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The UPMC Neuroendocrine Cancer Treatment Center's multidisciplinary group of health care professionals are leaders in methods for early detection, innovative treatment strategies, and cutting-edge research for this rare cancer. We also are a regional and national educational resource for patients with neuroendocrine cancer and their families, as well as for future physicians and other clinicians. Neuroendocrine cancer is a rare type of cancer that starts in the neuroendocrine system – the part of the body where the nervous system and endocrine system work together.
While neuroendocrine accounts for less than one percent of all cancers in the United States, it can cause severe symptoms. To schedule an appointment for an evaluation with one of our neuroendocrine cancer specialists, call 412-692-2001 or toll-free at 1-855-74-LIVER. You may also request an appointment online. The UPMC Neuroendocrine Cancer Treatment Center wishes to acknowledge the commitment and support of Mrs. For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. Neuroendocrine tumors (NET) of the pancreas are uncommon neoplasms that arise from the pancreatic islet cells.
Arnold R, Wittenberg M, Rinke A, Schade-Brittinger C, Aminossadati B, Ronicke E, Gress TM, et al.
Steve Jobs was right to be optimistic when, in 2004, he announced that he had cancer in his pancreas. But although neither Apple nor those close to Jobs were willing to discuss the treatments he elected or the course of his disease, interviews with experts on neuroendocrine tumors suggest that some of the choices he made did not extend his life and may have shortened it. The cancer was detected during an abdominal scan in October 2003, as Fortune magazine reported in a 2008 cover story. Jobs was relieved that, as he put it in that 2004 email, he did “not require any chemotherapy or radiation treatments.” He took that as a sign that the surgery “got it all,” as every cancer patient desperately wishes to hear. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, gender identity, marital status, familial status, disability, veteran status, or any other legally protected group status.
Eric Liu with patient Harold Caplan who will receive first dose of new radioactive drug for treatment of neuroendocrine tumor. Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis and recent trend toward improved survival.
One hundred years after “carcinoid”: Epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. Everolimus in patients with advanced pancreatic neuroendocrine tumors: Updated results of a randomized, doubleblind, placebo-controlled multicenter phase III trial (RADIANT-3). Octreotide acetate long-acting formulation versus open-label subcutaneous octreotide acetate in malignant carcinoid syndrome. Placebocontrolled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. Placebo controlled, double blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors (PROMID): Results on long-term survival. Updated overall survival and time to progression results in NETs treated with everolimus combination with octreotide LAR as first-line treatment.
Durable disease control with sunitinib and everolimus in well-differentiated neuroendocrine tumors of the pancreas with a high ki67 index.
Drug resistance by evasion of antiangiogenic targeting of VEGF signaling in late-stage pancreatic islet tumors.

It was 7:30 in the morning, Jobs said in his 2005 commencement address at Stanford University. He reportedly spent nine months on “alternative therapies,” including what Fortune called “a special diet.” But when a scan showed that the original tumor had grown, he finally had it removed on July 31, 2004, at Stanford University Medical Clinic. In many cases, says Kim, “you can just remove the tumor with a little of the surrounding [pancreatic] tissue.” But Jobs’s was not such a simple case. In fact, any surgeons who say they “got it all” should be slapped: no existing technology can detect micrometastases, let alone a few million rogue malignant cells floating in the bloodstream or lymph fluid and just waiting to invade some vital organ. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. Nuclear medicine is used for both diagnosis and treatment in neuroendocrine tumors (NETs).Ebrahim S. Current treatment options for nonresectable disease include somatostatin analogs and chemotherapy. But cancers in the pancreas, called neuroendocrine tumors, arise from islands of hormone-producing cells that happen to be in that organ. He reportedly had the scan—which is seldom done, much less advised, as a routine part of a physical—because he had a history of gastrointestinal problems, but he also may have been experiencing symptoms, most likely gastrointestinal ones. In a 2010 analysis of cancer registries, he and colleagues found that patients with neuroendocrine cancer who were eligible for surgery (the cancer has not spread beyond the pancreas) “can have outstanding outcomes,” living for many more years. He underwent an operation called a modified Whipple procedure, or a pancreatoduodenectomy, Fortune reported.
That strongly suggests the cancer had spread beyond the digestive system that was the focus of the surgery and into the organ that is one of the most common sites of metastasis. Raizman's drive to educate patients and promote advances in management of neuroendocrine cancer continues to motivate our team and provide an example to us all. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. Delpassand, MD,  Chairman and Medical Director of Excel Diagnostics, serves as Principal Investigator of the NETTER-1 clinical trial at Excel.  NETTER-1 is an international study and Excel Diagnostics is the first center in the United States to recruit and enroll patients and the only non-university center to participate in the trial. New therapies focus on specific molecular targets such as sunitinib, angiogenesis inhibitor, that target vascular endothelial growth factor receptor (VEGFR) and other growth factor receptors and everolimus, an inhibitor of the mammalian target of rapamycin. Jobs learned in 2003 that he had an extremely rare form of this cancer, an islet-cell neuroendocrine tumor.
Those tend to arise from the hormone that the particular neuroendocrine tumor produces, explains medical oncologist Matthew Kulke of Dana-Farber Cancer Institute in Boston. In part, that is because neuroendocrine cancers tend to be quite slow growing, or indolent. The surgery removes the right side of the pancreas, the gallbladder, and parts of the stomach, bile duct, and small intestine.
Liver transplants are a well-established treatment for tumors that originate in that organ, such as hepatocellular cancer, says City of Hope’s Kim. One of the few bright spots when it comes to neuroendocrine cancer was the Food and Drug Administration’s decision, in May 2011, to approve two new drugs against the disease. It is a multicenter randomized clinical trial of Lu-177 Octreotate PRRT  in patients with progressive midgut carcinoid.Ebrahim S. Functionally based medical therapies for NET include somatostatin analogs to control symptoms. As the name implies, it arises from islet cells, the specialized factories within the pancreas that produce and secrete insulin, which cells need in order to take in glucose from the food we eat.

