Carcinoid Clinic – Nebraska Medicine


Here’s a disease that appears to be, fallen
into this basket of often diseases that people tend not to focus on, and we felt that we
had the means here at The Medical Center to take a little bit of extra time and focus
on this disease and be able to help people certainly in Nebraska and in the region who
have this, give them a place where there’s knowledge and the ability to offer them a
wide range of treatments without having to travel to east or west coast or down to some
of the major Medical Centers in the south. So, we thought there was a need locally and
we felt that we had the means to be able to address that need, and that stimulated us
to start this Neuroendocrine Tumor and Carcinoid Clinic.
It’s grown dramatically, I mean we’ve been doing it for three, nearly four years
now, our number of referrals have increased, these patients live for a long time, it’s
a disease, while we can never get away or escape the fact that this remains a cancer,
these are patients that if they’re treated appropriately, can live a very long time.
So we have accumulated a number of patients and we continue to follow those patients,
on a semi-annual, annual basis, depending on the stage of their disease and the treatments
that are required, so it’s not as if a patient comes in, has a treatment, the survival rate
poor as in a lot of cancers today. These patients live for a very long time, so we’re able
to follow these patients out many years now, after first seeing them three or four years
ago. Carcinoid falls under a group of tumors called,
Neuroendocrine tumors, they arise from what we know as Neuroendocrine cells and can occur
in multiple organs, they can occur in the skin, in the bowel, in the pancreas, in the
stomach, in the colon, rectum it can occur all over the body. So it has, Carcinoid really
refers to those tumors that occur in the intestine, the stomach, the small-bowel and the colon,
but they occur in the lung, in the pancreas and so it’s a multi-system disease that
can affect anywhere in the body, these tumors are slow growing, they tend to spread. Sometimes
patients have manifestations of hormone secretion, as we said, it’s a cell of endocrine origin,
some of these cells secrete hormones and that’s how the patient presents not so much do to
the size or bulk of tumor but in terms of what this tumor is doing in terms of secreting
hormones and that’s where the term Carcinoid Syndrome develops. Excess of hormone of secreted
by the tumor, and it’s that excess of hormone circulating around the body, that results
in the symptoms that the patient have of flushing, diarrhea, chest pain, anxiousness and that’s
often how these patients do present, but not all tumors do that, some of them don’t secrete
hormone at all, and the patients present with intestinal obstruction or large bulk of tumor
within the liver. So it’s a very protean manifestation of this tumor and because it’s
uncommon, people don’t think about it, when patients first present, and a lot of patients
have symptoms for a very long time before diagnosis is made.
Something called a staged Hepatic resection, it was first described by a group of French
surgeons for Colon Cancer, that group in Paris, supplied the same thing to these Neuroendocrine
tumor patients with very satisfying results. So this relies on the innate capabilities
of the liver to be able to regenerate, so what we do is take out the primary tumor,
which is in the Intestine. At the same time then take a tumor from one side of the liver,
the side of the liver that we envisage as being the future remnant, that’s going to
be left behind, and so that all happens at the first operation. We then stimulate the
liver that left side of the liver to grow. We do this by ligating or blocking one of
the portal veins and that allows that half of the liver to grow and become bigger. Once
that has occurred we then go back in and remove the other side of the liver that has the remaining
tumors, and so by doing that, rid her liver of all the tumor that’s in her liver, as
well as taking care of the primary. So it’s a fairly cool procedure, but again very demanding
on the patients, to have to undergo multiple major hepatic surgeries is a big deal. And that’s where the Carcinoid Neuroendocrine
Tumor program grew out of our expertise, in liver transplantation and liver surgery, to
be able to give us the ability to do these very big, very invasive procedures, as again
the support and everything around here, we’re well placed to provide this kind of expertise.
It’s that trust that patients put in you that make this very, very satisfying.

2 thoughts on “Carcinoid Clinic – Nebraska Medicine

  1. Hi, im 32 years old Singaporean. Was diagnosed with Neuroendocrine tumour abt 1.5 years ago. when i first diagnosed it was 15cm x 10 cm pressing on my stomach. at first doc suggested we do 4 session Peptide Receptor Radionuclide therapy (PRRT). Every 3 month done for a year. (4 session completed). After that i had ct scan to check the progress, doc said it has shrunk 50%. now the tumour is 5cm x 6cm. But doc told me the sad news that they cant do surgery due to my tumour is sorrounding the major blood vessels. So they can only give me injection every month to control it from growing as long as they can. I do not want to live with this cause i believe there is other option. and i really want this out cause im still young and trying to get pregnant. Im in Singapore and im willing to go anywhere to get this treatment. Please advice.

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