Shubham Pant, MD: Hello, and welcome to CURE Connections®. I’m your host, Dr. Shubham Pant. When you first learn that you or a loved one has a cancerous tumor, you probably don’t realize that there’s a lot more to learn about the particular cancer beyond even the stage or grade. A tumor is a tumor, right?
When it comes to carcinoid tumors, nothing can be further from the truth. Carcinoid tumors are a rare type of neuroendocrine tumor that most commonly affects the gastrointestinal system. People with carcinoid tumors can have a wide variety of debilitating symptoms that can come and go. Or, they may have no symptoms at all.
Here to help us understand what can be done to manage carcinoid tumors, and carcinoid syndrome, is Dr. Michael Morse, an oncologist from Duke Cancer Institute who specializes in gastrointestinal cancers. We are also pleased to have Professor Larry Pleasant, who was diagnosed with having a carcinoid tumor 6 years ago. Larry is here to share his story. Later in the program, we will be joined by Maryann Wahmann, founder of the Neuroendocrine Cancer Awareness Network. Welcome to the program, Larry and Dr. Morse.
Larry Pleasant: Thank you.
Shubham Pant, MD: So, Larry before the program, we were talking about how you’re a professor of a number of things. Can you tell me again?
Larry Pleasant: I teach international relations, international business finance, and criminal justice for the University of Mount Olive, which is a private school in eastern North Carolina, and several other schools in that region.
Shubham Pant, MD: Larry, we are looking at your treatment this time. We’re talking about your treatment and what happens. So, first, tell me about your diagnosis. How was this diagnosis made?
Larry Pleasant: For my diagnosis, I was actually fortunate. I hear stories regularly about people who go years without being diagnosed with neuroendocrine cancer. I was diagnosed through a routine colonoscopy.
Shubham Pant, MD: This was routine. And what age was that?
Larry Pleasant: Well, it was 6 years ago, so I was 63, and I went in for a colonoscopy.
Shubham Pant, MD: Was that your first colonoscopy?
Larry Pleasant: No, this was my third, actually. The second one, my physician found something in my colon that he didn’t like the looks of. He biopsied it and the biopsy came back negative. But he still wasn’t satisfied so he asked me to come back a year later, rather than waiting the 10-year period.
Shubham Pant, MD: But did you have any symptoms?
Larry Pleasant: The only symptom I had was I had noticed in the previous year or so that any time I had an alcoholic drink, if I had wine with dinner or a beer, I had a flushing episode. My face would turn red and I’d feel the flushing, but I had no other symptoms, nothing.
Shubham Pant, MD: You had the routine colonoscopy. And when did you hear about the diagnosis, when you woke up from the colonoscopy?
Larry Pleasant: After I had the colonoscopy, he told me when I woke up that something was there. He had biopsied it, the results came back, showed positive for neuroendocrine, and he referred me to Duke for treatment within the week.
Shubham Pant, MD: Within the week. And is that when you met Dr. Morse?
Larry Pleasant: It is; the first visit to Duke.
Michael A. Morse, MD: We’ve known each other a while.
Larry Pleasant: Yes, we have.
Shubham Pant, MD: Dr. Morse, is that how people normally get diagnosed, by just a routine colonoscopy, or do they have symptoms? How do normally people get diagnosed with carcinoid tumor?
Michael A. Morse, MD: A carcinoid is a disease that people can experience in many different ways and that’s how they present to their physicians. Some people are completely asymptomatic and have it picked up on routine…
Shubham Pant, MD: That is no symptoms at all, feeling great, no problems.
Michael A. Morse, MD: In retrospect, many people will tell you they had symptoms, but they didn’t make much of it at the time. There are some people who are completely asymptomatic and they’re found for some other reason, like they’re having surgery for another reason and they identified they have a carcinoid tumor. And then there are the people who have been symptomatic, know they’ve been symptomatic, have brought that up to their physicians, but it never clicked that they might have a carcinoid tumor. It was thought to be some other disease.
Shubham Pant, MD: Irritable bowel syndrome or something, because there can be other manifestations of disease. So, Larry, coming back to you, what kind of manifestations did you have? You said you had the flushing. Did you have any other problems?
Larry Pleasant: No, nothing. Other than the flushing, I was totally asymptomatic.
Shubham Pant, MD: And then the flushing, how did it impact your life? You had a wine and then you had this flushing, but did it impact your life, like your daily living things?
Larry Pleasant: Not initially. It was inconvenient and it was curious, but I assumed it was perhaps just a function of getting older, something like that. I didn’t associate it with any particular disease.