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Neuroendocrine Cancer (NET Tumors)

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Neuroendocrine cancers are also known as NET tumors. They can arise in the stomach, small intestine, rectum, colon, and liver. These tumors are usually carcinoid tumors — rare, slow-growing tumors. A neuroendocrine tumor begins in the hormone-producing cells of the body's neuroendocrine system. Neuroendocrine cells regulate air and blood flow through the lungs. They also help control how fast or slow food moves through the gastrointestinal tract.

NET tumors are called the zebras of the cancer world. This is because of the rarity of the disease and how its symptoms may appear as symptoms of much more common illnesses. These include Crohn's Disease, asthma, irritable bowel syndrome, and rosacea.

Types of neuroendocrine tumors:

Neuroendocrine carcinoma
Approximately 60 percent of all neuroendocrine tumors are labeled "neuroendocrine carcinoma." Neuroendocrine carcinoma can start in the stomach, pancreas, and gastrointestinal/digestive tract.

Carcinoid tumors
Carcinoid tumors usually occur within the lining of the digestive (gastrointestinal) tract. Carcinoid tumors that develop in the stomach are mostly slower growing. They do not cause as many symptoms.

Pheochromocytoma
This rare tumor starts in the chromaffin cells of the adrenal gland. These specialized cells release the hormone adrenaline during times of stress. Pheochromocytoma usually occurs in the adrenal medulla, the area inside the adrenal glands, above the kidneys. These tumors increase the production of adrenaline and noradrenaline, hormones that increase blood pressure and heart rate.

Merkel cell cancer
Merkel cell cancer is highly aggressive, fast-growing and rare. Merkel cell cancer may also be called neuroendocrine carcinoma of the skin or trabecular cancer.

Why Choose Sylvester Comprehensive Cancer Center?

High volume experience with stomach, gastric, and neuroendocrine (NET) cancers. Because we see so many patients with stomach, gastric, and neuroendocrine (NET) cancers, we have the experience needed to provide better outcomes with fewer potential complications.

Minimally invasive NanoKnife® radiosurgery. We provide more treatment options for patients with inoperable or difficult-to-reach tumors, producing little pain and requiring only a brief hospital stay.

Multidisciplinary care teams. Your care team is made up of experts in all aspects of your exact type of cancer. All of your physicians, nurses, and more collaborate to offer outstanding care.

Advanced radiation oncology tools. Sylvester is one of only five medical centers in the country with ViewRay™ — MRI-guided radiation therapy. Our RapidArc® radiotherapy system delivers intensity modulated external radiation therapy (IMRT). These tools lead to more efficient and effective treatments, shorter treatment times, pinpoint accuracy in tumor targeting, and less damage to surrounding healthy tissue.

More cancer clinical trials than any other South Florida hospital. If appropriate for your cancer and stage, our clinical trials provide you with easy access to the very newest ways to treat and potentially cure your cancer.

Precision medicine options. We define your cancer and its treatment by the genes driving it, rather than solely its location and stage, so we can offer more targeted and effective therapies.

Questions? We're here to help.

Our appointment specialists are ready to help you find what you need. Contact us today.

Treatments


The main goals of NET tumor treatment are to debulk, or find and remove as many of these tumors as possible, then to manage your symptoms. Treatment plans are customized for each patient and can include the following options:

  • Surgery

    Your surgeon removes the tumor and the margin of healthy tissue around the tumor. Some NET surgical procedures are debulking or cytoreductive surgery, minimally invasive laparoscopic resections and, transplantation.

    • Laparoscopic Surgery: Laparoscopic surgery is a less invasive type of surgery often used for NET tumors. It uses three or four small incisions instead of one large incision. A thin, lighted tube called a laparoscope has a tiny video camera on it. The laparoscope gets inserted through one opening. This helps guide the surgeon's operation. The surgeon inserts small instruments into the other ports to reach the tumor and operate.


  • Chemotherapy

    Chemotherapy treats tumors with drugs that destroy cancer cells. Chemotherapy can be delivered using an intravenous (IV) tube placed into a vein using a needle or with oral pills. It is often combined with radiation therapy or surgery.

    • Chemoembolization: May be used for NET tumors that have spread to the liver. Your medical team will inject a medicine into the hepatic artery through a catheter (thin tube). The drug is mixed with a substance to embolize (block) the artery and cut off blood flow to the tumor.

    • If you need intravenous (infusion) chemotherapy, you can have it at the Comprehensive Treatment Unit (CTU) at Sylvester’s main location in Miami, a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. If you prefer, you may have your infusion treatments at the Kendall, Plantation, Hollywood, Coral Springs, Coral Gables, and Deerfield Beach locations.


  • Radiation therapy

    Modern radiation therapies use image-guided approaches to deliver very targeted treatment. Radiation therapy may be used before surgery to shrink the size of the tumor or after surgery to destroy any remaining cancer cells.

    • Sylvester offers advanced radiation therapy options like ViewRay™  (one of just five centers nationwide) and RapidArc®, offering intensity modulated external radiation therapy (IMRT). These technologies may provide shorter treatment times, improved accuracy, and less damage to surrounding healthy tissue.

