Neuroendocrine Tumor treatment in Delhi India (NET) | Carcinoid tumor therapy, chemotherapy, targeted therapy and immunotherapy
The treatment of neuroendocrine tumor (NET) in Delhi by AIIMS Gold Medalist cancer specialist in Delhi, Gurgaon, Noida, Faridabad, Ghaziabad. Previously at AIIMS New Delhi for more than 12 years. Access the best carcinoid and neuroendocrine tumor treatment in Delhi with scientific, ethical, world-class and affordable targeted therapy, chemotherapy, immunotherapy and surgical care.
What is a neuroendocrine tumor (NET)?
A neuroendocrine tumor is a rare, very special kind of cancer. Cancer is a condition where the cells of the body start dividing uncontrollably and gain the ability to spread locally and to different sites. Most cancers arise from certain fixed parts of the body, like lung, kidney, mouth, testes, ovary etc. Neuroendocrine tumors are unique in that they can arise in several different organs of the body. These tumors behave in a variety of unique ways.
NEUROENDOCRINE TUMORS ARE RARE, AND SHOULD ONLY BE MANAGED BY AN EXPERT ONCOLOGIST
What are the different types of neuroendocrine tumors?
In general, there are 3 kinds of neuroendocrine tumors:
- Low-grade NET, also called “typical carcinoids”
- Intermediate-grade NET, also called “atypical carcinoids”
- High-grade NET, also called “neuroendocrine carcinomas” or “small cell carcinomas”
The grade is seen on biopsy and describes how fast the NET grows and spreads.
What sites in the body can neuroendocrine tumors arise at?
The most common sites of origin of neuroendocrine tumors are…
- The stomach and intestines
- The lungs
- The Pancreas
However, neuroendocrine tumors are known to occur at several locations, including thyroid, adrenals, cervix, vagina, ovary etc
It is important to note that neuroendocrine cancer arising from lung, stomach etc is not the same as the usual cancer (carcinomas) of these organs. To learn more, visit the lung cancer and stomach cancer pages.
Can neuroendocrine tumors spread from person to person?
NET is not communicable and does not spread.
What are the symptoms of NET?
Typically, NET presents with masses that gradually enlarge, so symptoms are related to the site where the NET starts from. For example:
- Lung NETs cause cough, blood in sputum, breathlessness, chest pain, etc
- Gut and pancreatic NETs cause abdominal pain, abdominal lumps, liver abnormalities, swelling of abdomen etc
Additionally, some NETs may produce hormones which interfere with the body’s normal functioning. These can cause a variety of symptoms such as:
- Low blood glucose (insulinomas)
- Acidity and stomach ulcers (gastrinomas)
- Diarrhea (VIPomas)
- Diabetes and rash (Glucagonomas)
How is NET diagnosed?
The diagnosis of NET rests upon a biopsy. A biopsy can be obtained by a number of ways:
- By a needle inserted into the tumor seen on ultrasound or CT
- By studying cells obtained in a fluid collection of the body
- By biopsy of a convenient lymph node visible from outside
- By inserting a tube into the lungs or gut and taking a piece of tumor seen
Biopsy of NET is safe and does not cause spread of tumor.
What is a DOTANOC scan?
A DOTANOC scan is a special kind of whole body scan which detects cells that specifically express receptors of the neuroendocrine system. It can usually tell precisely which parts of the body are involved by NET.
Are neuroendocrine tumors curable? How are they cured?
Neuroendocrine tumors are curable. Generally cure consists of various combinations of the following:
- Surgery to remove all sites of tumor from the body
- Radiation, generally used in cases where the tumor is not spread but cannot be operated safely
- Chemotherapy is used in the treatment of high-grade neuroendocrine tumors together with surgery and radiotherapy
My doctor tells me I have metastatic neuroendocrine tumor. What does that mean? Is it curable?
Metastatic NET is NET which has spread from its initial location. Common sites of spread include bone and liver. It is a curable disease in selected cases. In cases where cure is not possible, it is still possible to control the disease for very long times (many years, even a decade or more).
