Every part of your body – your skin,
bones, hair, blood, muscles, organs – they’re all made out of cells, and
inside each of the tens of trillions of cells that make up your body is an
identical copy of your DNA, a molecule that basically lays out the blueprint
for building you.
When you get injured, the way your body repairs that injury is that the healthy cells around it divide, making copies of themselves to replace the damaged cells. This is also how we grow and make things like hair and blood.
Every cell in your body has this capacity to copy itself. But every time a cell divides, there’s a small chance that it won’t go exactly as planned. What can result, then, is an unplanned cluster of cells somewhere in your body. We call this cluster a tumour.
So, if you were to imagine that any cell that’s capable of cell division all of a sudden acquired the ability to divide without
control, meaning one cell becomes two, two become four, four become
eight, eight become sixteen, then that lack of control of cell division
would allow that individual cell to become a lump, and that lump is
basically what a tumour is.”
So, “tumour” can be a scary word, but many tumours really aren’t such a big
deal.
Abnormally-growing cells that might not
have acquired the biological characteristics that would allow them to And so benign – meaning non-cancerous – tumours can sometimes be uncomfortable, can sometimes even make you sick and need to be dealt with,
but they are called “benign” because they basically stay put and mind their
own business. They grow in one place and only one place, and when they’re
removed or destroyed, that’s the end of it.
Sometimes, though, we develop a tumour that has other ideas. This tumour has
developed a glitch in its DNA that inspires it to not just copy itself uncontrollably, but to cause other cells it comes in contact with to do the same, causing chain reactions of uncontrolled cell growth to spread wider and wider around your body. This is called cancer, and as we all know it is a big deal because it can often mean that these out-of-control clusters of
dividing cells can grow in such a way that they prevent your organs from
functioning properly. Tumours develop because cells, the cell of origin, tend to divide out of control, and they become cancer when they develop the potential to spread to other places.
Cancer happens to have started in a kind of cell called a neuroendocrine
cell. Everyone has these all over their body. They’re mainly in places like
gastrointestinal tract,
the lungs and airways, and the various glands
all around your body. These cells make up a system that control a bunch of
important bodily functions – things like heart rate, blood pressure, air
flow, digestion, and lots of other things. They do this by being the meeting
points between two different kinds of signalling systems that keep the body
running.
Some of the cells in your body communicate with each other by
sending and receiving chemical signals, such as hormones, which are produced
by the endocrine system.
Other cells though, such as the cells in your brain, they run on an entirely different system of electrical signals – sending
sparks of electricity between the different neurons.
So, there are cells in the body that are neurons, they’re nerves, and other cells in the body that are endocrine cells that form
parts of glands, and these are all essential for normal function. So
those cells are all over our body, and you’ve got millions and millions of these kinds of cells that do regulatory functions of hormonal balancing and control, nervous function, sensory, and motor, and
keeping everything together so that we are functioning normally.
And in many of these places, like in the glands that make those hormones,
there’s a need for a group of cells that can bridge the gap between those two
kinds of signalling systems – receiving an electrical message from the nerves
and turning it into a chemical message. These intermediaries are your
neuroendocrine cells. It’s a translator, so it translates a neurologic – which is
really an electrical – communication to a hormonal – which is a molecular – communication, where a molecule is released by a cell and goes and attaches to a different cell and in so doing sends a message to that cell to do something.”
Just like any other kind of cell in your body, these neuroendocrine cells, they need to divide and replace themselves periodically, and when they do there is a chance that a mistake might be made that will cause them to form a malignant tumour. And because neuroendocrine cells are everywhere in your body, neuroendocrine tumours can form just about everywhere also. About 25% of primary neuroendocrine tumours begin in the lung. About 54% begin somewhere in the gastrointestinal tract – 12% in the small intestine, 9% in the pancreas, and 29% elsewhere, including the stomach lining, appendix, and rectum. Other sites or primaries of unknown origin, they account for the remaining 21% of primaries.
One confusing term you may have heard as you began to learn about NETs is
“carcinoid”.
