Neuroendocrine tumours (NETs) represent a diverse group of neoplasms that originate from neuroendocrine cells distributed throughout the body. These tumours can be benign or malignant and are often characterised by their ability to produce hormones and other bioactive substances.
Among the myriad of symptoms and complications associated with NETs, unexplained weight loss is particularly troubling, as it can significantly impact a patient’s quality of life and overall prognosis.
This article examines unexplained weight loss in NETs patients, explores the potential causes, and discusses effective strategies for diagnosis and management.
Neuroendocrine Cancer Australia (NECA), is dedicated to assisting individuals with neuroendocrine cancer and their families. NECA offers a wealth of resources, educational programs, and advocacy efforts aimed at deepening the understanding of NETs, improving patient care, and encouraging research advancements. Patients diagnosed with NETs can engage with NECA’s comprehensive support and information by calling the NET nurse line.
Unexplained weight loss in patients with neuroendocrine tumours is more than just a symptom; it is a clinical challenge that can have profound implications for patient health. Weight loss can lead to malnutrition, decreased muscle strength, increased susceptibility to infections, and a diminished ability to tolerate treatments.
Addressing this issue promptly is crucial not only for improving the patient’s quality of life but also for optimising treatment outcomes and potentially enhancing survival rates. For healthcare providers, recognising and addressing unexplained weight loss early can lead to better patient management and care.
NETs arise from cells of the neuroendocrine system, which have characteristics of both nerve cells and hormone-producing cells. These tumours can occur in various parts of the body, including the gastrointestinal tract, pancreas, and lungs. NETs are known for their diverse clinical manifestations, primarily due to their potential to secrete a variety of hormones, leading to complex syndromes and symptoms.
The clinical presentation of NETs varies widely depending on the tumour’s location, size, and hormonal activity.
Common symptoms include:
The hormonal activity of NETs can cause specific syndromes, such as carcinoid syndrome, which is characterised by flushing and diarrhoea, and insulinoma syndrome, which leads to hypoglycemia and associated symptoms. These varied presentations often result in a delay in diagnosis, as they can mimic more common conditions.
There are a range of causes of unexplained weight loss for NET patients. Keep in mind that this is not a totally exhaustive list, and depending on the tumour location and stage, that weight loss may be attributed to other factors.
One of the primary causes of unexplained weight loss in NET patients is the altered metabolism induced by the tumours. NETs can create a hypermetabolic state by increasing the body’s energy expenditure.
The tumours themselves can consume a significant amount of energy, leading to an overall increase in the metabolic rate. This hypermetabolic state can result in significant weight loss, even if the patient maintains an adequate caloric intake.
Many NETs secrete hormones or hormone-like substances that can profoundly impact metabolism and appetite. For instance, serotonin-secreting tumours (neuroendocrine tumours) can cause carcinoid syndrome, characterised by diarrhoea and subsequent weight loss.
NETs often affect the gastrointestinal (GI) tract, leading to various complications that contribute to weight loss. Tumours in the GI tract can cause mechanical obstruction, malabsorption, and chronic diarrhoea, all of which can result in significant nutrient loss and weight reduction.
Additionally, surgeries or treatments aimed at managing these tumours can further impact GI function, exacerbating weight loss.
Evaluating unexplained weight loss in NETs patients requires a comprehensive approach. Clinicians should take a detailed medical history, including:
This approach helps identify potential causes of weight loss and related symptoms, guiding further diagnostic testing.
A variety of diagnostic tests and imaging studies are essential for diagnosing NETs and understanding the extent of the disease. Blood tests for hormone levels can help identify functional tumours, while imaging studies such as CT scans, MRI, and PET scans are crucial for locating tumours and assessing their spread. Endoscopic procedures may also be necessary to visualise the GI tract and obtain biopsy samples, providing histological confirmation of NETs.
