs and are well described throughout the gastrointestinal tract, the respiratory tract and within the central nervous system (CNS). While NENs are known to develop in all of the aforementioned systems, there are only few reports to suggest NENs originating primarily from the brain. Neuroendocrine cells are naturally involved in the coordination of neurotransmitter-initiated synthesis and release of biologically active substances. Therefore, NENs possess unique properties such as secreting physiologically active amines and peptidyl hormones which allow NENs to retain unique methods for identification.

The incidence of NENs has been prominently increasing over the past two decades.This is believed to be secondary to increased detection rates. While the incidence is increasing, these tumours are still very uncommon, and they account for only 4%–6% of all extracranial malignancies.NENs most commonly arise from the lungs, liver and the gastrointestinal tract.

In rare instances, NENs can metastasize to the CNS. The incidence of patients with NENs having brain metastases is <5%. Furthermore, only 1.4% of metastatic brain tumours are NENs, and the majority of these lesions originate from primaries in the lung.6 When patients do present with metastatic NENs to the brain, they typically present with other local and distant metastases.

Often, when NENs of the brain are discovered as the first sign of disease, an extracranial primary tumour is discovered on further diagnostic imaging. In cases when the extracranial NENs are diagnosed first, the time to brain metastasis is an average of 13 months. Brain metastases are associated with a poor prognosis, with a median overall survival of 8 months from the diagnosis of CNS involvement. However, the leading cause of death in patients with metastatic CNS NENs is secondary to systemic disease progression itself, with the majority of cases being associated with organ dysfunction (eg, liver failure).

Primary NENs versus NEN metastases to the brain, and that longer periods of surveillance are likely required for primary NENs. This is important because the prognosis between primary NENs and metastatic NENs to the brain are vastly different and should not be treated as equal diseases. An unfortunate patient eventually died of her recurrence secondary to complications of a ventriculoperitoneal shunt placed for treatment of hydrocephalus from the disease.

Brain metastases are associated with a poor prognosis, with a median overall survival is dismal from the diagnosis of CNS involvement. However, the leading cause of death in patients with metastatic CNS NENs is secondary to systemic disease progression itself, with the majority of cases being associated with organ dysfunction (eg, liver failure).When patients do present with metastatic NENs to the brain, they typically present with other local and distant metastases.Worsening headaches, nausea and emesis.

Help before nemesis.

Creation of men who has anger and ego stuffed inside was a bad move

 He who laughs longest

With a tattered body

Loves to study

Standing up to every test

Met the worst with her best

The diarrhea might tell you the truth 

Symptomatic brain metastases

With dismal prognosis

Early detection and treatment is advisable

Well, I say you can't indemnify

Serious trouble will bypass you 

Just because there's a smile on you

Doesn't mean you're 

Helping with your head off,

Your encouraging words

"You want to get any test you want..

Pay for it and get it done wherever you want"

Successfully fend off the ailment

Rasping, hacking, coughs

While breathing

Weezing can hear my own breath

Whanging headache

Its a cold in the nose

Its a pain in the neck

It'll make me a wreck

Will life never treat me decently?

 I am wracked by despair!

 My head is pounding

Shaky and infirm and unable to hold

Being deaf can't hear what Mum told

I don't swallow what other people told me

Never being able to swallow

Haunting events follow

Rasping, hacking, phlegm-laden noise follow

The engine started long time ago

With signs of going slow

Always forgetting to slow down

With maximum battery charge

War drums beating, giddy as the World is large

Never took a slow, idle, leisurely walk

Had an opportunity to incessantly talk

My life slowed down

Before the car started moving forward

One terrible night nausea attacked 

Oh, this is a true yet funny fact

Circumstance or fact, situation

Psychologically inspired destination

Slimy stuff came out while having dinner.

Destined to make me thinner

 It was awful on 10th February

Shitty scary

 I had diarrhea and vomiting the entire night

 In the morning I saw in the process I lost weight. 

Being overweight 

I was overjoyed to become  slimmer.

