DOCTOR:​ Excuse me, so your test results came in.

Your ​Upper GI series with small bowel

follow-through ​test​ came in. There is no way of telling you this in a good way. I’m sorry, but ​a
tumor has been found growing in your ​gastrointestinal tract​ (digestive system). Specifically,
we found it in your small intestine.
PATIENT: How bad is it?
DOCTOR: ​Well, this tumor is definitely ​malignant​ (cancerous). If it was ​benign
(non-cancerous), you would be okay. I brought in a few diagrams to show you. This one shows
where gastrointestinal cancer affects.

.
Neuroendocrine Tumours
PATIENT: What type of cells does my cancer affect?
DOCTOR: ​They are called neuroendocrine cells. Neuroendocrine cells don’t form individual
organs, but they are scattered throughout the digestive system such as the esophagus,
stomach, pancreas, both intestines, and the appendix. These cells can also be found in the
lungs, but the digestive system has more neuroendocrine cells than anywhere else in the body.
This is a possible explanation for why carcinoid tumours usually start here.
Neuroendocrine cells help regulate the release of digestive juices, and how quickly food
moves in the ​GI tract​. These cells also aid in the growth of different kinds of digestive system
cells, and release hormones to move food through the bowel. To become cancerous, the cells
perform changes, such as the ones above, to grow chaotically and form cancer. These are
dubbed ​neuroendocrine tumours​.
Most ​GI ​(Gastrointestinal) start at the glandular cells that create mucus for the inner
lining of the digestive system. ​Pancreatic neuroendocrine tumours​ are different than
carcinoid tumours because they have a different ​prognosis​, or course of disease in the future.
Other kinds of tumours in the digestive system can be ​esophagus cancer​,​ stomach cancer​,
small intestine cancer​,​ and colorectal cancer

Grades of Gastrointestinal Carcinoid Tumours

PATIENT: How bad is my cancer?
DOCTOR: ​Your cancer has three different grades. Take a look at this diagram:
Grade 1 ​(Low grade) Tumours have cells that look more like normal cells, and not multiplying fast.
Grade 2​ (Intermediate Grade) Tumours have resemblance in between ​Grade 1​ and ​Grade 2

Grade 3​ (High Grade) Tumours have cells that look very abnormal and are multiplying quicker.
Cancers in grade 1 or 2 are classified as ​GI neuroendocrine tumours (NETs)​. These tumours
typically grow slowly, but could spread to other parts of the body. Grade 3 is classified as ​GI
neuroendocrine carcinomas (NECs)​. The word “carcinoid” is normally used to talk about
Grades 1 and 2. It can also be used for Grade 3, unless talking about it specifically. You have
grade 2.

Gene mutations (Inherited)

PATIENT: I heard that cancer affects genes. What type of genes does my cancer affect.
DOCTOR: ​Great question. There are two genes that affect your cancer: Here’s a diagram:
MEN1 Multiple neuroendocrine neoplasia 1: Changes in this particular gene accounts for most inherited
cancers. This is caused by inherited mutations in the following genes: NF1, TSC1, TSC2, and VHL

NF1 Neurofibromatosis 1: gene

MEN1
PATIENT: What’s MEN1?
DOCTOR: ​People with this rare condition have a high risk in getting tumours in pituitary,
parathyroid, and pancreas with an added on increased risk of carcinoid tumors. Research
estimates that 5% to 10% or carcinoid tumours are because of mutations of the MEN1 gene.
Children have a 50/50 chance of inheriting this mutation from their parents.

NF1
PATIENT: What about NF1?
DOCTOR: ​This mutation is classified by many neurofibromas (benign tumours that are found in
nerves under the skin, and in different parts of the body. It also can create carcinoid tumours in
the small intestine.

Causes of GI Cancer
PATIENT: How was my cancer caused?
DOCTOR: ​There are many known causes of GI cancer. If a person has a disease that damages
the stomach, or reduce the quantity of acid it creates, such as atrophic gastritis or
Zollinger-Ellison syndrome, have a higher risk of receiving stomach carcinoid tumours, but not in
other organs. Smoking, excessive alcohol drinking, obesity, hormone replacement therapy,
diabetes, and eating a lot of saturated fats may increase the risk of getting tumours as well.

Conclusion
PATIENT: Will I be okay? I mean, am I going to die?
DOCTOR: ​For now, well, you don’t have long. But, treatment can heal you, or it can stretch out
the amount of time you have left.

Citations
What Is a Gastrointestinal Carcinoid Tumor? (2018, September 24). Retrieved February 13, 2019, from
http://www.cancer.org/cancer/gastrointestinal-carcinoid-tumor/about/what-is-gastrointestinal-carcinoid.html. 
 
What Causes Gastrointestinal Carcinoid Tumors? (2018, September 24). Retrieved February 13, 2019, from
http://www.cancer.org/cancer/gastrointestinal-carcinoid-tumor/causes-risks-prevention/what-causes.html 
 
Gastrointestinal Carcinoid Tumor Risk Factors. (2018, September 24). Retrieved February 13, 2019, from
http://www.cancer.org/cancer/gastrointestinal-carcinoid-tumor/causes-risks-prevention/risk-factors.html 
 
Carcinoid. (2016, July 02). Retrieved February 13, 2019, from
https://www.cancerresearchuk.org/about-cancer/carcinoid/risks-causes 
 
Gastrointestinal Stromal Tumors Treatment. (2018, February 16). Retrieved February 13, 2019, from
https://www.cancer.gov/types/soft-tissue-sarcoma/patient/gist-treatment-pdq#section/all 
 
Side Effects of Cancer Treatment. (2018, August 9). Retrieved February 13, 2019, from
https://www.cancer.gov/about-cancer/treatment/side-effects 
 
Angiogenesis Inhibitors. (2018, April 2). Retrieved February 13, 2019, from
https://www.cancer.gov/about-cancer/treatment/types/immunotherapy/angiogenesis-inhibitors-fact-sheet
Angiogenesis 
Angiogenesis is the creation of new blood vessels. This process contributes in the migration,
growth, and differentiation of endothelial cell. This cell is the main type of cell located in the
inside lining of blood vessels, lymph vessels, and the heart. Normally, signals such as vascular
endothelial growth factor (VEGF) attach to the surface of endothelial cells. These signals create
signals inside the cell that promote the survival and growth of new blood vessels.
Usually, angiogenesis inhibitors, another chemical signal, are balanced to form blood
vessels only when they are needed. Most likely this happens during growth and healing. But,
diseases and abnormal conditions can occur when these signals become unbalanced and
create increased blood vessel growth.
In cancer, angiogenesis plays a critical role in the growth of malignant tumours. In order
for these tumours to grow more, they need more oxygen, glucose, and nutrients. Cancerous
cells can give off chemical signals that stimulate angiogenesis, which makes their own personal
blood vessels. These blood vessels literally feed the tumours, which the tumours can enlarge.
Now that the tumours are exponentially growing, they can invade the surrounding tissue and
even travel to other parts of the body by the bloodstream.