Home » Abdominal Pain in NETs
Neuroendocrine tumours (NETs) are a complex and heterogeneous group of neoplasms that originate from neuroendocrine cells dispersed throughout the body.
These tumours can secrete various hormones and a variety of peptides (little proteins) leading to a wide range of symptoms. Among these, abdominal pain is a particularly significant and distressing symptom for patients.
This article explores the significance of abdominal pain in NETs, examining its causes, diagnostic approaches, management strategies, and its impact on patients’ quality of life.
Neuroendocrine Cancer Australia (NECA), is dedicated to assisting individuals diagnosed with NETs, 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.
Abdominal pain is one of the most common and troubling symptoms experienced by patients with NETs. It can significantly affect the quality of life, leading to decreased functional ability, increased emotional distress, and a negative impact on overall wellbeing.
Understanding the causes and characteristics of abdominal pain in NETs is crucial for providing effective management and improving patient outcomes.
Early recognition and intervention can help alleviate pain, prevent complications, and enhance the overall treatment experience for patients.
NETs arise from neuroendocrine cells that have both nerve and endocrine functions. These cells are found in various organs, including the gastrointestinal tract, pancreas, and lungs.
NETs can be benign or malignant and are characterised by their ability to produce hormones and other substances, leading to diverse clinical presentations.
The hormone-secreting nature of these tumours often results in complex syndromes that require specialised diagnostic and therapeutic approaches.
Abdominal pain in NETs can result from various pathophysiological mechanisms. Understanding these mechanisms is essential for developing targeted treatment strategies.
While some abdominal pain related to NETs can be obscured by the disease’s indistinct and rare characteristics, some can be readily identified.
The physical growth of NETs can cause significant pressure on surrounding organs and tissues, leading to pain. This is particularly common in tumours located in the gastrointestinal tract and pancreas. As the tumour enlarges, it can compress nerves, blood vessels, and adjacent organs, resulting in varying degrees of discomfort and pain.
NETs can secrete hormones that affect gastrointestinal motility and function. For example, serotonin-producing tumours can lead to carcinoid syndrome, characterised by abdominal pain, diarrhoea, and flushing. Excessive hormone production can disrupt normal digestive processes, leading to pain and other gastrointestinal symptoms.
NETs in the gastrointestinal tract can cause partial or complete obstruction, leading to severe abdominal pain. Obstruction occurs when the tumour physically blocks the passage of food and waste, causing symptoms such as cramping, bloating, nausea, and vomiting. This condition requires prompt medical attention to relieve the obstruction and alleviate pain.
Symptoms and characteristics of abdominal pain related to NETs can often arise as other conditions that affect the abdomen, including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), peptic ulcer disease, gallstones, and appendicitis.
This overlap can complicate the diagnosis and delay appropriate treatment. If you are concerned, it’s always best to consult your healthcare professional.
The nature and location of abdominal pain in NETs can vary widely depending on the tumour’s size, location, and hormone production. Pain may be dull, sharp, cramping, or constant. It can also vary from being localised or diffused across the gastrointestinal system. The specific characteristics of the pain can provide important clues for diagnosis and management.
Abdominal pain in NETs is often accompanied by other gastrointestinal symptoms such as bloating, nausea, vomiting, diarrhoea, and constipation. These associated symptoms can provide additional insights into the underlying cause of the pain and help guide diagnostic and therapeutic decisions.
The type of NET can influence the nature and severity of abdominal pain. For example, patients with neuroendocrine tumours may experience pain associated with carcinoid syndrome. Understanding the specific characteristics of different NETs is essential for accurate diagnosis and effective management.
The diagnosis of abdominal pain related to NETs should always be undertaken in conference with a primary care team. Here’s how a typical process flows.
A thorough clinical evaluation and detailed patient history are crucial for diagnosing abdominal pain in NETs. Clinicians should assess the onset, duration, intensity, and pattern of the pain, as well as any associated symptoms. A comprehensive history can provide valuable information about potential triggers and underlying causes.
Imaging studies are essential for identifying the location and extent of NETs and assessing their impact on surrounding structures. Computed tomography (CT) scans, magnetic resonance imaging (MRI), and ultrasound are commonly used to visualise tumours, detect obstructions, and evaluate the extent of disease spread. Additional scans such as Ga68 Dotatate PET scans and FDG PET scans can also be used for treatment, planning and staging.