    • Internal radiation therapy is a technique using radioactive substances placed directly into or near the tumor. Internal radiation therapy gets delivered through needles, seeds, wires, or catheters.


  • NanoKnife® Radiosurgery

    This technique is a minimally invasive option for difficult-to-reach or inoperable tumors. The NanoKnife® System uses electric currents to destroy NETs. For NETs that have spread to the liver, embolization procedures may help reduce or cut off the supply of blood to the tumor.

  • Hormone Therapy

    Some hormones in the body actually help tumors to grow. Hormone therapy is a treatment that stops extra hormones from being made. GI carcinoid NET tumors are treated with a drug (injected under the skin or into the muscle) to help stop tumor growth.

  • Supportive care

    Pain management and palliative care can be important parts of your treatment plan. Throughout your treatment, the pain management team is on call 24/7 to help you anticipate and proactively manage pain and to manage any side effects of pain medication.

  • Clinical Trials

    Clinical trials study the next potential treatments for your cancer. Ask your doctor if you are a candidate for a clinical trial.


Tests


Along with a physical exam and review of your medical history, diagnostic tests may include any combination of the following procedures:

  • Blood Chemistry Studies

    Blood samples are checked for the presence of any hormones produced by carcinoid tumors.

  • Tumor Marker Test

    Tumor markers are substances known to be signs of neuroendocrine tumors.

  • Chromogranin A Test

    Chromogranin A is a protein found in neuroendocrine cells. Higher than normal amounts in the blood could be a sign of a neuroendocrine tumor.

  • Twenty-Four-Hour Urine Test

    Urine is collected and reviewed for a full day to measure the amounts of 5-HIAA or serotonin (hormone) in it. Higher or lower than normal levels could be a sign of disease.

  • MIBG Scan

    MIBG (metaiodobenzylguanidine) is a radioactive substance. We inject a small amount into a vein and then watch it travel through the bloodstream. Carcinoid tumors take up the radioactive material. We can see this using a device that measures radiation.

  • Computed Tomography Scan (CT or CAT Scan)

    CT scans are a series detailed pictures of areas inside the body are taken from several angles with a computer and x-ray machine. Dye can be put into your blood through a vein or it can be swallowed orally. This allows us to see the organs or tissues clearly. Computerized tomography or computerized axial tomography are other names for this test.

  • Magnetic Resonance Imaging (MRI)

    A magnet, radio waves, and a computer help to create detailed images from inside your body. Nuclear magnetic resonance imaging is another name for this test.

  • Positron Emission Tomography (PET) Scan

    Glucose is sugar that cells use for energy. We inject a little glucose tagged with a small amount of radioactive material through a vein. The scanner will rotate around your body. It takes pictures of the places that glucose is being used the most. Any cancer cells will show up brighter than normal cells. Cancer cells ingest glucose more than normal cells for energy.

  • Endoscopic Ultrasound (EUS)

    An endoscope (thin, lighted tube with a lens) is inserted into the body, usually through the mouth or rectum. It has a probe at the end that bounces high-energy sound waves off of the stomach, small intestine, colon, or rectum. The echoes from the ultrasound waves create a picture of body tissues called a sonogram. Endosonography is another name for this test.

  • Laparotomy

    Laparotomy is a surgical procedure used to check the inside of the abdomen for any signs of disease. The abdominal wall is where a surgeon can make a small incision. Laparotomy is used to remove an organ or can be used to remove a tissue sample. Such samples are then reviewed under a high- powered microscope to look for any signs of disease.

  • Upper Endoscopy

    Endoscopes are flexible tube-like instruments. They have a light and may have a surgical tool on them to help the doctor see clearly and remove any tissue or lymph node samples. Samples get reviewed under a high-powered microscope to assess any signs of disease.

  • Biopsy

    Removing tissues or cells to check them out under a high-powered microscope is called a biopsy. Biopsies for pancreatic NETs may use a fine or wide needle inserted into the pancreas during an X-ray or ultrasound. Tissue also can be removed during a laparoscopy (a surgical incision made in the wall of the abdomen).

     

Accepted Insurances

Note: Health plans that are currently contracted with UHealth are listed below. However, please check with your insurance provider to verify that UHealth is part of your provider network.

