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Neuroendocrine tumours (NETs) are a diverse group of cancers that arise from neuroendocrine cells, which are found throughout the body. These cells are responsible for producing hormones that regulate various bodily functions.
NETs can develop in different organs, including the pancreas, lungs, and gastrointestinal tract.
The complexity of NETs lies in their ability to produce excess hormones, affecting the the neuroendocrine system
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.
Somatostatin analogues (SSAs) are a cornerstone in the treatment of NETs, particularly for patients with functional tumours that secrete hormones.
SSAs are synthetic versions of somatostatin, a naturally occurring hormone that inhibits the release of several other hormones, including growth hormone, insulin, and glucagon.
SSAs work by binding to somatostatin receptors on the tumour cells, thereby reducing the secretion of excess hormones and alleviating symptoms such as flushing, diarrhoea, and abdominal pain.
SSAs, such as octreotide and lanreotide, are designed to mimic the action of natural somatostatin but with a longer duration of action. These medications are typically administered as long-acting injections every four weeks.
By targeting somatostatin receptors on NET cells, SSAs can effectively:
The most commonly used SSAs in the treatment of NETs are octreotide and lanreotide.
Both medications are generally well-tolerated by most patients and have become standard treatments for NETs worldwide.
SSA therapy offers significant benefits for NET patients by effectively controlling hormone-related symptoms and improving quality of life.
Studies have shown that SSAs can reduce the frequency and severity of symptoms such as flushing, diarrhoea, and abdominal pain in over 70% of patients.
Moreover, SSAs have demonstrated the ability to stabilise tumour growth in a substantial proportion of patients, thereby delaying the progression of the disease and extending survival rates.
As effective as SSA therapies are for NET patients, there are some gall bladder issues that have been associated with treatment. Both patients and their healthcare teams should be abreast of these before beginning treatment.
One of the known side effects of long-term SSA therapy is the increased risk of gallstones, also known as cholelithiasis.
Gallstones are hardened deposits of bile that can form in the gallbladder due to the altered bile composition caused by SSAs.
The formation of gallstones occurs in approximately 10-50% of patients receiving SSA treatment, making it a significant concern for those undergoing long-term therapy.
While many gallstones are asymptomatic, they can lead to complications if they block the bile ducts, causing pain, inflammation, or infection.
In addition to gallstones, SSA therapy can also lead to the development of gallbladder sludge, a mixture of particulate matter and mucus that forms in the bile. Gallbladder sludge can be a precursor to gallstones and may cause similar symptoms, including abdominal pain and nausea. It is often detected incidentally during imaging studies but can sometimes lead to more serious biliary complications if left untreated.
Biliary complications such as cholecystitis, an inflammation of the gallbladder, can arise from the presence of gallstones or sludge. Cholecystitis is a potentially serious condition that can cause severe abdominal pain, fever, and nausea, often requiring medical intervention.
In NET patients on SSA therapy, the risk of cholecystitis and other biliary complications is heightened due to the increased likelihood of gallstone formation. Prompt diagnosis and treatment are essential to prevent further complications, such as gallbladder rupture or biliary sepsis.
The frequency of gallbladder issues in NET patients on SSA therapy varies depending on several factors, including the duration of treatment – with longer treatments givin rise to additional risk factors
Risk factors for developing gallstones or sludge while on SSA therapy include:
Monitoring and early intervention are crucial for patients at higher risk to mitigate the potential complications associated with gallbladder issues.
It’s important for all NET patients, regardless of their risk factors, to be able to recognise the symptoms of gallbladder issues.
Symptoms of gallbladder issues in NET patients can vary but often include:
The discomfort may be intermittent or constant and can be triggered by eating fatty foods.
Diagnostic imaging plays a key role in identifying gallbladder issues in NET patients.
Blood tests, including liver function tests (LFTs), can provide valuable information about gallbladder function and the presence of biliary complications.
Elevated levels of liver enzymes, such as alkaline phosphatase (ALP) and bilirubin, may indicate bile duct obstruction or inflammation.
Additionally, tests for markers of infection, such as white blood cell count, can help identify cases of cholecystitis.
Fortunately, there are ways that NET patients can manage gallbladder issues. These should always be undertaken under consultation with your healthcare team.
Preventive measures are essential for managing the risk of gallbladder issues in NET patients receiving SSA therapy.
Dietary modifications, such as reducing the intake of fatty foods and increasing fibre consumption, can help reduce the risk of gallstone formation.
Regular monitoring through ultrasound and liver function tests is also recommended to detect early signs of gallbladder issues before they become symptomatic.
Pain relief is often necessary, and nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol are commonly used to manage mild to moderate pain.
For patients with nausea or vomiting, antiemetic medications can provide relief. It is also important for patients to stay hydrated and maintain a healthy diet to support overall digestive health.
Cholecystectomy, the surgical removal of the gallbladder, is often recommended for NET patients who develop symptomatic gallstones or recurrent cholecystitis.
The procedure can be performed laparoscopically, which is minimally invasive and allows for faster recovery.
Cholecystectomy effectively eliminates the risk of future gallbladder issues and is generally well-tolerated by most patients.
In some cases, minimally invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) may be used to remove stones from the bile ducts or to place stents to relieve obstructions.
These procedures can be an alternative to surgery for patients who are not candidates for cholecystectomy or who have complex biliary anatomy.
ERCP is often combined with sphincterotomy, a procedure that enlarges the bile duct opening to facilitate stone removal.
Patients suffering from gall bladder issues can have a serious impact on their quality of life. Understanding and managing these impacts is the best way for NET patients to live with their condition during treatment.
Managing SSA treatment and gallbladder issues concurrently can be challenging for NET patients, as both conditions require careful monitoring and management. Patients may need to:
Effective communication between healthcare providers and patients is crucial to coordinate care and address any concerns that arise.
Patient education is a key component of managing gallbladder issues in NET patients. Educating patients about the potential risks associated with SSA therapy and the importance of regular monitoring can help them take an active role in their care.
Lifestyle modifications can also help reduce the risk of gallbladder issues and improve overall health.
These include:
Living with NETs and managing the associated complications can take an emotional and psychological toll on patients.
Support from healthcare providers, family, and support groups is essential to help patients cope with the challenges of their condition.
Counselling or therapy may also be beneficial for patients experiencing anxiety, depression, or stress related to their health.
As research continues, advances may lead to more effective and less burdensome treatments for NET patients.
Further information and support for people diagnosed with NETs is available by calling the NECA NET nurse line.
