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.

Not only Irrfan Khan and Steve Jobs, Allan Rickman fought neuroendocrine cancer I am fighting it too.

 

The unusual birth of the eye-catching child of fond parents after a miscarriage and fetus getting problems while in the womb, were lost in the thought that behind the outer shell there might lurk some sickness never known to humanity and the ill-fated, ill-starred child would have to endure the worst in all walks of life and face countless challenges my parents never thought of that.

Have you ever said, "I'm fine, very good when you weren't because most people don't understand?"

But my heart was like a sponge, sucking up feelings and emotions, even pain. Born with a soul of a mermaid who could only suffer pain since mermaids have no tears I suffered more acutely.

From my early childhood, Mum became a vital and integral part of my life, the magic charm of my gloomy and solitary life. She has always made me feel so special.

Faces beshrouded 'neath a mask; I can't shun curiosity, and I wear a grinning mask.Pretending to be what they truly are. You don't need to look too far.

I have spent a lot of time in recent years trying to forget unnecessary things so that I will have room in my brain attic for some things that may be more useful. For instance, I have forgotten the longest word in the English language-- “pneumonoultramicroscopicsilicovolcanoconiosi”,*** or was it, “floccinaucinihilipilification”¨?

and what these terms mean but I can never forget those wretched smiling faces on the balcony. My father called the ambulance at night due to my pain because of a hemorrhaging liver and took me to the hospital and it's that view, when I looked up to the verandah above that has clung to my memory forever like flies in flypaper.

Uncle,  aunt and the Didi singer at Kolkata who tried to swat her out of the way like a fly sitting on the wall can be easily swatted with a rolled-up magazine.

‘Money’ and ‘Power’ are the root causes in every act of a felony, every crime, every treachery committed since time immemorial. Money, gold, holds allure because it gives power, a lavish lifestyle and many are ready to harm a life for its powerful charisma. Money tempts most people to wrongdoing. Crime is as old as humanity. Thus, it is since ancient times that brothers are slaughtering brothers for the power of the throne and the wealth it brings along. Slaughtering, poisoning, strangling, asphyxiating, backstabbing, but achieving money and power and destroying every life in the way. Such is the queer nature of the human race. A son instead of being dutiful towards his parents desires the end of the ailing, helpless parents and shoves them out of the way, a raving egomaniac parent drunk with the influence of wealth, affluence, power withholds what the offspring truly deserves, thus strangling the life out bit by bit.

From childhood, I have not been as others were,I never enjoyed hop-skip-jump that's for sure,Being a sick girl looking for the doctor's cure. .Do you ever wonder just what God requires? Given just one life to face things where everyone conspires. Without any play-fellow at school thinking I am in need some solicitude against the deluge of solitude.Parental solicitude was quite tireless.Father wasn't tough and prepared With faith 80% heart's blockage gasping for air. His efforts nobody in the world could compare.Gave her daughter a new lease of life. Soon the commander, solver of every problem died, Warrior Princess was born.

My foxy uncle took our house from us and we were left penniless and homeless. It was then that my real tough times began and we had two choices ...death or preservation of life.

Not only did we face shocking poverty where we didn’t have money for food the next day, but I acquired MDR- TB living in shabby houses and changed houses seven times. 

When in poverty, you face medical embarrassments, the humiliation of asking for financial help, physical suffering which is always there money concerns for food, medicines and rent.

My brain tumours are the rarest ones from 1902-2013 only 132 cases have been reported globally. A fellow remarked after he saw the picture of the scan of my brain tumours.

" you have more tumours in the brain than people have lice in hair.''

I know they are worthless thoughts, but memory and forgetfulness are beyond one’s control. I will tell you more about that later. I didn't have the language to express my feelings then and I felt like hiding in my shell with just books.

and my sketches when there was nobody to hear me out.

When life was sliding out of me

Hope roused the warrior inside

And I started my journey

A couple of weeks ago through medical doubt

I met someone I'd heard lots about

It was not an earnest medical scan

Her unaided eye could verify that her bumptious rudest ego began

Extreme mental distress—elevated pulse, perspiration, acute abdominal pain,

Suffered from diarrhea Pancreatic cancer is one of the most lethal malignancies in the world, with mortality rates being close to the incidence rates. The incidence rates of pancreatic cancer is 3%. Most patients with pancreatic cancer are diagnosed at the advanced stage due to the deficiency of a standard program for screening patients at a high risk of pancreatic cancer,leading to a poor prognosis with a 5-year survival rate of <7%

MK-6482 demonstrated durable efficacy in patients with Von Hippel-Lindau disease-associated clear cell renal cell carcinoma, pancreatic lesions, and hemangioblastomas by targeting the underlying pathophysiology of the disease.