  • Aetna WC
  • Aetna Affiliates/Signature Adm (ASA)
  • Aetna Behavioral Health
  • Aetna Elect Choice (EPO)
  • Aetna Florida Healthy Kids
  • Aetna HMO
  • Aetna Medicaid HMO
  • Aetna Medicare HMO
  • Aetna Medicare PPO
  • Aetna POS
  • Aetna PPO
  • Aetna UM Employee HMO 1
  • Aetna UM Employee HMO 2
  • Aetna UM Employee POS HRA
  • Aetna/Coventry Institutes of Excellence (IOE)
  • Amerigroup Florida Healthy Kids
  • Amerigroup Medicaid HMO
  • Argus Vision
  • AvMed Choice
  • AvMed HMO/POS
  • AvMed MDC and JHS Groups
  • AvMed Medicare HMO
  • AXIS
  • BCBS Blue Options Network Blue PPO
  • BCBS BlueCare HealthOptions HMO
  • BCBS BlueChoice PPC/PPO
  • BCBS Miami Dade Blue PPO Limited Benefits Plan
  • BCBS of Florida (All products except "SELECT" Plans)
  • BCBS of Florida (Commercial plans exclude HIX Select)
  • BCBS Traditional PHS/PPO
  • Beacon Health (ValueOption)
  • Beech Street PPO
  • Broward Health Medical Center
  • CarePlus Medicare HMO
  • Catholic Hospice
  • CCP/CMS Title XIX (Medicaid Enrolled in South Florida)
  • CCP/CMS Title XXI (Non Medicaid Enrolled in South Florida)
  • CCP/MMA (Broward County residents)
  • Charlotte County Sheriffs Office PPO
  • Cigna Affiliates
  • Cigna Behavioral Health
  • Cigna Dental HMO/PPO
  • Cigna EPO
  • Cigna HMO
  • Cigna Life Source (Intracorp is part of Cigna Lifesource)
  • Cigna MDCPS Jackson Sr. High
  • Cigna POS
  • Cigna PPO
  • Cigna Shared Administration
  • Clear Health Alliance SNP Medicaid HMO
  • Concordia Behavioral Health
  • CorVel WC
  • Coventry First Health WC
  • Coventry Health Care of Florida (HIP) HMO/POS
  • Coventry Health Care of Florida (HIP) PPO
  • Coventry Health Plan of Florida (Foundation) HMO
  • Coventry Health Plan of Florida (Foundation) POS
  • Coventry National PPO
  • Coventry Summit Medicare HMO
  • Coventry Vista Medicare HMO
  • Coventry First Health PPO
  • Delta Dental PPO
  • DentaQuest (ADI)
  • DIKLA
  • Dimension WC
  • Dimension Plus PPO
  • EHN PPO
  • EQUIAN (Health Systems International)
  • Europe Assistance/Global Corporate Solutions (Care Management Network)
  • eyeQuest
  • FCCI WC
  • Florida Healthcare Plan (Affiliate of BCBSFL)
  • Florida PACE (FPC)
  • Freedom Health Medicaid HMO
  • Freedom Health Medicare HMO
  • Gallagher Bassett WC (MDCPS & FCSRMC)
  • Global Excel Mgt PPO
  • Great West (Cigna) HMO/POS
  • Guardian Life PPO
  • HAA Preferred Partners
  • Health First Health HMO/POS
  • Health First Health Medicare HMO
  • Health First Health PPO
  • Health Net Veterans Choice HMO
  • Heritage Summit Healthcare WC
  • Humana Behavioral Health (LifeSynch)
  • Humana Dental/CompBenefits/OHS
  • Humana EPO
  • Humana HMO
  • Humana Medicaid HMO
  • Humana Medicare HMO
  • Humana National Transplant
  • Humana PPO
  • Humana Premier
  • iCare Health Solutions
  • Interlink Health Services
  • International Kids Fund (IKF)
  • League Medical Concepts Federal Inmates
  • Life Trac
  • Magellan Behavioral Health
  • Magellan Complete Care SNP Medicaid HMO
  • MDAbroad
  • Medica Medicare HMO
  • Medical Development In't (MDI)-Federal Inmates
  • Medicus
  • Metlife Dental PPO
  • MHNet Behavioral Network (MHNet)
  • Molina
  • Molina Market Place
  • Molina Medicaid HMO
  • Molina Medicare HMO
  • Morgan White International
  • MultiPlan PPO
  • Naphcare (Federal Prisoners)
  • National Healthcare Solutions Inc.
  • Neighborhood HealthPlan HMO/POS
  • Neighborhood HealthPlan PPO
  • North Broward Hospital District PPO
  • Olympus Managed Healthcare
  • Optum
  • Positive Healthcare SNP Medicaid HMO
  • Positive Healthcare SNP Medicare HMO
  • Prestige Health Choice Medicaid HMO
  • Prime Health Services WC
  • Quality Health Management
  • Religious Order of Jehovah's Witnesses PPO
  • Rockport Healthcare Group WC
  • Royal Caribbean Cruises PPO
  • Sanus Health Corporation
  • Seasons Hospice
  • Simply Healthcare Medicaid HMO
  • Solstice Dental HMO/PPO
  • Start Healthcare Network
  • Sunshine
  • Sunshine AMBETTER
  • Sunshine Healthy Kids HMO
  • Sunshine Medicaid HMO
  • Sunshine Medicare HMO
  • Tricare South Prime HMO
  • Tricare South Standard PPO
  • United Behavioral Health (UBH)
  • UnitedHealthcare Affiliates
  • UnitedHealthcare Healthy Kids HMO
  • UnitedHealthcare HMO/POS
  • UnitedHealthcare Medicaid HMO
  • UnitedHealthcare Medicare Nursing Home Plan
  • UnitedHealthcare PPO
  • University of Miami Athletic Dept PPO
  • VUMI
  • Wellcare/Staywell Healthy Kids HMO
  • Wellcare/Staywell Medicaid HMO
  • Wexford Health State Inmates
  • Worldwide Managed Care