Nutritional assessment is a critical component in the evaluation of unexplained weight loss in NETs patients. This assessment includes evaluating dietary intake, calculating body mass index (BMI), and conducting laboratory tests to assess for nutritional deficiencies. The involvement of a dietitian is often beneficial, as they can develop and monitor a tailored nutrition plan aimed at addressing weight loss and improving overall health.
Fortunately, there are ways to manage unexplained weight loss for NET patients. These strategies should always be undertaken after instruction from a dietician, GP, oncologist, or related member of your healthcare team.
The primary goal of medical management for weight loss in NETs patients is to treat the underlying tumour and associated symptoms. Surgical removal of the tumour, when feasible, can alleviate symptoms and potentially allow for weight gain.
For patients who are not candidates for surgery, other treatments such as chemotherapy, targeted therapy, or peptide receptor radionuclide therapy (PRRT) may be used to control tumour growth and hormonal secretion. These treatments can help stabilise the patient’s condition and mitigate weight loss.
Nutritional support is a cornerstone of managing unexplained weight loss in NETs patients. This can include high-calorie and high-protein diets to meet the increased metabolic demands. Oral nutritional supplements may be necessary to ensure adequate nutrient intake.
In severe cases, enteral nutrition (tube feeding) or parenteral nutrition (intravenous feeding) may be required. Dietitians play a crucial role in developing these nutritional plans, monitoring the patient’s progress, and making necessary adjustments to optimise their nutritional status.
In some cases, medications may be prescribed to stimulate appetite and promote weight gain. The use of medication Creon to assist with pancreatic enzyme supplements to help with digestion and absorbing food. However, the use of these medications should be carefully monitored due to potential side effects, including fluid retention and an increased risk of infection.
Weight loss and other bodily changes can significantly impact a patient’s quality of life. Here are some things to be aware of when moving through NET treatment.
Unexplained weight loss can have profound physical and emotional effects on NETs patients. Physically, it can lead to weakness, fatigue, and decreased ability to tolerate cancer treatments. This, in turn, can result in a diminished quality of life and reduced functional status.
Emotionally, the stress and anxiety associated with significant weight loss can exacerbate feelings of distress, depression, and hopelessness, further impacting the patient’s overall wellbeing.
Patients with NETs experiencing weight loss can benefit from various coping strategies. Support groups provide a platform for sharing experiences and receiving emotional support from others facing similar challenges. Psychological counselling can help patients manage anxiety and depression associated with their condition.
Additionally, engaging in physical activity where possible can improve overall strength, mood, and wellbeing. Educating patients and their families about the nature of the disease and the importance of nutrition can empower them to take an active role in managing their health.
Research on unexplained weight loss in NETs patients is ongoing, with studies focusing on understanding the underlying mechanisms and developing effective management strategies. Clinical trials are exploring new therapies and interventions aimed at addressing weight loss and improving patient outcomes. These studies are crucial for advancing our understanding of NETs and their impact on metabolism, paving the way for more effective treatments.
Unexplained weight loss in NETs patients is a complex issue that requires a comprehensive approach to diagnosis and management. Understanding the causes, performing thorough evaluations, and implementing targeted interventions are essential steps in addressing this symptom. Effective management includes treating the underlying tumour, providing nutritional support, and addressing the physical and emotional impacts of weight loss.
Early intervention and a multidisciplinary approach are crucial for managing unexplained weight loss in NETs patients. By providing comprehensive care that includes medical, nutritional, and psychological support, healthcare providers can significantly improve the quality of life and outcomes for patients with neuroendocrine tumours.
Neuroendocrine Cancer Australia (NECA) remains committed to supporting patients with NETs and their families. Through educational programs, advocacy efforts, and the NET nurse line, NECA provides valuable resources and guidance to help patients navigate their journey with NETs. Early and comprehensive care can make a profound difference in the lives of those affected by this challenging condition.
Further information and support for people diagnosed with NETs is available by calling the NECA NET nurse line.
