The Answer: The neuroendocrine system is made of a network of specialized, nerve-like cells that can produce and release hormones into the blood stream. Neuroendocrine tumours are relatively rare and can present anywhere in the body but more commonly in the small bowel, rectum, appendix, pancreas or stomach. Half of these tumours secrete hormones such as serotonin that, in turn, have the potential to damage heart valves.

Since the symptoms – bloating, wheezing, flushing, diarrhea, persistent cough and loss of appetite to name a few – can be vague or generalizable to other medical conditions, it can take up to three years before patients are accurately diagnosed, according to Simron Singh, medical oncologist and co-head of The Susan Leslie Clinic for Neuroendocrine Tumours at Sunnybrook. Sometimes there are no symptoms until a patient is seen in emergency, which is consistent with your Godfather’s situation.

“Every month, we see cases just like what is being described,” said Dr. Singh, who co-heads the largest neuroendocrine clinic in Canada, at Sunnybrook’s Odette Cancer Centre, seeing about 200 new patients each year, plus up to an additional 400 in follow up. “Treatment is very individualized.”

You may recall that Steve Jobs, entrepreneur, inventor and co-founder, chairman and CEO of Apple Inc. was diagnosed with islet-cell neuroendocrine cancer, which manifested itself in his pancreas. He initially resisted recommendations for mainstream medical intervention, instead consuming an alternative medicine diet, that, according to Harvard research associate Ramzi Amri, “eventually led to an unnecessarily early death,” he was quoted as saying in the Daily Mail. Though Mr. Jobs did eventually pursue conventional medical treatment, including surgery, he died in October 2011 due to a relapse of his condition.

Due to its rarity and complexity, I would suggest your Godfather obtain an opinion from a cancer centre that has extensive expertise in the treatment of these tumours. That does not mean he has to leave his community oncologist – only that he obtains a treatment plan from an experienced cancer centre that can likely coordinate his treatment and ensure the best possible outcome. In short, there is nothing to lose and everything to gain from an extra set of expert eyes.

“For patients outside of Toronto, this one visit can allow us to create a personalized plan that the patient can share with their oncologist,” said Calvin Law, head of the cancer surgery program at Sunnybrook, who has operated on many patients with neuroendocrine cancer. “Some can receive therapy closer to home.”

Your Godfather may or may not need more treatment. His treatment plan will involve a detailed analysis of the pathology of the tumour, specifically reviewing the type, size, grade, plus any additional complications. They may want to do an octreotide scan, which allows doctors to see inside the body to locate the tumour and determine if it has spread elsewhere in the body. As well, doctors would likely do a pathological test called Ki-67, which if high, suggests the cancer is aggressive. Depending on other features, your Godfather may require more surgery.

The post Diagnosed with a Rare Cancer, a Patient Needs a Plan appeared first on Your Health Matters.

It’s not the happiest news. Experts published in the most recent edition of the Journal of the American Medical Association suggest cancer is poised to become the leading cause of death worldwide. That’s despite major strides forward in cancer treatment and prevention.

That said, there is a lot you can do as an individual to reduce your risk. That includes things like healthy eating, staying active and being screened, when indicated. Cancer screening is something most of us will experience, and it simply means you’re being checked. If something suspicious is found, your doctor will likely order a biopsy, a sample of tissue taken for closer examination. And while you wait at home, worrying and wondering, what happens behind the scenes is something you simply have to see.

At Sunnybrook Health Sciences Centre, thousands of such tissue samples are sent to our state-of-the-art pathology lab every year. When I walked in for the first time, I was amazed by the process. It’s something patients usually never get to see. But if you click on my video link, I’ll walk you through every step and introduce you to our Chief of the Department of Anatomic Pathology, Dr. Mahmoud Khalifa.

Step one is receiving the sample, processing it into the system with a unique patient code number. A technician then sits at a table, cutting it into smaller pieces that will fit into a special color-coded cassette. The one-inch cassette is porous to allow different chemical solutions to pass through, the purpose being to dry out the tissue during overnight processing.

Once that’s complete, the sample moves on to a so-called embedding station, where it’s removed from the cassette and covered in liquid wax. The wax is then allowed to harden on a small black cold plate. You might wonder, why wax? The reason is that the wax suspends the tissue sample, allowing for the next step in this intricate process: cutting. Picture the meat slicer you find at the grocery store. Well, that’s what happens to the tissue suspended in wax: it’s sliced like salami so different depths of the sample can be examined. Then, these thin sheets of wax are placed to float in a small water bath, where the technologist can literally scoop up what they need onto a glass slide. These glass slides are labeled with the patient’s specific code to eliminate any mix-ups.

Once the section is on the slide, it needs to be stained so the pathologist can do their job. Pathologists are physicians who have specialized training and examine tissue, blood or other body fluids to help diagnose diseases, blood disorders and infections. The staining process takes about one hour, and the pink color allows for the cells to be viewed under the microscope to check for cancer. Sunnybrook has one of the most up-to-date staining systems in the country. By laying the glass slides flat, it virtually eliminates the risk that cells from one slide will contaminate another. In short, cutting the chance of receiving a false-positive result.

After staining, another technologist matches the slides with a pathology report before they are sent on. Sunnybrook is also a leader here, having teams of pathologists who specialize in each type of cancer. And that’s an added benefit to patients, especially in more complex cases.

Our hospital has one of the most robust quality assurance programs in Canada. And the bottom line for patients is simple: when they get a result, they can rest assured that every step has been taken to make sure it’s accurate.

I hope you’ll check out my video. It’s a story you won’t see anywhere else.

The post What happens to your biopsy? appeared first on Your Health Matters.