What does that mean? This is a term that dates back more than 100 years and refers to the fact that most NETs are really very different from other kinds of cancer. The main difference is that some NETs grow very, very slowly. So slowly, in fact, that when they were originally discovered,
it was thought that they might not actually be cancer at all, so this new term – carcinoid, which literally means “cancer-like” – was invented to
describe them.
It’s a problematic term, though, because as our understanding of NETs has
increased, we’ve come to realize that they do behave like other cancers –
they just do it at a different pace.
Neuroendocrine tumours, in general, you often hear the description as being ‘cancers in slow motion, because even
neuroendocrine tumours that have spread to other parts of the body, such
as the liver, can be indolent and not grow for months or even years.
And so, this is in contrast to many other types of cancers that have
spread to the liver where week by week, month by month, there’s clear,
gradual growth.”
And partially because of this “carcinoid” label, physicians until very recently tended to misunderstand just how dangerous NETs actually are.
Neuroendocrine tumours, even as recently as ten to fifteen years ago, were actually all classified as being benign.
Pathologists for a long, long time called these benign, and thus so did doctors taking care of these patients, and so then patients had this belief that these cancers would never come back. And we now know that these in fact are cancers, and they can grow and spread, and therefore
they need to be treated as such. They need to be treated like cancers,
and therefore patients need to have appropriate surgeries and
treatments, et cetera.”
Neuroendocrine tumors, in general, are all
malignant. They all have malignant potential. The number usually
quoted is 60-90%. I think of them all as having the potential for
malignancy if you leave them alone long enough.”
What does that word mean, exactly – “malignancy”? Well, your cancer is
named for its “primary” site – the place where the very first tumor appeared,
but that location is just the beginning. Like all cancers, NETs have the
potential to spread elsewhere. That tendency to spread is called
“malignancy”, and the new tumors that form are called “metastases” or
“metastatic tumors”.
The first place that most NETs spread it into the lymph nodes that are
nearest to the primary site. Lymph nodes are a kind of gland that work as
filters for harmful substances in the body. They carry oxygen and other
nutrients to cells and carry away waste products that flow out of the cells.
It’s almost like the plumbing system in your house.
So a lymph node is basically a docking station of immune surveillance, as fluid tracks back to the circulation from really any end organ. So as blood pumps into any organ, so the fluid pressures
basically push some of the water out into this space – the lymphatics –
and then that will drain back through these little docking stations where we find these various immune cells.
Multiple ill-defined calcified & non-calcified nodules are seen scattered in both lungs, predominantly in
upper lobes, the largest measuring 2x1.3 cm in the right upper lobe.
A thin-walled cyst in the left upper lobe.
Few calcified sub cm mediastinal lymph nodes. CT study reveals multiple calcified nodular lesions in both lungs, more prominent in the upper lobes,
suggestive of old granulomatous lesions.
My lymph nodes:
A few small calcified mediastinal lymph nodes are also noted.
Compared to the last PET-CT of 07/02/2022, there is no significant interval change
Life is not a party after several misdiagnoses, Spleen is normal in size. Multiple small calcific nodular foci are noted in the spleen.
Both adrenals appear normal. ( functionally active producing fight or flight hormone report given)
The right kidney is normal in position and size. Few small subcentimeter sized cysts are noted in the right kidney, the largest in its
upper pole measuring 0.9 x 0.8cm. The largest cyst in the upper pole of the right kidney shows relatively higher attenuation in noncontrast sections, suggestive of a complex cyst (Bosniak type 2). The sparkling sky of Ga 68 Dotanoc glows under the vault of the brain
Somatostatin (SST) and somatostatin receptors (SSTRs) finding them in my brain play an important role in diagnosis in the brain. Gastrointestinal (GI) system SST is produced in various organs and cells, and the inhibitory function of somatostatin-containing cells is involved in a range of physiological functions and pathological modifications. The GI system is the largest endocrine organ for digestion and absorption, SST-endocrine cells and neurons in the GI system are a critical effecter to maintain homeostasis via SSTRs 1-5 and co-receptors, while SST-SSTRs are involved in chemo-sensory, mucus, and hormone secretion, motility, inflammation response, itch, and pain via the autocrine, paracrine(Paracrine signalling is a form of cell signalling, a type of cellular communication in which a cell produces a signal to induce changes in nearby cells, altering the behaviour of those cells.) endocrine, and exoendocrine pathways. It is also a power inhibitor for tumour cell proliferation, severe inflammation, and post-operation complications, and is a first-line anti-cancer drug in clinical practice. This focuses on the current function of producing SST endocrine cells and local neurons SST-SSTRs in the GI system, discusses new development prognostic markers, phosphate-specific antibodies, and molecular imaging emerging in diagnostics and therapy, and summarizes the mechanism of the SST family in basic research and clinical practice. Understanding of endocrines and neuroendocrines in SST-SSTRs in GI will provide an insight into advanced medicine in basic and clinical research.