Endoscopic procedures, such as gastroscopy and colonoscopy, allow direct visualisation of the gastrointestinal tract and the opportunity to obtain biopsy samples. These procedures are invaluable for diagnosing NETs, assessing tumour involvement, and monitoring treatment responses. Endoscopy can also be used therapeutically to manage complications such as bleeding or obstruction.
Laboratory tests, including hormonal assays and blood tests, are crucial for diagnosing NETs and assessing hormonal activity. Measuring hormone levels can help identify functional tumours and guide treatment decisions. Additionally, blood tests can provide information about overall health and detect any complications associated with the tumour.
Fortunately, abdominal pain related to NETs can be effectively managed with a combination of pain relief, surgeries, and related therapies. Your primary care team will be able to advise on the best course of action.
Medical management of abdominal pain in NETs focuses on alleviating pain, controlling hormone levels, and addressing any underlying complications. Treatment plans are tailored to the individual patient’s needs, aiming to provide effective symptom relief and improve quality of life.
Pain relief medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), Non-opioid analgesic (e.g. Panadol), and opioids, can help manage abdominal pain in NETs patients. The choice of medication depends on the severity of the pain and the patient’s overall health. It is important to use these medications under medical supervision to avoid potential side effects and complications.
SSA therapy is used to control the production and effects of hormones secreted by NETs. Medications such as somatostatin analogues (e.g., octreotide and lanreotide) can inhibit hormone release and alleviate symptoms such as pain, diarrhoea, and flushing. SSA therapy is often an integral part of the treatment plan for patients with functional NETs.
Surgical interventions are often necessary for managing NETs and alleviating abdominal pain. Surgery aims to remove the tumour, relieve obstructions, and reduce hormone production.
Tumour resection involves the surgical removal of the NET, which can significantly reduce hormone levels and improve symptoms. This intervention is particularly effective for localised tumours and can be curative in some cases. Surgical resection may also be combined with other treatments, such as chemotherapy or radiation therapy, to enhance outcomes.
Palliative surgeries are performed to relieve symptoms and improve quality of life in patients with advanced or metastatic NETs. These procedures aim to reduce tumour burden, and alleviate symptoms. Palliative surgeries are an important option for patients who are not candidates for curative surgery.
Interventional radiology techniques, such as radiofrequency ablation and embolisation, can be used to destroy tumour tissue and reduce hormone production. These minimally invasive procedures can provide effective symptom relief and are particularly useful for patients who are not candidates for surgery.
Nutritional support is essential for managing abdominal pain and associated symptoms in NETs patients. A dietitian can help develop a personalised nutrition plan to address specific dietary needs and improve overall health. Nutritional support may include dietary modifications, oral nutritional supplements, and, in severe cases, enteral or parenteral nutrition.
Abdominal pain can have significant physical and emotional effects on NETs patients. Physically, pain can limit daily activities, reduce functional ability, and lead to fatigue and weight loss.
Emotionally, chronic pain can cause anxiety, depression, and decreased quality of life. Addressing these physical and emotional impacts is essential for holistic patient care.
Effective pain management and coping strategies are crucial for improving the quality of life in NETs patients. Pain management may include a combination of medications, surgical interventions, and complementary therapies such as acupuncture and physical therapy.
Coping strategies, such as psychological counselling, support groups, and stress-reduction techniques, can help patients manage the emotional burden of their condition.
Ongoing research is focused on improving our understanding of the mechanisms underlying abdominal pain in NETs. Advances in molecular biology, genetics, and imaging techniques are providing new insights into the pathophysiology of NETs and their associated symptoms. These discoveries are essential for developing targeted therapies and improving patient outcomes.
Emerging therapies and interventions are being explored to provide more effective management of abdominal pain in NETs patients. These include novel pharmacological agents, advanced surgical techniques, and innovative approaches to pain relief and symptom management. Clinical trials are essential for evaluating the safety and efficacy of these new treatments and expanding the range of therapeutic options available to patients.
Abdominal pain is a significant and challenging symptom in NETs patients that requires comprehensive management. Understanding the causes, characteristics, and diagnostic approaches is essential for providing effective treatment and improving patient outcomes. Management strategies should include medical and surgical interventions, nutritional support, and symptom relief, all tailored to the individual patient’s needs.
Comprehensive symptom management and support are crucial for enhancing the quality of life in NETs patients. A multidisciplinary approach that includes medical, nutritional, and psychological support is essential for addressing the complex needs of these patients.
Neuroendocrine Cancer Australia (NECA) is committed to supporting NETs patients and their families through educational programs, advocacy efforts, and the NET nurse line, offering valuable resources and guidance. Comprehensive care and early intervention 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.