Neuroendocrine Cancer Specialist at the Rocky Mountain Cancer Centers, Dr. Eric Liu talks about a new way to treat cancer.
Interview conducted by Ivanhoe Broadcast News in 2022.
What is neuroendocrine cancer? What does it affect? Do you know liver cancer is your liver?
LIU: So when people think of cancer, they think of the usual types of things. Lung cancer, breast cancer, prostate cancer, pancreas cancer. They can be quite scary. But truthfully, you can get cancer from any part of your body. Every single cell can turn into cancer. You can have unusual types of cells. People don’t even realize this, there are control cells called neuroendocrine cells that help control digestion and breathing that you don’t even think about, and even those can turn into cancer. The good thing about some of those cancers, they can be really quite slow, and they can be cancer in slow motion. It can cause problems, cause pain, and symptoms, definitely. But these neuroendocrine cancers affect people all over the world. The way we treat them is extremely important to have specialty, expertise.
What are the symptoms that these people feel?
LIU: The problem with neuroendocrine cancers, is it can come from any part of your body. From your lungs, from your pancreas, from your intestines. In fact, people don’t even know it’s the number one cancer in the small intestine, which is very unusual. It happens quite commonly, and the symptoms can be varied. They can be as simple as abdominal pain, they can be blockage, bleeding, or weird symptoms like flushing and diarrhea. Keeping an eye on these types of symptoms can be very challenging for a patient or for a physician. Just imagine if you had abdominal pain every 6 to 12 months, people would say, you have Irritable bowel syndrome. Well, imagine if you are a woman and you start to flush and they would say you have menopause. It might be true and that is common, but sometimes these relatively common symptoms can be caused by something very unusual like neuroendocrine cancer.
Is it misdiagnosed for awhile, and then by the time they they figured it out, it’s advanced?
LIU: That’s exactly right. The problem with neuroendocrine cancer is it can be misdiagnosed for quite some time. If you have very subtle symptoms, if they come and go, people may not do a full workup to figure things out. You may say, “I have some abdominal pain every now and then, I have some diarrhea.” You might get a colonoscopy, you might get an endoscopy and they’ll be negative because that’s not where the tumor hides. It’s only after someone says, “This is strange, why am I having these symptoms for years and years and years before someone takes them more seriously?” They go to the emergency room, they get a CAT scan. What was irritable bowel syndrome for three years actually is metastatic cancer. Now I don’t want to cause too much fear because it actually irritable bowel syndrome is more common. Food allergies, those kind of things happen, do happen more often. But it’s important to always think about some of these rare things because if it happens to you, it happens 100 percent of the time.
How traditionally was NET treated?
LIU: The most important part of NET and neuroendocrine tumors is to find it. Making the diagnosis is absolutely the most important thing. When I go and tell people about neuroendocrine, Itell them to think about the possibility. You don’t have to know anything about it, you don’t have to cure it, just think about it. If you get the right scan, which is can be a very simple CAT scan, you can usually get a sense of if the neuroendocrine is there. The treatments that we have, despite it being a relatively unusual and rare disease, is plentiful. We have lots of treatments for them, lots of tools in the toolbox. It can be as simple as observation because sometimes people can live with cancer very slowly. I know it’s a new concept, but people can live with cancer for many years. In the past, we’ve learned sometimes the treatment is worse than the disease. We can watch it and we can certainly treat them with suppressive hormones that works very well for many years and people tolerate it very well.. Surgery is always should be an upfront therapy because a lot of people have pain. If you have pain or discomfort, or you have symptoms from doing surgery, is something we always turn to. Now, we have even newer treatments. We have a hormone that we have that we can inject. Imagine if I could put a tiny little nuclear bomb on the back of this medicine. You have a tiny little guided missile and a tiny little nuclear bomb. It’s an injectable radiation therapy. You can inject radiation, the little hormone guided missile. It takes it right to the tumor, the tumor absorbs the radiation and you get radiation treatment from the inside out in front instead of from the outside in. The neat thing about it is a treatment goes to every single tumor in the body. You can have this wonderful treatment and it’s expanding. Neuroendocrine was the first place where it was developed. But now they’re developing for prostate cancer and hopefully they’ll develop it for other kinds of cancer also.