Right side and submandibular highlighted my thyroid lesion – still under a watch and wait regime due to poverty and a surgery every year.
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
Thyroid.
Seems to be the unknown source behind the cancer.
Sneaky Net Scan now I will win
Amines in food are chemicals that occur naturally, caused by bacteria that breaks down amino acids. They are related to the inorganic compound ammonia. Higher levels of amines are found in fermented, charred, grilled, overripe, over cooked or decomposing foods.
Amines are harmless for most people, however, when consumed in excess or by people sensitive to amines, they can cause a range of symptoms. Amines can cause an increase in cardiac output and constriction of blood vessels in the head which can cause migraines.
A person may think they have an intolerance to a food but the next time they try it, they don’t experience the same problem so they assume that food is safe. What they don’t realise is the foods they consumed prior were low in amines so their body tolerated the food with high amine levels.
People often look for one single food as the cause of their symptoms rather than the range of foods they ate within a two day period. Amine levels can be high in foods that people consider healthy and safe like fruit and vegetables so they don’t consider them as a potential source of amines.
For many years, conflicting data made it difficult to make conclusive links between children’s behaviour and their diet. In the late 1990s, 423 children who had presented to a NSW Hospital Allergy Unit were sent a questionnaire about their child’s symptoms and diet modifications. Of the 77% who started an elimination diet, 91% reported improved symptoms. The most common chemicals respondents reacted to were
amines,
salicylates,
colours,
glutamates and preservatives respectively.
Parents reported significant improvements in behaviour when these were removed from their child’s diet.
Amines in food have been linked to migraines. Around 60%-80% of the immune system is in the gut. When a sensitive person eats a food or chemical, the immune system releases mediators such as cytokines, leukotrienes, or prostaglandins they know which cause a host of chronic inflammatory conditions, including migraines.
The most common foods that can cause migraines include
canned soup,
processed meats,
chocolate,
olives,
onions,
overripe avocados,
tomatoes and bananas,
soy sauce, smoked and pickled foods.
Another chronic inflammatory condition, IBS, has been linked to food chemical sensitivity. IBS symptoms include diarrhoea, bloating, abdominal pain and constipation.
man holding his stomach because of IBS caused by amine sensitivity
The bacteria in the large bowel ferments undigested nutrients from food but IBS symptoms can occur when food chemicals are present. Management of IBS has focused on fermentable carbohydrates, a group of dietary sugars
For many eczema sufferers, diet can contribute to their painful skin condition but it’s difficult to know which foods cause the problem.
With eczema, foods that aren’t usually a problem can make an eczema flare-up worse. It seems the immune system has already been triggered during an eczema attack and so many foods can cause the condition to worsen. The reaction time to eczematous food can be multiple days making it difficult to isolate problematic foods. Most times, once the eczema is under control, people can reintroduce the foods with no problems.
Dopamine
Dopamine is a chemical messenger in the brain that signal other nerve cells. Dopamine is involved in reward, motivation, memory and attention and is blamed for addiction. As well as emotional responses, dopamine controls body movement so it is important for both physical and mental wellbeing.