MK-6482 demonstrated durable efficacy in patients with Von Hippel-Lindau (VHL) disease-associated clear cell renal cell carcinoma, pancreatic lesions, and hemangioblastomas by targeting the underlying pathophysiology of the disease.

Transcription:

So, let me give you a little bit of background to start with. VHL is, as you know, a disease associated with an increased risk of developing tumors in multiple organ systems, including the development of bilateral multifocal… so, kidney cancer. Traditionally, this disease is managed surgically, or sometimes with ablative procedures. In the context of kidney cancers, the goal of surgery is to minimize the risk of metastatic spread. So usually when tumors reach the size of around 3 centimeters or so, we think there begins to exist a risk for metastatic spread, and the bigger the tumor gets, the more the risk of metastatic spread. And so, to prevent this or minimize the risk of this metastatic spread, people remove these tumors, usually with a nephron sparing procedure.

New tumors keep growing because the basic issue, which is germline VHL mutation driving this process, isn't being taken away by surgical procedures, and so patients often undergo multiple surgical procedures in their lifetime. And when you add the surgical procedures occurring in the kidney, in the CNS, for pancreas, and other things, it gets to be quite burdensome for the patients over the course of their lifetime.

An attempt to treat patients with systemic therapy, you know, has been… several attempts have been made over the last several years. Initially, based on our understanding of the biology of VHL loss and how that leads to tumorigenesis… targeted agents were designed, evaluated, found to be effective in metastatic kidney cancer and the same agents were then tried in patients with VHL. We tried to see if we could trim their tumors and maybe minimize the need for surgery or delay the need for surgery. While several of these studies suggested that you could reasonably shrink tumors in the kidneys, we found that what was an acceptable toxicity profile for patients with metastatic kidney cancer wasn't necessarily so for patients with VHL.

These patients have, you know, a very, very different, you know, prognosis, very different outlook, very different lifestyles than patients with metastatic kidney cancer do and consequently, their ability to tolerate some side effects is very different from those in metastatic kidney cancer patients. So, in my experience, it's been very hard to effectively deliver VEGF targeted therapy in patients with VHL. And I've never really viewed it as a viable option for the majority of patients, particularly for long term years. In addition, it's been my experience, and those of others, that you don't see much by way of responses in the central nervous system… tumors. And there's very little experience in… with regard to pancreatic tumors, particularly neuroendocrine tumors in the pancreas. So for all these reasons, it's very clear that if you had an agent that was one more effective and better tolerated, we might begin to make an impact on these patients and maybe just begin to move away from surgery to some extent, or at least minimize the lifetime surgical burden of some of these patients. And so that was the logic really in trying to devise the study with MK6482.

Now, why MK-6482? It’s a drug that... It's one of the group of agents that was developed initially by a company that was then taken over, but the idea was to selectively inhibit HIF-2α. This is a transcription factor that we think plays an important role in mediating cancer formation in the setting of VHL loss, which is what we see in VHL patients. So, we think HIF-2α plays a very, very critical role and the two agents develop sort of in parallel, one called PD2385, was available for clinical use first. And indeed, it was looked at in both sporadic cancer kidney cancer patients and patients with VHL associated kidney cancer. We had a very small phase two trial with that agent in VHL patients and very quickly found that although the agent had some potential, there were some issues with the pharmacokinetics – the way the drug was handled by the body – such that not all patients, you know, achieved reliable levels of the drug in their system. So, with the availability of MK6482, which was a sister drug, with much, much better pharmacokinetic properties, attention quickly shifted to this drug. And this phase two study was designed really to address the question of whether we could control, shrink, or stabilize tumors in the kidneys, as well as some other tumors that are associated with VHL with this drug. The other end points… whether or not patients tolerated this drug. And so that really was the basis for the study.

The design was very, very simple. We… treat approximately 50 patients and then we treated around 61 patients in the study and wanted to ask what proportion of patients had what we call an objective response by traditional research criteria when looking only at the kidney tumors. So, we looked at the kidney tumors separately and determined what the number of responders was. And we did the same for other organ systems. So, each organ system was individually reviewed, so we would be able to calculate overall response rate in the CNS, for instance, or the pancreas. And that was essentially the rationale for designing the study and a very simple overview of the study design.

This drug if imported can save me.

Not only Irrfan Khan and Steve Jobs, Allan Rickman fought neuroendocrine cancer I am fighting it too.