Medics had forgotten about my hypodense pancreas areas

Careful monitoring

 Lethal cancer , the body harbouring

Early detection, and appropriate treatment,

Frequent maltreatment

Is common as medical men wear degrees as ornaments

Their Demonic side was produced

As I have them few news

 The most harmful consequences can be greatly reduced, 

Or in some cases even prevented entirely.

Loathe the laughter and happiness 

Of a happy sufferer 

 So you dare feel guilty

As they having such a good time 

When a friendly prey is struggling

 Your path is what you  create for yourself. 

You shall be  reaping what you have sown.

Knowledge is not your own

Fighting lethal cancer with knowledge, spirit, strength confidence

 I've never been in low spirits

Intelligence, confidence, the strength of spirit

Never been dispirited: deprived of spirit, hope, enthusiasm

While crossing the deep chasm

Living in a fractured World 

Invigorating effect on my body and my spirits

But O, sick people of the world,

Are always hurled

Forget your troubles and let your woes lay

And when again there's morning they'll wash away

Put me in a gale of laughter spirits will rise more

There was the shrieking  of a door

 Being torn from its rusty, creaky hinges

Anything worth dying for is certainly worth living for

That I am  here--- that life exists,

 And identity, that the powerful play goes on

The meanness of spirit, slowness of intelligence

I was not sick of any fear from thence

My best defense is belligerence

All dumb arrogance 

In a soup of anger, frustration ,fear

Without broadcasting it

Feel so good to say

A deeper sense of satisfaction

PRRT is recommended for patients who have somatostatin receptor-positive

Vibes I got from medical folksies so  negative 

As a matter of fact that sound the opposite

If you don't have a stable but progressive NET cancer

As I qualify for PRRT thats my  best answer

To win the War.

 Receiving a dose of amino acid solution through an IV to protect the kidneys from radiation

Like chemotherapy it's not a tradition.

 By reducing how much radiation they absorb. 

They don't blunder, bungle or poorly perform

Then, octreotide, a synthetic cell-targeting protein, or peptide, 

Life has been ebb and tide

Neuroendocrine tumors (NETs) are neoplasms derived from nerve and endocrine cells.

Hippocrates is often credited with developing the theory of the four humorsm

—blood, yellow bile, black bile, and phlegm—and their influence on the body and its emotions.

NETs have the ability to produce hormones and have similarities with nerve cells, 

NETs were called “carcinoid” 100 years ago and were considered benign neoplasms. 

Metastatic disease is a major prognostic factor in neuroendocrine neoplasms

 in addition to differentiation and proliferation rate 

Currently they are considered to be malignant, WHO's histopathological classification eliminated the “carcinoid” label in 2000.

In the WHO classification of 2010, NETs were defined as neuroendocrine neoplasms and were classified as NET G1, NET G2, NEC (large cell or small cell type), mixed adeno neuroendocrine carcinoma (MANEC), hyperplastic, and preneoplastic lesions, by the Ki-67 index.

NETs are increasing and are therefore attracting interest and attention.

Generally, the majority of metastases occur in the liver, lungs, and bone.

As during acidity they shone

Other sites are rarer, and brain metastases are very rare.

Here we present a probable primary brain NET. To knowledge, this is the first reported case of a primary NET arising in that anatomical location.

Brain metastases (BM) are rarely reported in patients with neuroendocrine carcinoma (NEC) of non-lung origin and neuroendocrine tumors (NET) of the gastro enteropancreatic (GEP) or bronchopulmonary system.

Nobody ever miss'd them.

But her tight fisted mastery and ego missed them

 However, symptomatic brain metastases are associated with dismal prognosis, so early detection and treatment could be advisable

In almost all cases, the presence of BM was a characteristic of a systemic dissemination

 And disease progression.

Symptomatic brain metastases are associated with dismal prognosis, so early detection and treatment could be advisable

Proteins are made of amino acids arranged in a linear chain joined together by bonds of peptide

 Is combined with a small amount of radioactive material,

Or radionuclide, to create a radiopeptide.

When the radiopeptide is injected into a patient’s bloodstream, it binds to protein receptors called somatostatin receptors, located on NET cells,

Delivers high doses of radiation to the tumor. Because it’s a systemic treatment,

Like lock and key they tell

She isn't a doctor who's halfway decent

PRRT targets NETs with somatostatin receptors anywhere in the body.