Serotonin
Similar to dopamine, serotonin is a chemical and neurotransmitter that impacts mood, anxiety and happiness. Large amounts of serotonin are released in people using recreational drugs and may damage the nerves that contain serotonin. Produced in the brain and intestines, serotonin can’t cross the blood-brain barrier. The brain must produce any serotonin used in the brain.
The body produces more serotonin after eating something that is toxic or irritating. The increased level of serotonin causes the food to move through the body faster and be expelled in diarrhoea.
Schizophrenia is an illness where people experience episodes of delusions and hallucinations. Genetics, substance abuse and trauma, particularly in childhood, can cause schizophrenia. Schizophrenia starts in the late teens to early 30s.
In the last few years, there has been researching conducted into the role of amino acids and biogenic amines as a potential cause of schizophrenia. One study found people with psychotic symptoms had higher levels of some amino acids and biogenic amines and lower levels of others compared to the control group with no schizophrenic symptoms. Research is continuing.
Amines Link to Depression and Schizophrenia
There are five biogenic amine neurotransmitters (brain chemicals) - dopamine, norepinephrine (noradrenaline), epinephrine (adrenaline), histamine and serotonin.
When an imbalance of these neurotransmitters occurs such as a lack of dopamine and serotonin, nerve impulses or messages aren’t effectively transmitted in the brain.
Histamine and Amines
Histamines are both produced by the body and consumed in foods.
Histamine helps with communicating messages in the brain, triggering the release of stomach acids for digestion and following an injury or allergic reaction. Histamines can make you sneeze, itch, cough and scratch. An overreaction in the body is the cause of allergic reactions that we use antihistamines to relieve.
woman with histamine allergies blowing her nose
Are Amines and Histamines the same thing?
Histamine is one type of biogenic amine that occurs in many foods. When we consume food that contains histamine, our gut uses its special enzymes to destroy the histamine before it’s absorbed into the bloodstream. The enzyme, Diamine Oxidase (DAO), is released into the gastrointestinal tract as the first line of defence against histamine exposure.
Histamine intolerance occurs when there aren’t enough of these enzymes in the body. The average human can cope with 50 to 100 mg/kg but people with histamine intolerance react to much lower levels. The reactions can vary from anaphylaxis to mild localised allergic reactions. Around 80% of people with histamine intolerances are women. Estrogen and histamine can increase histamine levels and vice versa.
Histamine sensitivity is difficult to diagnose because a food can cause symptoms one day and no symptoms another. Common symptoms include heachaches, migraines, nasal congestion, hives, fatigue, nausea and vomiting. Some drugs including opioids, muscle relaxants, and alcohol cause a histamine release from immune cells.
Fish is a risky food for high histamine levels and scombroid poisoning. It occurs when the fish is not kept cold so biogenic amines form. Fresh, canned or smoked fish may be affected particularly if it is a dark meat fish such as tuna, kahawai, mackerel, bonito, kingfish, WA salmon, sardines or blue marlin. Heating or re-cooling can’t destroy amines once they have formed.
Symptoms of scombroid poisoning include rash, palpitations, headache, dizziness, sweating, and burning of the mouth and throat. Gastrointestinal symptoms can include stomach cramps, nausea, vomiting and diarrhoea. Respiratory distress is also possible. Symptoms begin within 10 to 90 minutes after eating the fish.
PRRT
While PRRT has been used for more than 20 years to treat patients with inoperable or metastatic somatostatin receptor–positive tumors, knowledge of long-term outcomes has been limited. A number of clinical studies have demonstrated PRRT’s efficacy, and the overall response rate (including complete response, partial response, minor response, and stable disease) is about 70% to 80% for the most commonly used radiopharmaceuticals: yttrium-90 (90Y)-DOTATOC (best suited for treating larger tumors) and lutetium Lu-177 dotatate (preferred for smaller tumors). For patients who respond to PRRT, the prognosis is generally favorable, with a median time to disease progression of 3 to 4 years.
A 12-year retrospective clinical study of patients who received peptide receptor radionuclide therapy (PRRT) for malignant neuroendocrine tumors demonstrated the long-term effectiveness of this treatment, which also allows patients to maintain a high quality of life.
Which I am being purposely denied.
