Treatment of Neuroendocrine Tumors

Neuroendocrine tumors are formed from neuroendocrine cells – specific cell type which occupies in its functions an intermediate position between the cells of the nervous and endocrine systems. The treatment of neuroendocrine tumors in Israel is comprehensive. In private clinic Herzliya Medical Center, it includes surgical and therapeutic approaches: chemotherapy and radiation therapy, as well as targeted therapy.

The neuroendocrine system is represented by cell clusters located in different organs: digestive tract, thyroid gland, adrenal glands, respiratory tract, etc. This cell type has regulatory functions and it is able to synthesize biologically active substances, including hormones. Neuroendocrine tumors are divided into malignant (Merkel Cell Carcinoma, neuroendocrine tumors of the thyroid gland) and tumors with potential for malignant transformation, such as pheochromocytoma or carcinoids.

Neuroendocrine tumors are functional, in other words, they are characterized by hypersecretion of hormones. For example, pheochromocytoma produces large quantities of epinephrine and norepinephrine, leading to persistent hypertension, which may endanger the patient’s life. Primarily, neuroendocrine tumors treatment in Israel is surgical. It is complemented by procedures which aimed to normalize hormonal balance, as well as chemotherapy and radiotherapy in case of malignant tumors.

Types of neuroendocrine tumors

Pheochromocytoma

Pheochromocytoma – a rare tumor of the adrenal chromaffin cells. Chromaffin cells secrete the hormone adrenaline, its concentration in the blood rises in times of stress. Despite the fact that most of the pheochromocytomas are benign tumors, they represent a significant hazard to the patient. High level of adrenaline in the blood due to pheochromocytoma’s hormonal activity is a cause of hypertension and tachycardia, moreover, it can be complicated by pulmonary edema, retinal hemorrhage, and stroke. In most cases, pheochromocytoma affects one adrenal gland. Extraadrenal and bilateral pheochromocytomas are extremely rare tumors.

Merkel Cell Carcinoma

Merkel Cell Carcinoma is a rare type of primary skin malignant tumors. It is formed in the neuroendocrine cells of the skin and hair follicles, mainly in the neck and head areas, and it is characterized by a severe course. CK20 – is a key diagnostic biomarker of Merkel Cell Carcinoma. Differentiation of Merkel Cell Carcinoma and Melanoma is based on the positive CК20-marker in a case of Merkel carcinoma and negative HBM45, NKI / C3, S-100 markers.

Neuroendocrine carcinomas

Neuroendocrine carcinoma – the general term of malignant neuroendocrine tumors localized in different parts of the gastrointestinal tract, lungs, brain, and other organs. Cancer diagnosis and treatment in Israel include detecting the degree of malignancy. Neuroendocrine carcinomas may have low malignant potential, as well as it can be very high. Non-differentiated neuroendocrine carcinomas with high potential for malignancy is characterized by fast growth and a tendency to the early development of metastases.

The symptoms of neuroendocrine tumors

Pheochromocytoma:

• Arterial hypertension
• Tachycardia
• Panic attacks
• Increased body temperature
• Headache
• Sweating
• Nausea and vomiting

Merkel Cell Carcinoma:

• Solid painless lump on the skin-colored in red, pink or cyanotic.

Neuroendocrine carcinoma:

Symptoms of neuroendocrine carcinomas depend on their localization. In particular, the following symptoms may be present:

• Chronic pain in a tumor localization
• Loss of appetite
• Significant reduction or increase of body weight
• Hoarseness, chronic cough
• The presence of the tumor, determined by palpation
• Urination disorders, bowel disorders
• Jaundice
• Bleeding or pathological discharge from the internal organs
• Increased body temperature
• Headache
• Anxiety
• Stomach ulcer
• Skin rash

Symptomatic therapy is aimed at the relief of suffering due to disease and it is an important part of the treatment of the neuroendocrine tumor in Israel. Moreover, this tumor type has multiple varieties of manifestations, consequently, the treatment plan must be individual and modify, if necessary, for each patient.

Diagnosis of neuroendocrine tumors

Cancer Treatment in Israel begins from diagnosis, visualization of the tumor, its size, location, determination of histological type and stage of the process. Diagnosis of neuroendocrine tumors includes the following procedures:

• Examination and consultation by an internist (general practitioner)
• Examination and consultation by an oncologist
• The biochemical blood and urine tests for determination the hormones or other substances levels
• A blood test to detect chromogranin A
• The 5-hydroxy indole acetic acid (5-HIAA) urine test (it is used to help diagnose and monitor carcinoid tumors)
• Radiography
• Somatostatin receptor imaging using PET/CT
• Computed tomography or magnetic resonance imaging (CT/MRI)
• Histological revision of biopsy specimens. A biopsy and histopathological examination are needed to confirm the differentiation of tumors (benign or malignant). Biopsy of neuroendocrine tumors is not always technically possible, and in such cases, the diagnosis must be based on indirect evidence
• Immunohistochemical analysis. Neuroendocrine tumors may have specific molecular signs including genetic characteristics, the presence of specific proteins in the cell membrane, etc. It is important because oncological treatment in Israel often includes targeted therapy, which is aimed at the specific component of the tumor cells

Treatment of neuroendocrine tumors in Israel

Treatment of Merkel Cell Carcinoma and pheochromocytoma must include surgical removal of the tumor. Pheochromocytoma resection is often performed by minimally invasive surgery with laparoscopy. In these cases, surgeons use video endoscopic equipment and microsurgical instruments.

Treatment of neuroendocrine tumors in Israel often includes radiotherapy. Indications for radiotherapy are inoperable tumor location or the presence of metastases in distant organs. Radiotherapy is administered in the form of external radiation therapy or brachytherapy with granules containing radiation sources which are implanted in the tumor tissue.

Chemotherapy may be administered as an independent method of treatment or in combination with radiotherapy. This technique is called chemoradiotherapy.

One of the hopeful oncology areas in Israel is targeted therapy. Targeted drugs identify tumor cells by specific criteria: the genome, the presence of certain proteins, etc. The drug attaches to the cancer cell and inhibits the vital processes.

In a private clinic “Herzliya Medical Center”, patients with neuroendocrine tumors receive comprehensive and individually tailored treatment. Experts in various fields take part in its planning: oncologists, surgeons, endocrinologists, radiologists.