Her work has always been shoddy

The amino acid solution is also delivered to PRRT patients Post radiopeptide injection.

For years some practiced practiced at the art of deception

Because small amounts of radiation may remain in the body, patients are generally advised to take certain precautions after treatment, especially for the first one to two days.

NETs that cannot be removed with surgery

 Are typically treated with hormone therapy 

to control symptoms and tumor growth. 

But in cases when tumors continue to grow despite treatment,

Would use PRRT who's halfway decent

Use of contrast agents has resulted in reduced radiation, while maintaining image quality. 

"If you want my advice or support..you cannot dictate what test or scan I do and how"

"You want to get any test you want..pay for it and get it done wherever you want"

Well, I say you can't indemnify the loss to my health 

Ma'am Director of Nuclear Medicine at FMRI just concerned about power, wealth, rank 

Momma you stank

Wise yourself up

Instead of talking pointedly

Primary well-differentiated neuroendocrine tumors arising in the intracranial portion of the central nervous system (CNS) are occasional findings.

 

On the other hand, the CNS more frequently represents a metastatic site for primary poorly differentiated NET arising elsewhere, most often in the lung (small-cell lung cancer) .

In such cases, other secondary lesions, such as liver, lung and lymph nodes metastases, are often detected synchronously or metachronously with CNS localizations.

Patients with brain metastases are rare;

"Payal...there are many centres offering PRRT..please go to them. I will never do what I am not convinced will help my patient."-- don't prefer tyrant 

You define them as you call this one ignorant

Thinking they are the masters under the illusion of wealth, 

Facts are superior to lies,

Conflict between science and ethics

And lies cannot cover up facts

 Desired superiority thinking of attainments

Calcifications are visible within the necrotic areas of a tumor nest

My spleen isn't a jest

Neuroendocrine differentiation was confirmed using the following immunohistochemical markers: 

Chromogranin, synaptophysin and neural cell adhesion molecule.  

 With one study reporting a median survival time of 10.0 months after diagnosis of brain metastases 

Overall, brain metastases occur in 1.5–6% and their detection is usually preceded by the documentation of the primary, extracranial tumor 

Nevertheless, neuroendocrine markers have been found to be overexpressed in rare oral neuroendocrine tumors, 

But also in quite common inflammatory conditions, such as severe periodontitis. 

The monitoring of neuroendocrine markers is, thus, a common factor of interest among dentistry and neurology: the analysis of neuroendocrine markers in oral diseases may be predictive and prognostic about the severity of neurological ailments

There are only a few reports to suggest NENs originating primarily from the brain. Neuroendocrine cells are naturally involved in the coordination of neurotransmitter-initiated synthesis and release of biologically active substances.

Therefore, NENs possess unique properties such as secreting physiologically active amines and peptidyl hormones which allow NENs to retain unique methods for identification

People are too complicated to be figured out objectively, plus they are known to change their minds! 

When you hear hoofbeats, think of horses not zebras

The wrongness of the moment

So frivolous, so ridiculous!

Gotten more out of life!

Slow and scary, deadly scatteredly.

 If there’s a word that is synonymous with cancer, it’s chemotherapy.  It’s what most people have in their mind when they are talking to a cancer patient…… ‘have you had chemotherapy‘ or ‘when do you start chemotherapy‘.

An acquaintance asked nonchalantly some time ago ‘how did you get on with chemotherapy’ – he was surprised to hear my daughter hadn’t had it despite her widespread disease.  Cue – lengthy explanation!  I wasn’t annoyed by the question; I just think people automatically assume every cancer patient must undergo some form of systemic chemotherapy.  If you read any newspaper article about cancer, they do nothing to dispel that myth, as many articles contain a story about a cancer patient with no hair.

Sure, chemotherapy is not the nicest treatment to receive, and it does have pretty awful side effects for most. I, watching my daughter go through 3 or 4 months of this treatment where she seemed to be confined to a combination of her bedroom and her bathroom.  And it did shock me to see her without hair after radiation therapy.  I would never want anyone to go through that and it really brings it home when it happens to a close member of your family.