My metastatic neuroendocrine cancer battle

 

Not only Irrfan Khan and Steve Jobs fought neuroendocrine cancer I am fighting it too

Neuroendocrine tumors (NET) are tumors arising from neuroendocrine cells in the body and are found in the gastrointestinal tract, and less commonly pancreas, lungs,thymus and thyroid C-cells. There has been a recent increase in the prevalence of the NETs, which is attributed to better diagnostic procedures. NETs were thought to be slow growing benign tumors in the past but almost all NETs are now considered to have malignant potential.

These tumors cause systemic symptoms by releasing vasoactive substances to the bloodstream and are often associated with psychiatric symptoms like depression,anxiety or psychosis. Treating such individuals would require multidisciplinary team approach due to the complexity of the illness. The purpose of this article is to review the various aspects of this illness and challenges of treating the associated psychiatric symptoms.

Neuroendocrine tumors (NETs) form in cells that interact with the nervous system or in glands that produce hormones. These cells, called neuroendocrine cells, can be found throughout the body, but NETs are most often found in the abdomen, especially in the gastrointestinal tract. These tumors may also be found in the lungs, pancreas and adrenal glands. Merkel cell cancer, a type of skin cancer, also is considered a neuroendocrine cancer.

KEY POINTS

The plan for cancer treatment depends on where the NET is found in the pancreas and whether it has spread.

There are three ways that cancer spreads in the body.

Cancer may spread from where it began to other parts of the body.

Treatment of pancreatic NETs is based on the following:

Whether the cancer is found in one place in the pancreas.

Whether the cancer is found in several places in the pancreas.

Whether the cancer has spread to lymph nodes near the pancreas or to other parts of the body such as the liver, lung, peritoneum, or bone.

Cancer may spread from where it began to other parts of the body.

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.

Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.

Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of tumor as the primary tumor. For example, if a pancreatic neuroendocrine tumor spreads to the liver, the tumor cells in the liver are actually neuroendocrine tumor cells. The disease is a metastatic pancreatic neuroendocrine tumor, not liver cancer.

Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.

Symptoms of neuroendocrine carcinoma can include:

Hyperglycemia (too much sugar in the blood)

Hypoglycemia (too little sugar in the blood)

Diarrhea

Persistent pain in a specific area

Loss of appetite/weight loss

Persistent cough or hoarseness

Thickening or lump in any part of the body

Changes in bowel or bladder habits

Unexplained weight gain or loss

Jaundice (yellowing of the skin)

Unusual bleeding or discharge

Persistent fever or night sweats

Headache

Anxiety

Gastric ulcer disease

In metastatic carcinoid tumor,the prevalence of depression is about 50% and anxiety about 35% .

Presence of psychotic symptoms with carcinoid tumors was reported in two studies . Two article reviews reported presence of cognitive symptoms in cases of carcinoid tumor .

The psychiatric symptoms may be due to multiple causes including the release of biogenic amines. Prevalence of psychiatric symptoms in cancer is high in general but studies have reported that symptoms of anxiety and depression are relatively higher in carcinoid tumors.

Serotonin: Serotonin is one of the biogenic amines secreted by the carcinoid tumors that play an important role in producing the symptoms of carcinoid crisis .

• About 95% of body’s serotonin is found in the enterochromaffin cells in the GI tract and the remaining 5%

in the platelet and the brain. The platelets do not produce serotonin, they uptake the serotonin produced by the enterochromaffin cells. In the brain, serotonin is secreted by the serotonergic neurons.

• Serotonin is produced from its precursor tryptophan which is also a precursor of Niacin. In carcinoid syndrome,

excessive production of serotonin causes depletion of tryptophan and decreased production of niacin as a result.

This leads to niacin deficiency symptoms, namely pellagra,

which can also contribute to the psychiatric symptoms.

• In the brain, serotonin production is dependent on the availability of tryptophan. As only L- tryptophan or free tryptophan [unbound to albumin] can enter the brain by crossing the blood brain barrier; it affects serotonin biosynthesis by the neurons. L- tryptophan level is also reduced by substances like cortisol, the level of which is high in cases of depression, which can further reduce brain serotonin production.

• Half-life of serotonin is about 5 days in the platelet, same as the life of platelet, whereas in the brain it is only few minutes and is quickly deactivated by the monoamine oxidase enzymes.

• Peripheral effects of serotonin are local vasoconstriction where it is released and also vasodilatation and increased capillary permeability; constriction of veins and induction of venous thrombosis and promotion of platelet aggregation.