What is the treatment of metastatic neuroendocrine tumor in Delhi?
Metastatic NET is treated in a variety of ways. In fact, an interesting thing about NETs is that some NETs can simply be oberved closely, and no therapy may be needed for several years.
This is a complex topic and an expert medical oncologist opinion is strongly recommended.
Some treatment options include:
- No treatment, or observation alone
- Hormonal therapy, with drugs like octreotide, somatostatin and their long-acting forms
- Targeted therapy
- Nuclear therapy (also called PRRT)
These are discussed in more detail below.
Why is “observation” a treatment option? If I have cancer, shouldn’t I get some treatment?
An interesting thing about low-grade NET is that it is a very slow disease. In fact, the rate of growth may be so slow that patients may have little to no increase of disease despite no treatment. In this circumstance, patients with a small volume of metastatic, incurable disease can often be managed initially with observation alone, with serial scans to see the level of cancer in the body. If the disease progresses while on observation, therapy can be inititated. In some patients, this period of observation without therapy may be many years.
What are octreotide/somatostatin/sandostatin LAR/Long-acting somatostatin?
Many neuroendocrine tumors are hormone-sensitive. Various hormonal agents can help relieve symptoms due to hormonal production as well as control the disease, often for many years. These drugs are very safe and effective.
What is PRRT/Lutetium radionucleide therapy/Lutetium DOTATATE/DOTANOC therapy?
PRRT is a powerful new way to treat low-grade and intermediate-grade NET. In PRRT, radioactive molecules are attached to molecules which find and attach with cancer cells. These cells are then killed by the radioactive molecules. PRRT is a highly potent and safe way to treat metastatic NETs. Learn more about PRRT here.
What is targeted therapy? How does it work in NET?
Targeted therapy is a powerful new way to treat cancer. Targeted therapy works by specifically attacking specific molecular abnormalities that are present in cancer cells and absent in normal cells.
Targeted therapy has many benefits in treatment of NET:
- It is highly active, often more active than chemotherapy in low and intermediate-grade disease
- Side-effects are usually low and well-tolerated
- Often these drugs are taken as tablets and don’t need hospital visits for injections
What is chemotherapy? Does it work in NET?
Chemotherapy refers to drugs that kill cancer cells. Chemotherapy is commonly used in NET, however the benefit of chemotherapy is best seen in high-grade NETs. Chemotherapy is generally a mandatory part of treatment in high-grade NETs or small cell carcinomas.
What is immunotherapy for NET? Is cancer immunotherapy available in Delhi, India?
Immunotherapy is a new way to treat neuroendocrine tumors. It is a way of allowing the body’s own immune system to fight and kill cancer cells. Research indicates that immnotherapy is highly potent, safe, has fewer side-effects, and is sometimes capable of dramatic results. However, at present it is an emerging technology in the field of NET and is not used routinely in every patient.
What is the cost of treatment of neuroendocrine tumor in Delhi, India?
In the current era, there are numerous treatment options for neuroendocrine tumors at every stage. The precise cost depends upon the stage of the patient, the kind of tumor and kind of therapy planned. A skilled medical oncologist can help in achieving the best cancer care at the lowest price. Many times, more expensive drugs are just as good as less expensive drugs. For example, a patient with low-volume metastatic NET my simply need observation (which costs nothing) instead of PRRT (which costs several lakh rupees per dose). Thus, a good oncologist can help you pick the most cost-effective therapy. A careful discussion can help design the best, most affordable regimen each patient.
Why is it important to consult a neuroendocrine tumor specialist in Delhi?
Neuroendocrine tumors are rare, complex and difficult to treat. Due to their rarity and complexity, often even experienced oncologists lack experience with their treatment. Inappropriate treatment can lead to spread of disease and risk of it becoming incurable. With proper care, NET can be cured or controlled for many, many years. Dr Vineet Govinda Gupta is Gold Medalist medical oncologist from AIIMS New Delhi and has been trained at AIIMS for 12+ years. He has a large amount of clinical experience and numerous research publications in the field of cancer care.
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