Despite its terrible news 📰 in regard to toxicity and its awful side effects, chemotherapy is widely used in many cancers.  Statistics show that it does work for many patients even my daughter  was pushed to it . However, I suspect it has a limited future as more efficient and less toxic drugs and delivery systems come online downstream. 

Biopsy is the gold standard to confirm the diagnosis but does not differentiate between pheochromocytomas and paragangliomas. Since most paragangliomas are vascular, a preoperative biopsy is not common.

Reside in ignorance. Where ignorance is the Master They handover prescription for disaster; If you don't know either you loose your life being a scapegoat or be blocked by doctors who are supposed to keep themselves updated and save the lethal Neuroendocrine Cancer warrior fighting since 3 years old of a genetic mutation One is named as king of the sky, the doctor of hormones Went into warzones, the next whose negligence pushed me to last stage is always proud and egotistical about mastery, wealth, superiority, this she's most desired. As for her eminence.the protegee smelly as my poop akin to perfume

Immunotherapy is often used as a replacement for chemotherapy, but this may be a while yet.  So, for now, millions of cancer patients worldwide will continue to be prescribed chemotherapy as part of their treatment regime. What if the patient is immunocompromised?

However, for some cancers, chemotherapy is not particularly effective. Neuroendocrine Tumours (NETs) is one such cancer, particularly for the low-grade of well- differentiated tumours, although but can be more effective in particular anatomical locations and at the higher numbers in Grade 2 and in Grade 3 well differentiated NET. It’s a first line therapy for most poorly differentiated Neuroendocrine Carcinomas.   I’m not saying the lower grades will never receive chemotherapy – that door is always left open for those with progressive cancer who perhaps have run out of treatment options. 

Putting Grade 3 to one side, I’ve heard people say that NETs is the ‘good‘ cancer or the ‘good looking’ cancer often citing the chemotherapy thing as some justification. That is of course a stupid thing to say.  I accept that not everyone will lose their hair and not every chemo will cause hair loss.

Here’s the message.  Many other treatments come with pretty challenging side effects. Moreover, the side effects and the consequences of these other treatments can last for some time, and for many, a lifetime. For example, with NETs:

Surgery can be pretty extensive, in some cases radical and life changing.  Many cancer patients receive surgery for NETs which is still the only real ‘curative’ treatment, although for most, it’s cyto reductive or palliative in nature.  If you lose bits of your small intestine, large intestine, liver, spleen, cecum and appendix, gallbladder, stomach, rectum, lungs, pancreas, thyroid, parathyroids, pituitary gland, adrenal gland, thymus gland, ovaries, oesophagus (…….I could go on), this comes with various side effects which can present some quality -of - life issues.  There can be huge consequences of having this treatment.

Other ‘consequences’ of cancer surgery include (but are not limited to), pulmonary emboli (blood clots), lymphedema, short bowel syndrome, gastrointestinal malabsorption, diabetes.

Somatostatin Analogues do a great job, but they do add to some of the effects of surgery (e.g. malabsorption).

Even the so-called ‘silver bullet’ treatment Peptide Receptor Radio Nuclide Therapy (PRRT) can have pretty severe side effects and presents some risk to kidneys and bone marrow as a long-term consequence.

