Signs and symptoms of neuroendocrine cancer

Neuroendocrine cancer may not cause any signs and symptoms in the early stages if it grows slowly and doesn’t make too much of a certain hormone. Signs and symptoms often appear as the tumour grows and causes changes in the body or when the tumour releases more hormones than we normally need (if it is a functional tumour).

The signs and symptoms of neuroendocrine cancer vary depending on where the tumour develops in the body. Other health conditions can cause the same signs and symptoms as neuroendocrine cancer.

Gastrointestinal (GI) neuroendocrine cancer can develop in any part of the gastrointestinal tract, including the small or large intestine and stomach. The signs and symptoms of GI neuroendocrine cancer include:

• discomfort or pain in the abdomen or rectum
• nausea and vomiting
• diarrhea
• bleeding from the rectum or blood in the stool
• anemia– may cause fatigue
• heartburn or indigestion
• stomach ulcers – can cause heartburn, indigestion and pain in the chest or abdomen
• weight loss
• jaundice
• blockage in the intestine (bowel obstruction) – may cause pain in the abdomen or constipation
• fatigue

Carcinoid syndrome is a group of symptoms caused by a neuroendocrine tumour (NET) releasing large amounts of serotonin and other chemicals into the blood. Carcinoid syndrome may happen in people with any type of NET. It most commonly occurs with NETs of the small intestine or appendix. The signs or symptoms of carcinoid syndrome include:

• flushing of the skin, mainly the face and neck
• widened blood vessels under the skin (telangiectasias)
• diarrhea
• pain in the abdomen
• wheezing and difficulty breathing
• fast or irregular heartbeat
• low or high blood pressure
• heart failure
• watering eyes

Carcinoid crisis is a severe case of flushing, low blood pressure, difficulty breathing and an irregular heartbeat. It may be triggered by anesthetic given during surgery, cancer treatments or other procedures that may affect the tumour. Carcinoid crisis is a serious and possibly life-threatening problem that needs to be treated right away. A drug called octreotide (Sandostatin) can be given to treat and reduce the risk of carcinoid crisis.

Lung neuroendocrine cancer usually develops in the airways (bronchi). The signs and symptoms of lung neuroendocrine cancer include:

• a cough that doesn’t go away
• coughing up blood
• difficulty breathing
• fatigue
• pneumonia
• carcinoid syndrome – may include flushing of the skin, diarrhea and wheezing

Cushing syndrome is a group of symptoms caused by too much cortisol in the body. Cushing syndrome may happen with NETs, including some lung and pancreatic NETs, that release too much adrenocorticotropic hormone (ACTH). A high level of ACTH causes adrenal glands to make too much cortisol. The signs or symptoms of Cushing syndrome include:

• weight gain
• a red, round and full face
• muscle weakness
• increased hair growth on the face and body
• a buildup of fat between the shoulders or above the collar bone
• purple lines on the skin
• high blood pressure
• high blood sugar (glucose) levels
• changes in mood and behaviour

Signs or symptoms of pancreatic neuroendocrine cancer depend mainly on the type of hormone released by the tumour. The signs or symptoms of pancreatic neuroendocrine cancer include:

• low blood sugar levels (hypoglycemia) – may cause sweating, shakiness, dizziness, extreme hunger and problems concentrating
• high blood sugar levels (hyperglycemia) – may cause extreme thirst and frequent urination (peeing), diarrhea and fatty stools (called steatorrhea) that are lightly coloured, bulky and float in the toilet
• stomach ulcers – may cause heartburn, indigestion and pain in the chest or abdomen
• weight loss
• loss of appetite
• patches of red, itchy and painful skin
• jaundice
• blood clots
• Cushing syndrome – may include a red, round and full face

Zollinger-Ellison syndrome is a condition caused by gastrin- producing NETs (gastrinomas) that form in the pancreas and the upper part of the small intestine. Gastrinomas produce large amounts of gastrin that increase the amount of stomach acid made. Too much stomach acid eventually can lead to ulcers of the stomach or small intestine. The signs or symptoms of Zollinger-Ellison syndrome include:

• pain in the abdomen
• severe diarrhea
• heartburn
• nausea and vomiting, sometimes vomiting blood
• weight loss