Medical Assessment of Neuroendocrine Cancer

Having a thorough assessment of your condition at diagnosis and finding the right care are interrelated and essential to optimal treatment. A full assessment can help you determine what constitutes the best physician choice for you, but sometimes it takes finding the right physician before you get a true full assessment.

It is not possible to generalize, for example, what a Stage 4 diagnosis of NETs means until as much information as possible is gathered. Many NET patients have metastatic disease at the time of diagnosis, but where are all the tumors and metastases? How aggressive is their growth (grade), and are they growing in a location that interferes with important functions? Is the tumor releasing hormones (functional) and does it have receptors (a characteristic of the cells that impacts diagnosis and treatment)? Every part of the assessment informs your eventual treatment plan. In many situations, given limited disease and indolent or slow-growing tumors, even Stage 4 disease can be controlled for years if not decades. However, aggressive tumors, or tumors impacting vital structures, usually require intervening vigorously and with urgency. Patients are always best served by comprehensive assessments that provide the complete picture.

Assessment tools can include biomarkers in blood and urine, tissue analysis (biopsy), and imaging (CT, MRI, and PET or other nuclear imaging). If a certain test or scan has not been ordered for you, don’t hesitate to ask your health care provider why. These tools may not all be available at your local care center, and some may not be covered by your insurance without an appeal from your doctor. Tests, biopsies and scans alone may not give the whole picture. In certain cases, your doctor may want to observe your disease status over a period of time; watching can be informative.

“When establishing a treatment plan, it is very important to know as much as possible about the tumor itself—grade, origin, stage, organs involved by the cancer, whether the tumor makes any biochemical substances (hormones) and if the patient has any symptoms from the cancer. Additionally it is important to consider any previous history of cancer and related treatments, as well as the patient’s overall state of health.”
--Boris Naraev, MD, PhD