Serotonin has a positive chronotropic effect on the heart through 5HT4 receptors and can cause cardiac rhythm disorders.

• Excessive serotonin gives rise to debilitating diarrhea affecting the quality of life of patients with carcinoid syndrome.

• Prolonged exposure to high level of serotonin can cause fibrosis of heart valves, more commonly on the right side,

causing valvular heart disease. Excessive serotonin is also linked to fibrosis of uterus, skin (scleroderma),

pulmonary and retroperitoneal fibrosis in the long run,causing multiple complications.

Low levels of serotonin are often associated with many behavioral and emotional disorders. Studies have shown that low levels of serotonin can lead to depression, anxiety, suicidal behavior, and obsessive-compulsive disorder. If you are experiencing any of these thoughts or feelings, consult a health care professional immediately. The sooner treatment starts, the faster you’ll see improvements.

Psychological aspect 

• Supportive psychotherapy, instillation of hope and providing support.

• Teaching coping skills and grounding techniques using mindfulness-based training.

• Getting connected with social worker and therapist.

Social and community aspect • Discharge planning meeting involving multidisciplinary team.

• Assignment of outreach worker to continue with the supportive work.

• Outpatient mental health follow up appointments.

• Pain clinic referral.

• Continuation with follow up with cancer clinic, cardiologist and other specialists follow ups.

• Follow up with her family doctor, Social worker and dietician.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

My Cancer

 

My genetic cancer chases me incessantly 

Von Hippel–Lindau (VHL) has no outward manifestation only detected upon periodic screening/imaging, 

Suffering from a case of restless cancer syndrome

But I am not alone

Thousands of people may be suffering from this syndrome without knowing 

People, can't live like that

Wherever the wind starts blowing

Where there's river overflowing

When each time the medical man claims his price

It's rude and more often than not nice

Not when he failed in his line

MRI and pain is the same, doctor is sleeping on the job sign

Not when there's a constantly recurring off-beat fatal ailment.

The professional beguilement

Cancer is essentially side effects of the relentless mutation that made the diversity of life on earth possible.

Mutation is the key to our evolution.

 It has enabled us to evolve from a single-celled organism into the dominant species of the planet. 

Fighting the strange enchantment

The process is slow normally taking 1000 And 1000 of years. 

For 38 long years

And old homes scenes of my childhood

A fond memory appears.

But every few hundred millennia evolution leaps forward

Facing the mutation drives outwards

Urges me to go onwards

It is hard to look at the tumor and not come away with the feeling that one has encountered a powerful monster in its infancy

In the folklore of science, there is the often-told story 

Of the moment of discovery: 

The quickening of the pulse, the spectral luminosity

 But there is another moment of discovery—

Its converse—

that is recorded rarely: 

The discovery of failure. 

It is a moment that a scientist often encounters alone. 

A patient’s CT scan shows a relapsed neuroendocrine cancer.. 

Or negligence caused the cancer to metastasize

A cell once killed by a drug begins to grow back.

 A patient returns to the doctor with a headache after cyberknife of trigeminal nerve.

It is not in things it's in us

All memory is porous

No one pays me any mind

When medicine is socialized, when you have true universal health care, when everyone's treatment is the same regardless of age and socioeconomic station,

We  go along with that perceived injustice, 

it's just not just in the equation in the country 

Nothing doing inadequate and volatile knowledge

She said all Bengalis have stomach protruding upsetting stomach

I was so sick to my stomach

After every meal I run to the loo

Clutching my stomach like a kangaroo

Saw me through the most physically intense ordeal of my life

Stale relentless kind of quippiness

The world has no place for immortals

Ignorance leads to peoples death of sickness 

Deflecting any emotion with repartee

With my mysterious sickness I don't treat diagnosis by medical men as Gospels

They become vaingloriously hostile

After completing their medical degrees

 Do they plunge into the world of unique diseases, 

Keep themselves updated, 

What have I done, why am I hated?

Keep track of all those maladies?

Their misconceptions mistook for realities

The melancholia of the medical lore 

And fac'd grim Danger's loudest roar,

Because I possess possess full knowledge of those things or just a hunch what is right and what is wrong

I am brave and valiant, my knowledge is sharp and I want to finish strong.

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

The neuroendocrine system is made up of nerves and gland cells.

 It makes hormones and releases them into the bloodstream my research tells

require urgent aggressive chemotherapy

survival in metastatic disease or recurrence after curative surgery.

All NETs are malignant (cancer) by definition. 

Some NETs are diagnosed early and you might be able to have treatment to cure it.