The Neuroendocrine Cancer Foundation Podcast - Top 10 FAQs with neuroendocrine cancer experts

NET dietician Sina Teskey from the Medical College of Wisconsin answers common questions about diet and nutrition raised among NET patients and caregivers. She addresses special diets, food restrictions, and whether sugar “feeds” cancer. Sina also speaks to diarrhea, and digestive enzymes and shares tips on how to maintain nutrition and weight.
MEET SINA TESKEY, RD, CD
Sina Teskey, RD, CD received her B.S. from the University of Wisconsin-Madison in 2006 and completed her dietetic internship at the University of Minnesota Medical College-Fairview in 2007. She has spent most of her career working with cancer and eating disorder patients. Sina practiced in the Twin Cities area for 10 years where she also spent time guest starring on a local TV show called Twin Cities Live to share nutrition advice.

She moved to Milwaukee and has worked at Froedtert Hospital and the Medical College of Wisconsin since 2018. Sina sees all patients with cancer but specializes in GI cancers and neuroendocrine tumor patients. When she’s not working, Sina is a mom to three kids and a Labrador retriever. She loves to cook and bring people together with food. Her youngest son was diagnosed with non-Hodgkin’s Lymphoma in 2019. His cancer journey gave insight into what having cancer means to a family and has impacted her practice profoundly. Her son Milo is now 7 years old and in remission.

TOP TEN QUESTIONS

1. Is there a diet NET patients should follow? Are there foods NET patients should avoid? Some people say there are certain “trigger foods” to avoid. What CAN I eat?
2. What diet is helpful after bowel surgery? What about pancreas surgery?
3. Are there vitamins or supplements recommended for NET patients?
4. What can NET patients do about diarrhea? What diet or medications might help?
5. What can NET patients do if they struggle with a poor appetite?
6. What can NET patients do if they are struggling to keep on or gain weight?
7. What can NET patients do to stay hydrated?
8. What are pancreatic enzymes and how are they taken? Who are they recommended for?
9. What proteins can people take if they are vegetarian or vegan given soy may be a trigger for carcinoid syndrome?
10. What do you think of alternative diets such as the keto diet or other “special diets?” Does sugar feed cancer? What about intermittent fasting?

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Take a glimpse through the microscope and learn how pathology determines your NET diagnosis and guides treatment. How does one interpret differing Ki-67 results from the same specimen? Why might a patient have two different Ki-67 results from different specimens? How does pathology distinguish G3 well-differentiated NET from NEC? How does pathology help with NET tumors of unknown origin? NET pathologist Dr. Andrew M. Bellizzi from the University of Iowa sheds light on just how much information a tiny tissue sample may contain.

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Is it okay for NET patients to take “statin” medications to lower cholesterol or SSRI medication for depression? How often should full body scans be done? NET oncologist Dr. Jun Gong of Cedars-Sinai Medical Center addresses ten common questions you might ask your NET oncologist along your NET journey. Listen now!

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ABOUT THIS EPISODE

In this 2-part series, Dr. Osman Ahmed from University of Chicago covers liver-directed therapies for neuroendocrine neoplasms (NENs or neuroendocrine cancer). In this first episode, he outlines the types of liver-directed therapies and elaborates on ablative techniques including the newest technique, histotripsy. Listen to a frank discussion of how histotripsy works, when it might be used, and what its current limitations are.

TOP TEN QUESTIONS ABOUT LIVER-DIRECTED THERAPY INCLUDING HISTOTRIPSY:

1. What is liver-directed therapy? How does it work? Is this considered “surgery”? What is a surgery and what is a “procedure?”
2. What are the types of liver-directed therapies used for neuroendocrine cancer?
3. Which neuroendocrine cancers are they used for and when are they used? How do you decide who is a good candidate and if it will be effective?
4. When are liver-directed therapies NOT used? Can someone who has had a Whipple undergo liver-directed therapy?
5. What is the ablation zone? What is a heat sink effect?
6. What is histotripsy? How does it work?
7. When is histotripsy used (tumor grade, type of tumor - PNET/lung NET, size, number of tumor, location)? Can they be used for liver tumors even if there are tumors outside the liver?
8. What are the limitations to histotripsy?
9. What happens to the liver tissue after ablation? What are the results or success rates of patients being treated? Can histotripsy “cure” NET?
10. How do you decide between the various types of liver-directed therapies?