Even those that have been present for years, and in some cases decades, often stay safely confined to the pancreas. The fact that so much more than the pancreas itself had to be removed suggests that Jobs’s cancer had spread beyond the pancreas. But removing the liver because it has become riddled with tumors that originated elsewhere is rare.
One, called Sutent, from Pfizer, was previously approved for the treatment of kidney cancer; it is an angiogenesis inhibitor, targeting the blood vessels that tumors require for their survival. Delpassand, MDThe NETTER-1 study will evaluate the efficacy and safety of Lutathera® compared to high dose Octreotide LAR in patients with inoperable, progressive, somatostatin receptor positive, midgut carcinoid tumors.  According to Dr. The 2014 annual meeting of American Society of Clinical Oncology (ASCO) brought us new insights into the management of pancreatic neuroendocrine tumors.
Unlike pancreatic cancer, with neuroendocrine cancer “if you catch it early, there is a real potential for cure,” says cancer surgeon Joseph Kim of City of Hope, a comprehensive cancer center in Duarte, Calif. The cancer might have already spread by the time it was discovered in 2003, though Jobs’s sanguine description of his prognosis suggests that if that were the case, the metastasis might have been so small— “micrometastases”—as to be undetectable. For one thing, liver metastases probably mean the cancer is elsewhere, too, such as in the bones or brain. Specifically, it targets a molecule called VEGF that sends signals that promote the growth of blood vessels. Alternatively, the cancer could have spread during the nine months that Jobs was experimenting with nonstandard therapies. Swapping out a cancer-ridden liver for a new one may therefore buy some time, but not much.It can even be counterproductive.
The Lu-177 is delivered directly into the tumor cell, acting like a Trojan horse.  A Trojan horse in cancer therapy is the use of nanotechnology where cancer-fighting particles are targeted only for the cancer cells, leaving healthy cells alone. Transplant patients need massive doses of immune-suppressing drugs to keep their bodies from rejecting the foreign organ. Although experts differ on how big a role the immune system plays in keeping cancer, especially micrometastases, in check, there is a consensus that it provides some benefit. According to research in the New England Journal of Medicine, both drugs roughly double progression-free survival from 5.5 months to 11.
This has enormous value in patients with functional tumors who can be potentially cured following removal of localized disease.The Gallium-68 scan, says Dr. The first such studies were done in France, with surgeons reporting the first results in 1997. Based on 31 cases, including three patients who had a Whipple procedure similar to Jobs’s, they calculated that 59 percent of patients survived at least one year, 47 percent were alive at three years, and 36 percent survived five years or more.
The rates were better for the kind of neuroendocrine cancer Jobs had: 69 percent of patients with metastatic carcinoid tumors were alive at five years.
In a 2003 study, surgeons at the Mayo Clinic found that when only those parts of the liver that are riddled with neuroendocrine metastases (which Jobs apparently had) are removed, half of patients live 45 months or more.

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