Markey Cancer Center Neuroendocrine Multidisciplinary Clinic

Transcription

1 Markey Cancer Center Neuroendocrine Multidisciplinary Clinic

2 Markey launches Endocrine/Neuroendocrine Clinic The UK Markey Cancer Center is home to the region s first multidisciplinary clinic dedicated to endocrine and neuroendocrine tumors. Because the overall incidence of neuroendocrine tumors is rare, they present some unique diagnostic and therapeutic challenges. The neuroendocrine tumor team at the Markey Cancer Center believes that these tumors must be addressed for each individual, stressing patient education, patient care and innovative research. This will result in better care for patients, improving both their prognosis and their quality of life. Our multidisciplinary, team-based treatment approach incorporates chemotherapy, radiation therapy and interventional therapy. Physicians who would like to refer a patient to the UK Markey Cancer Center Endocrine/Neuroendocrine Clinic may call UK MDs toll free at or use the online referral form at ukhealthcare.uky.edu/refpatientform.

3 Meet our team Endocrinology Medical Oncology Thoracic Surgery Endocrine Surgery Kenneth Ain, MD Cortney Lee, MD David Sloan, MD Endocrine surgery section chief; associate professor of surgery Otolaryngology Head and Neck Surgery Rony Aouad, MD Thomas Gal, MD Associate professor of surgery Joseph Valentino, MD Professor of surgery Surgical Oncology Radiation Medicine Lowell Anthony, MD Philip DeSimone, MD Edward Wolin, MD B. Mark Evers, MD Markey Cancer Center director; professor of surgery Jitesh Patel, MD, FACS Ching-Wei Tzeng, MD Assistant professor of medicine Mahesh Kudrimoti, MD Associate professor of radiation medicine; vice chair for clinical operations Radiology Angela Mahan, MD Jeremiah Martin, MD Timothy Mullett, MD Thoracic surgery chief; associate professor of surgery Abdominal Radiology James Lee, MD Assistant professor of radiology Interventional Radiology Steven J. Krohmer, MD Assistant professor of radiology Neuroradiology Edward Escott, MD Neuroradiology division chief; associate professor of radiology Nuclear Medicine Partha Sinha, MD Nuclear medicine division chief; associate professor of radiology Thoracic Radiology M. Elizabeth Oates, MD Radiology department chair; professor of radiology

4 Endocrine and neuroendocrine tumors The endocrine system is a complex network of glands throughout the body that secrete various hormones, which act as chemical messengers. The nervous system fulfills a similar role, using electrical impulses to communicate. The neuroendocrine system is made up of cells that are a cross between traditional hormone-producing endocrine cells and nerve cells. Endocrine and neuroendocrine cells are found throughout the body and regulate biological processes. Endocrine tumors affect the parts of the body that secrete hormones. These tumors are located in the cells that make hormones and can therefore make hormones and cause serious illness. Neuroendocrine tumors arise from cells dispersed through the body but concentrated in certain areas, such as the lung, pancreas and intestinal tract. Specific clinical syndromes that may arise are related to oversecretion of amine and peptide hormones. Treatment is dependent upon the primary site and stage. Early stage disease may be surgically cured, whereas metastatic disease can be managed by multiple disciplines and controlled for many years. Because they often are slow-growing and without symptoms, neuroendocrine tumors can go undetected for years. The most common site for neuroendocrine tumors is in the hormone-producing cells lining the small bowel. However, these tumors can also be found in the lungs, stomach, pancreas and rectum.