MEET DR. OSMAN AHMED:
Osman Ahmed, MD, is an expert vascular and interventional radiologist who diagnoses and treats a wide range of conditions. Using image-guided technology and small, sophisticated instruments, Dr. Ahmed performs minimally invasive procedures for acute and chronic deep vein thrombosis, benign prostatic hyperplasia, peripheral vascular disease, liver/bone/lung/kidney cancer, spinal fractures, uterine fibroids and more. He also implants inferior vena cava (IVC) filters, which prevent a blood clot from traveling around the body or creating a blockage.

In addition to his clinical expertise, Dr. Ahmed researches novel treatment options that improve outcomes for patients. His research on liver cancer, IVC filters and venous diseases has been published in several high-impact, peer-reviewed journals, including the Journal of Vascular and Interventional Radiology, Radiology, Chest, Journal of American College of Radiology, and Journal of Surgical Oncology.

Dr. Ahmed also believes in the importance of educating medical students, residents, fellowships and peers in order to enhance health care across the world. He has been invited to speak at a number of symposiums, practicums and national/international meetings about the newest advancements in interventional radiology.
Visit lacnets.org/podcast/38 for the podcast, transcript, and resources.

For more information, visit LACNETS.org.

ABOUT THIS EPISODE

What are Targeted Therapies and how do they work? How and when would they be used in NETs? Dr. Scott Paulson from Baylor Cancer Center in Dallas discusses common questions and concerns about targeted therapies including side effects, dosing and treatment sequencing. Bonus: Dr. Paulson shares how we can learn from Harry Potter’s invisibility cloak in understanding treatment goals with NETs.
MEET DR. SCOTT PAULSON

Dr. Paulson is a medical oncologist and the medical director for the Neuroendocrine Research and Treatment Center at Baylor Charles A. Sammons Cancer Center in Dallas, Texas. He also serves as the co-director of the Gastrointestinal Research Program for the Sarah Cannon Research Institute.

Dr. Paulson earned his medical doctorate at The University of Texas Southwestern Medical School. He took his residency and an internship in internal medicine at Brigham and Women's Hospital in Boston, Massachuests. His fellowship was completed in medical oncology at the University of California, San Francisco.

Dr. Paulson is active in clinical research focused on neuroendocrine tumors as well as cancers of the pancreas, liver, esophagus, stomach, and colon. Dr. Paulson is active in clinical research focused on neuroendocrine tumors as well as cancers of the pancreas, liver, esophagus, stomach, and colon. He currently is an investigator on a clinical trial studying nab-sirolimus, a mTOR inhibitor, which is a type of targeted therapy.
TOP TEN QUESTIONS ABOUT TARGETED THERAPIES FOR NETs:

1. What are targeted therapies? Are they considered chemotherapy? How do they work?
2. What are the different types of targeted therapies for NETs?
3. When and how are targeted therapies used?
4. What side effects might someone have when taking a targeted therapy?
a.Can targeted therapies affect blood sugars or cause diabetes?
b. Can targeted therapies cause one to be immunocompromised?
c. Can targeted therapies affect one’s blood counts?
5. What is the goal of treatment with targeted therapies? (Why would one take these drugs given the potential side effects? Can the side effects be managed?)
6. How do you decide which targeted therapy to recommend for a patient?
7. Can a NET patient take more than one drug in this category? Can the medications be stopped and restarted?
8. What is your approach with dosing?
9. What is your approach with monitoring? What and how often do people need blood work?
10. Does taking a targeted therapy preclude someone from getting another treatment in the future, such as Lutathera/PRRT, or a clinical trial of alpha PRRT?
BONUS: What are the latest advances in targeted therapy? What is the future of targeted therapies?
For more information, please visit https://www.lacnets.org/podcast/33.

For more information, visit LACNETS.org.