Lost with no confirmation of NETs origin: Innumerable liver lesions

Posted by k8lyn23 @k8lyn23, Feb 13, 2023

Hi, my dad-active 63 year old kept complaining of boating and dull stomach pain. I am a nurse but am not very familiar with oncology specifics. CT and MRI scans later- mass-like lesion near pancreatic head also thickening in duodenal bulb(biopsied) and multiple lesions in liver (also biopsied)
Suspicious of stage 4 pancreatic cancer.
Fast forward to pathology report- only thing I understood was the liver biopsy saying “metastatic high grade neuroendocrine cell carcinoma” -I know this is bad.
Now this is the kicker- it also says “from either the GI tract or pancreas”
We have the first meeting with the oncologist in two days to talk about everything. But in the mean time to keep myself busy I am trying to research and get educated in order to ask better questions.
I’m lost with the fact that they can’t confirm or deny the origin from the pathology? And with the origin being unconfirmed now does that affect treatment options?
Any similar experiences here? Thank you!

Interested in more discussions like this? Go to the Neuroendocrine Tumors (NETs) Support Group.

@hopeful33250

Hello @bluedane and welcome to the NETs discussion on Mayo Clinic Connect. I am so glad that you were able to be seen at Mayo Clinic. It sounds like this was a better experience for you than that of the original doctor that you saw.

I have had three surgeries for NETs (over the last 20 years) in the duodenal bulb, with no apparent metastasis. I am also asymptomatic.

You were inquiring about anyone who has had "bland liver embolization." We do have other members who have discussed this procedure including @sturns
@sophiarose and @trivia. I hope that they will post with you about their experience with this treatment.

I'm glad that you have done a lot of research on this topic. NETs aren't something that come up in ordinary conversation, so it is important to be proactive and research as much as possible.

Has your medical team suggested bland liver embolization as the next step in your treatment?

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I recently had a bland embolization for liver metastasis 5 weeks ago
They did my right side since that was the worst
If it worked which I will know after my April MRI I will have my left side done
The procedure was done through my left wrist and was not invasive at all
I had minimal pain didn’t need pain meds for a few days
I was extremely fatigued for weeks
My carcinoid symptoms were a little out of control
However!!!
This week (5th week) was my turning week and I
feel fine
Please use the support groups get all the information and support you can get the groups have given me such a piece of mind and direction
They are truly amazing
Good luck

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@bluedane

Thank you for your response and treatment info. It seems a good thing that you have one in lung and one in liver and they can zap out the liver one good. The nurse practitioner who first told me of my diagnosis was " you are lucky - if you have to have something this is the best kind to have because it is treated as a chronic manageable condition" her words have stuck with me thru this. Good luck on your journey.

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Thank you for sharing what your nurse said - it gives me a litle more hope. I am hoping that the lung tumor can also be removed, but the doctor isn't as hopeful about that one. He is conferring with Mayo about that one.

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@sueannsellers

Thank you for sharing what your nurse said - it gives me a litle more hope. I am hoping that the lung tumor can also be removed, but the doctor isn't as hopeful about that one. He is conferring with Mayo about that one.

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For what its worth, I would go to Mayo asap.
I wouldn't want someone practicing on me. I'm on my 3rd hospital, was written off by the first two last year.

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@hopeful33250

Hello @bluedane and welcome to the NETs discussion on Mayo Clinic Connect. I am so glad that you were able to be seen at Mayo Clinic. It sounds like this was a better experience for you than that of the original doctor that you saw.

I have had three surgeries for NETs (over the last 20 years) in the duodenal bulb, with no apparent metastasis. I am also asymptomatic.

You were inquiring about anyone who has had "bland liver embolization." We do have other members who have discussed this procedure including @sturns
@sophiarose and @trivia. I hope that they will post with you about their experience with this treatment.

I'm glad that you have done a lot of research on this topic. NETs aren't something that come up in ordinary conversation, so it is important to be proactive and research as much as possible.

Has your medical team suggested bland liver embolization as the next step in your treatment?

Jump to this post

The video you posted, how do I contact his office? What hospital does he work from?

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@lastround

The video you posted, how do I contact his office? What hospital does he work from?

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Hello @lastround

As there are several doctors who have been presented on this video, here is a list of NETs specialists from the Carcinoid Cancer Foundation,
--Find a doctor
https://www.carcinoid.org/for-patients/treatment/find-a-doctor/

I hope you will find the doctor in this list.

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@lastround

The video you posted, how do I contact his office? What hospital does he work from?

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Hi hopeful33250,

Met with excellent interventional radiologist yesterday from Mayo and I will be able to have the SY90 embolization to hopefully get rid of my largest one and be monitored. Looking forward to getting this done. Will have to check which lecture I referenced as have been reading so much.

Thank you for your response. keep spirits up.

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@sueannsellers

Thank you for sharing what your nurse said - it gives me a litle more hope. I am hoping that the lung tumor can also be removed, but the doctor isn't as hopeful about that one. He is conferring with Mayo about that one.

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Hi Sueannsellers, You are welcome yes that nurse practitioner's words very helpful and reinforced in much reading and lectures. Yes I have the carcinoid in my lung this can be more tricky - keep getting info and opinions. Thank you for your response and best of luck to you! Definitely stay hopeful and knowledge is so important. Helps a lot to hear other persons journeys. Take care.