I am adviced this

The thyroid gland is not visualised (post thyroidectomy). Coalescing enhancing nodular areas are noted in the location of right lobe of thyroid, abutting the right lateral and anterior wall of trachea. The confluent lesion in this location measures 2.7 x 2.3 x 1.5cm in size. A smaller enhancing area is noted in the location of left lobe of thyroid, abutting the tracheal wall, measuring 1.0 x 0.7 x 0.6cm in size. Multiple calcified nodular lesions are seen in both lung fields, relatively larger and more in number in the upper lobes, suggestive of old granulomatous lesions. Fibrotic bands are also noted in both lungs. Air trapping is noted in both lung fields. Few small thin walled cysts are also noted in both lungs. Diffuse inhomogenous mosaic pattern enhancement is noted in the liver parenchyma in arterial phase Right kidney is normal in position and size. Few small subcentimeter sized cysts are noted in right kidney, the largest in its upper pole measuring 0.9 x 0.8cm. The largest cyst in upper pole of right kidney shows relatively higher attenuation in non contrast sections, suggestive of a complex cyst (Bosniak type 2). There is no hydronephrosis or ureteric dilatation. Left kidney is normal in position and size. Areas of cortical scarring are noted in left kidney, more prominent in the upper polar region. A simple cyst is seen in its mid polar region in peripelvic location, measuring 2.7cm in diameter. Another small subcentimeter sized simple cyst is also noted peripherally in its mid polar region. There is no hydronephrosis or ureteric dilatation. A hypodense mass is noted in uterus, which may represent a fibroid. The thyroid gland is not visualised (post thyroidectomy). Coalescing enhancing nodular areas are noted in the location of right lobe of thyroid, abutting the right lateral and anterior wall of trachea. The confluent lesion in this location measures 2.7 x 2.3 x 1.5cm in size. A smaller enhancing area is noted in the location of left lobe of thyroid, abutting the tracheal wall, measuring 1.0 x 0.7 x 0.6cm in size. CT study reveals focal enhancing areas in the location of right and left lobes of thyroid gland, relatively larger on right side. These are seen in the last PET-CT study of 07/02/2022 Multiple calcified nodular lesions are seen in both lung fields, relatively larger and more in number in the upper lobes, suggestive of old granulomatous lesions. Fibrotic bands are also noted in both lungs. Air trapping is noted in both lung fields. Few small thin walled cysts are also noted in both lungs. No significant enlargement of mediastinal/hilar lymph nodes is seen. Few small subcentimeter sized calcified mediastinal lymph nodes are noted, consistent with old granulomatous lesions. Trachea and main stem bronchi appear normal. OPINION: CT study reveals multiple calcified nodular lesions in both lungs, more prominent in the upper lobes, suggestive of old granulomatous lesions. Few small calcified mediastinal lymph nodes are also noted. Compared to last PET-CT of 07/02/2022, there is no significant interval change. Please correlate clinically. Spleen is normal in size. Multiple small calcific nodular foci are noted in spleen, suggestive of old granulomatous lesions. Both adrenals appear normal. Right kidney is normal in position and size. Few small subcentimeter sized cysts are noted in right kidney, the largest in its upper pole measuring 0.9 x 0.8cm. The largest cyst in upper pole of right kidney shows relatively higher attenuation in non contrast sections, suggestive of a complex cyst (Bosniak type 2). There is no hydronephrosis or ureteric dilatation. Left kidney is normal in position and size. Areas of cortical scarring are noted in left kidney, more prominent in the upper polar region. A simple cyst is seen in its mid polar region in peripelvic location, measuring 2.7cm in diameter. Another small subcentimeter sized simple cyst is also noted peripherally in its mid polar region. There is no hydronephrosis or ureteric dilatation. Diffuse inhomogenous mosaic pattern enhancement is noted in the liver parenchyma in arterial phase. CT study reveals multiple homogenously enhancing intracranial extra-axial dura based nodular lesions. Compared to last PET-CT of 07/02/2022, there is no significant interval change. Please correlate clinically. -- Test Name:CECT HEAD,CECT NECK,CT CHEST WITH CONTRAST (CECT CHEST),TRIPLE PHASE CECT WHOLE ABDOMEN CECT NECK,CT CHEST WITH CONTRAST (CECT CHEST),TRIPLE PHASE CECT WHOLE ABDOMEN TRIPLE PHASE CECT WHOLE ABDOMEN Anybody willing to help?

Daughter had  not had chemotherapy and I would rather avoided it if I can. However, as I’ve hinted above, there are other harsh (….perhaps harsher?) treatments out there. Moreover, whilst hair normally grows back, your small intestines, lungs and pancreas won’t.  Many people will have to live for the rest of their life with the consequences of their cancer and its treatment.