Is there any danger to it from treating from the inside out?
LIU: When people hear about radiation, it is scary. They think they’re going to turn to a green hawk, which is not going to happen. But radiation in the past 20 years has become a very powerful medical tool. People don’t realize that when you go on an airplane, you get a fair amount of radiation. But when it’s used medically, it can be a great diagnostic tool so we can do scans and see their cancers or it could be a therapeutic tool. We use radiation all the time. Understand it tends to be very low dose radiation. This is nothing compared to the nuclear weapons or the nuclear things that happened in laboratories. They’re very small. And It’s all been worked out through clinical trials and very well tested. We can use nuclear radiation for imaging, so we can find the tumors, and then now we’re upping the power of the radiation just enough so that it can become a therapeutic tool. We can treat people with it. But everyone needs to understand that all of these things are very well tested.
If someone comes to you with NET, could it be a front-line therapy instead of waiting through everything else?
LIU: When people come for treatment for their neuroendocrine, the the most important thing is not the actual treatment, it is the thinking. When I meet people, I tell them the reason that they are there with me is so I can study their case and think very hard about it. If this is a chronic slow disease, then I want to think about it and make sure that I have all the tools and use the tool at the right time. It’s not just what to do, it’s also when to do it. When you pull out the right tool, you want to say, well, what is the nature of the disease? Is it aggressive? Is it slow? Is it chronic? Can I watch it? Will it stay the way it is for a long time and maybe we can milk it for as long as possible? Specifically for neuroendocrine, which is different from other kinds of cancer, you may want to choose the right therapy for the right time. Everything that we do has side effects, nothing is benign. Certain treatments are certainly better tolerate than others, but nothing if it works as benign.
What would be the side effects for that?
LIU: The side effects for the treatments that we have for neuroendocrine are quite vary. Obviously people can have surgery.
Can you talk about the injectable radiation?
LIU: The injectable radiation therapy, we call it PRRT, Peptide Receptor Radionucleotide Therapy. The major side effects are bone marrow suppression, because it is radiation. When the radiation goes to your bones they can suppress its production of the cells that you need, red blood cells, white blood cells, and platelets. Most people tolerate very well. You give an injection that platelets go down a little bit, it comes back. It’s a little bit like chemotherapy in that way. Most people do recover and some people don’t. Some people have permanently suppressed bone marrow and some people have really permanently suppressed bone marrow in which it never comes back. These are the side effects we have to make sure that we can watch out for. Now the good thing is some people tolerate it well, and you can give it to them over and over again. Some people do not, and you can give it just once. Again, you have to tailor it and specialize it to the individual.
When you give it, is it through an IV and is it an injection?
LIU: Despite the fact that sounds very fancy, it really is not. What we do is we make sure that patient is suitable. The way we do that is by doing a special scan that has a diagnostic or scan version of it, so we can see the tumors and see if the tumors will absorb the radiation. If they pass that test, then they can have it. All we do is put in a couple of IVs, inject it, give them amino acids and fluids so they can pee it out eventually get them all cleansed from it, and they go home.
Seems it is such a life-saving complex thing.
LIU: That is correct. It is relatively simple as far as the administration and we want to keep all of our treatments and therapies as simple as possible for the patient. It took a lot of research and a lot of hard work to develop the therapy. that’s really where the magic is.
Can you talk about Mr. Hammer?
LIU: Mr. Hammer is a delightful man. He developed neuroendocrine cancer several years ago. He had surgery at Presbyterian St. Luke’s Hospital because we specialize in it and we found that he had more disease than I thought he really had. We were able to help him feel better because he was quite ill. He had blockages and was not doing well. We did surgery to help him feel better so he got stronger. Then as the disease slowly progressed and got worse, we added some hormone shots to see if that would be enough to keep it under control. It was not. Then we introduced this PRRT therapy and we gave it to him almost two years ago. Since then his disease has been quiet and stable and he’s living his best life. I am hoping he can tell you the story so that people understand that this is a novel therapy that can help many more people.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Tana Sykes
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here