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In reply to k8lyn23, Hi I had mentioned the LACNET which is a very good Los Angeles support group. It may be helpful for you. The director of that support asked a participant to describe her journey beginning in 2018 with high grade neuroendocrine tumors and her liver had innumerable mets and other areas. I think her primary was lung. Her talk was very helpful with regard to supports finding a care team and managing her NET. If you look up LACNET and go to patient stories with high grade you should find Cindy describing her experience. She is very well informed and positive. She had been hiking around Lake Tahoe and was working. Maybe this would help you to help your dad. Best wishes.

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@lastround

For what its worth, I would go to Mayo asap.
I wouldn't want someone practicing on me. I'm on my 3rd hospital, was written off by the first two last year.

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My oncologist in Indiana has already referred me to Mayo. We are running tests, etc. here and sending the info to Mayo. Thank you for your concern.

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@hollywood817

@k8lyn23 i was diagnosed on 1/5/23 via a biopsy with approx 25 cancerous lesions on my liver. It's NETliver and slow moving. I'm currently a "low" grade and a petscan on 2/10 indicated the source was the pancreas, though there are two tiny spots on the pancreas and my oncologist said I don't have pancreatic cancer. The focus right now is on the liver. On 2/15 I received my first injection of somatuline depot (generic name: Lanreotide). It's a shot I'll receive every 28 days. How does lanreotide work for neuroendocrine tumors? Lanreotide is a synthetic version of somatostatin (a somatostatin analogue) and slows down the production of hormones. This helps to control the symptoms of carcinoid syndrome and slow down the growth of the cancer. It's not a cure but allows one to control and manage the growth. Next week I have two appointments with specialist. One is a radiation oncologist and the other a specialist in oral chemotherapy. One option may be to inject radioactive beads into the liver with the objective to shrink and kill the cancer. My hope is this would then result in the ability to surgically cut out the cancer at some point in the future. The Lanreotide shot was fine when given (it's a wide needle and they inject you in the butt) that grew more painful over the course of the day. At bedtime I took two Tylenol and put a cold compress on the shot area. That dissipated the pain enough that I could sleep. Though one side effect is diarrhea and I certainly had my share of that during the night. I agree with the individual who advised you to bring a note taker. I've been keeping a journal of how I feel daily, notes from hospital visits, and food intake and results Diarrhea has been issue for me and was one symptom that drove my PCP to focus on the liver this past fall. Knowing what does or doesn't upset your stomach is key to feeling better. I feel fortunate to have a plethora of excellent Dr's in the Northern VA area and the two specialists I'm meeting with next week both called to introduce themselves. The plan is to do another petscan in May or June to see how I'm progressing. I hope this info helps. I'll post again after next week's appointments. Hugs to youk8lyn23 i was diagnosed on 1/5/23 via a biopsy with approx 25 cancerous lesions on my liver. It's NETliver and slow moving. I'm currently a "low" grade and a petscan on 2/10 indicated the source was the pancreas, though there are two tiny spots on the pancreas and my oncologist said I don't have pancreatic cancer. The focus right now is on the liver. On 2/15 I received my first injection of somatuline depot (generic name: Lanreotide). It's a shot I'll receive every 28 days. How does lanreotide work for neuroendocrine tumors? Lanreotide is a synthetic version of somatostatin (a somatostatin analogue) and slows down the production of hormones. This helps to control the symptoms of carcinoid syndrome and slow down the growth of the cancer. It's not a cure but allows one to control and manage the growth. Next week I have two appointments with specialist. One is a radiation oncologist and the other a specialist in oral chemotherapy. One option may be to inject radioactive beads into the liver with the objective to shrink and kill the cancer. My hope is this would then result in the ability to surgically cut out the cancer at some point in the future. The Lanreotide shot was fine when given (it's a wide needle and they inject you in the butt) that grew more painful over the course of the day. At bedtime I took two Tylenol and put a cold compress on the shot area. That dissipated the pain enough that I could sleep. Though one side effect is diarrhea and I certainly had my share of that during the night. I agree with the individual who advised you to bring a note taker. I've been keeping a journal of how I feel daily, notes from hospital visits, and food intake and results Diarrhea has been issue for me and was one symptom that drove my PCP to focus on the liver this past fall. Knowing what does or doesn't upset your stomach is key to feeling better. I feel fortunate to have a plethora of excellent Dr's in the Northern VA area and the two specialists I'm meeting with next week both called to introduce themselves. The plan is to do another petscan in May or June to see how I'm progressing. I hope this info helps. I'll post again after next week's appointments. Hugs to you.

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Hi - I hope your meeting with the specialists was good. Would you mind telling me who you’re seeing in the northern Va area and if, after meeting them, whether they seem experienced in NETs? I have a tumor in the mesentery by my small intestines and am told it’s likely to be a NET. I’m getting a PET/CT DOTATATE scan in a week to spot other locations. I’m seeing a surgeon at Johns Hopkins who has dealt with some NETs. I’m trying to figure out if Hopkins is a good place to go and am looking for an experienced oncologist. Good luck and thanks for posting.

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