It sometimes appears that every other cancer article involves someone undergoing chemotherapy.  I just wish someone would write an article about my daughter's small intestines and ascending colon, the malabsorption issues as a consequence of that, my missing mesenteric lymph nodes, my retroperitoneal fibrosis, not forgetting to mention my diseased liver, my left axillary lymph nodes (and the mild lymphedema I now have after their removal), her right supraclavicular lymph nodes, thyroid lesion and my daughter's hypoparathyroidism and hyperthyroidism, there may be due to that, my small lung nodule, rib lesion and pulmonary emboli or blockages which after nearly 6 years of daily blood thinning injections made the abdomen look and feel like she'd done rounds with Mary Kom who already had a couple of rounds making her body shake and she broke cups and plates and spilt water , juice and mouthwash. However, it just wouldn’t be a good picture, nor would it be as powerful as one of a person with no hair or just partial hair in the right side. Just saying!

I look well, I still have all my hair – but you should see my insides!

insides.

“Patients present in an almost surrealistic manner – a mix of tumor- related symptoms and signs, with bizarre and sometimes grotesque endocrine syndromes”

The article from 1987, when somatostatin analogues were starting to be used, must have been a hugely exciting time, perhaps more so than when peptide receptor radiotherapy (PRRT) became a thing in the 21st Century. 

In his own paper, Dr Lewis quite rightly points out the continued confusion whereby the classification of neuroendocrine tumors (NETs) has long been obfuscated by the etymology of the German word karzinoide, a misnomer if it is translated to mean that this cancer - like disease is uniformly benign. Clearly there’s still work to do to get rid of that obfuscation.

Covering the issue of patient quality of life.  Clearly there’s a balance required making therapy decisions often tough for the physician and patient, particularly when the therapy may be different across the broad spectrum of NET types and primary locations. Another area where many unmet needs still remain.

And he approaches the tricky subject of therapy sequencing with the words “This risk - benefit calculus is crucial in caring for patients whose longevity can be measured in years, if not decades, and for whom therapeutic options have multiplied to the point that the sequence of their use must be considered“. Working out the best sequencing is difficult, particularly with so many factors involved, not least the different types of NET and primary locations.  This is really a work in progress and perhaps will always be.

https://youtu.be/JrtgufwSISQ

Maryfilomena E Rita Viñcenza I am honoured by daughter's comment "Payel Bhattacharya you are what I call a beautiful soul . You see, I knew !!!! I see such light coming from you . There is a special reason why God saved you and uses you for his glory . I am so honored to have Met you . May God bless you . You have lightened up my mind and spirit ; you see , it is 20 years from 9/11, my love of my life Til death did we part , Mark , died from being a first responder a NYPD Sgt , who got kidney cancer from working months there . This puts my gift of life into perspective once again . I like you always chose to find the flowers the birds the breeze the music in life in the lil moments of the day . I have lost so much of my light since Mark died nearly 8 years ago . This is how I have written poems in the past and more importantly how I have spoken to encourage and enlighten others in their dark moments . Thank you . I’ll pray blessings over you . 💝"

I am happy she has  a great friend too.

Friendship is one of life's greatest treasures.

Souls connected in space and time beyond any measure 

Even if we don't see each other for years

Emotions yet untold;

As time goes on, and bonds grow strong,

They will all unfold.

You are my daughter's great friend  and I am happy.

 Pray she has such friends who care for her survival 

Not good to be bickering, having ego when it concerns a life.

  Note from Payel Bhattacharya's mother

https://www.ketto.org/fundraiser/i-need-your-urgent-support-for-my-neuroendocrine-tumors-nets-treatment-516332

That's what I learnt in life. It's about willing to hold your hands when you need them most. I let those creatures walk away who didn't want to stay because my destiny is not tied to them.

Apart from the couple of egotistical doctors my endocrinologist blocked me for maximum security while I have stage IV metastastatic neuroendocrine cancer. says my daughter

Next week starting treatment in a new and good hospital with good doctor

Those who have a willingness to burst less Chinese crackers, have gala parties, save someone's life kindly donate. Last night too couldn't sleep because I am a Bengali and had only chicken broth.