5 Types of endocrine and neuroendocrine tumors Carcinoid The indolent, or slow-growing, form of neuroendocrine tumors is called carcinoid, meaning cancer-like. Carcinoid tumors were so named because they appeared to combine features of benign and malignant tumors. Although slowgrowing, all carcinoids are now thought to have the potential to become malignant and spread to other parts of the body. A minority of carcinoid patients will develop carcinoid syndrome, which results from the secretion by the tumor of larger-than-normal amounts of hormones such as serotonin. Symptoms of carcinoid syndrome include flushing, shortness of breath, palpitations and diarrhea. However, most carcinoid tumors do not produce symptoms and are discovered accidentally, such as when a patient has surgery for an unrelated problem. Thyroid cancer The incidence of thyroid cancer is increasing dramatically and the lifetime risk is now 1 in 97. There are a variety of types of thyroid cancer, requiring specific treatments and having different risks. The most common type of thyroid cancer is papillary thyroid carcinoma followed by follicular carcinoma. Both of these differentiated thyroid cancers are treated with a thyroidectomy. A total thyroidectomy is almost always performed and the removal of the lymph nodes in the central compartment of the neck is fairly common. The surgery is typically performed through a small lower-neck incision, often as an outpatient procedure. Complications of thyroidectomy are rare, especially when performed by surgeons with high surgical volumes. Thyroidectomy is typically followed by oral treatment with radioactive iodine several weeks after surgery. Chemotherapy is not part of differentiated thyroid cancer treatment. Patients do require long and careful follow-up, but cure rates for patients with papillary and follicular thyroid cancer are high, particularly for younger patients. Medullary thyroid cancer is a less common but more aggressive thyroid cancer that can be part of a genetic syndrome sometimes inherited in families. A blood test is available to test for the abnormal gene in affected family members. Every medullary thyroid cancer patient is tested and if the results are positive, all members of the family are also tested. Medullary thyroid cancer treatment is generally limited to surgical excision of all disease, though that may not be possible if the cancer is not found at an early stage. Surgical treatment typically includes a total thyroidectomy and a much more extensive removal of lymph nodes in the neck than with patients with other thyroid cancers. Chemotherapy and radiation treatment is rarely appropriate. Patients undergoing surgery typically live many years, but long-term cure rates are lower than those for patients with papillary and follicular carcinoma. Anaplastic thyroid cancer is the most aggressive type of thyroid cancer with the poorest prognosis. Surgery is performed when possible but treatment usually consists of chemotherapy and radiation therapy.

6 A team approach to care When considering the treatment of thyroid cancer, it is very important that treatment of individual patients be given by specialists that work together as a team. At the UK Markey Cancer Center, this team consists of surgeons, endocrinologists, radiation oncologists and radiologists as well as other allied health professionals who are all focused on delivering the very best of care. Adrenal adenomas and cancer Adenomas, or nodules in the adrenal glands, are very common, occurring in up to one out of 50 people. They are usually noncancerous and non-functional. Rarely these nodules can cause problems by producing excessive amounts of hormones including adrenaline, cortisol and aldosterone. Blood and/or urine tests are the only way to evaluate the function of an adrenal nodule. Biochemical tests and follow-up imaging should be obtained in all patients with an adenoma. All functional adenomas and any adrenal mass with worrisome imaging characteristics or larger than 4 centimenters should be removed by an experienced adrenal surgeon. Adrenal adenocarcinoma is a deadly cancer with high recurrence rates. Complete surgical removal provides the only chance for cure. Radiation and chemotherapy can help control residual or recurrent disease. Adrenal diseases, including pheochromocytoma and adrenal adenocarcinoma, require very attentive pre-, peri- and postoperative care and should be managed by teams with experience in diagnosing, treating and following these rare diseases. At some UK HealthCare clinics, a complete team approach to care allows patients to have fewer office visits. A process that traditionally requires multiple visits over several weeks is accomplished in one office visit. In this manner, we are able to provide efficient, outstanding patient care while decreasing times to both diagnosis and treatment. For example, our newest endocrine surgeon, Dr. Cortney Lee, can perform thyroid ultrasounds and biopsies during the initial clinic visit. Pathologists then provide an immediate preliminary interpretation. Based on the initial biopsy results, Dr. Lee can discuss and schedule surgery during the same visit, if needed. At the Neuroendocrine Multidisciplinary Clinic, treatment planning begins with the patient s first visit. Specialists from medical, surgical and radiation oncology review cases with pathologists and diagnostic radiologists. Patients are treated with a coordinated comprehensive care approach, which includes communication with the primary care team and referring physicians.