The Neuroendocrine Tumor Center at Mercy

Neuroendocrine tumors are rare (considered an "orphan disease") and come from the hormonal cells controlled by the nervous system. Patients who are diagnosed with NETs in the early stages of the disease have a better chance of beating or managing the disease. This is why it is best to find a neuroendocrine specialist for early treatment options. Neuroendocrine cells secrete hormones that regulate the nervous and endocrine systems.

Neuroendocrine cells can be found throughout the body in the appendix, brain, lungs, ovaries, pancreas, rectum, small intestine and thyroid. The majority of neuroendocrine tumors start in the digestive tract (mouth, esophagus, stomach, small and large intestines), because there are more neuroendocrine cells there than any other area of the body. NETs are generally slow growing and can sometimes produce excess hormones. There are also fast growing and aggressive neuroendocrine tumors. 

At Mercy we believe following the guideline that suggests that patients should look for a Board Certified, highly trained and experienced neuroendocrine specialist is fundamental. Access to innovative technology and leading edge treatment options as well as the latest clinical trials and research give our doctors at Mercy and their patients an added advantage.

The Neuorendocrine Tumor Center at Mercy is proud to have a team of specially trained, knowledgeable doctors who focus on accurate, early diagnosis of the disease. Our doctors routinely hold multidisciplinary Tumor Board Conferences to explore resources, share information and discuss how to best design the optimal treatment care plan for each patient. They actively participate in continuing medical education courses and often present their findings at prestigious conferences across the nation.

Understanding the psychological impact of the disease is a critical component to treating the whole disease. The Neuroendocrine Tumor Center at Mercy includes our comprehensive network of healthcare professionals to complement the clinical work of our doctors. Mercy has a clinical nurse navigator who facilitates interaction between patients and medical specialists and other clinical staff as well as guides patients and their caregivers, answering questions and providing support through each phase of treatment and beyond. Our social workers and nutritionists also provide key support throughout the healing process. Patients also have the option to attend the patient and caregiver support group of the Neuroendocrine Tumor Program - ChesaNETs. 

Patients often turn to The Neuroendocrine Tumor Center at Mercy because the physician expertise opens the door for earlier and more accurate diagnosis of NETS. Frequently, neuroendocrine tumors present symptoms that are associated with less serious conditions or symptoms that mock other disorders. As a result, it takes the keen eye of a neuroendocrine specialist to accurately diagnose the situation and avoid the chance of misdiagnosis – a common problem for some patients who do not get to a neuroendocrine specialist until the disease has advanced to late stages of the disorder. That is why choosing a doctor who has the tools, diagnostic skills and clinical insight to determine the best course of action is key to selecting the best neuroendocrine doctor/center/team for you.

The symptoms and treatments for NETs depend on:

• Type of tumor
• Location of tumor
• Whether or not it produces hormones
• If the tumor is aggressive (grow quickly or slowly) or metastasized (is it cancerous and has it spread

Neuroendocrine tumors sometimes secrete hormones that cause symptoms such as:

• Abdominal pain and cramping
• Bowel obstruction
• Chest pain
• Cough
• Coughing up blood
• Diarrhea
• Fast heartbeat
• Flushing/abnormal redness in the face and neck
• Rectal bleeding
• Rectal pain
• Recurrent pneumonia
• Shortness of breath
• Wheezing

There are several types of neuroendocrine tumors, including:

• Carcinoid tumors – NETs of the lung and intestinal tract
• Paraganglioma – NETs of the head, neck, thorax and abdomen
• PNET, also called Islet cell tumors – NETs of the pancreas
• Medullary thyroid carcinoma – NETs of thyroid
• Merkel cell carcinoma – NETs of the skin
• Multiple Endocrine Neoplasias Type 1 and 2 – NETS of the endocrine gland
• Pheochromocytoma – NETs of the adrenal gland
• Small cell carcinoma – NETs of the lung and cervix
• Large cell carcinoid – NETs of the lung

The specialists of The Neuroendocrine Tumor Center at Mercy Medical Center in Baltimore, Maryland, offer team-based, focused and comprehensive evaluations using state-of-the-art diagnostic and therapeutic services for managing and treating NETs.

The Neuroendocrine Tumor Center at Mercy uses a variety of diagnostic procedures including:

• Biopsy
• Computed tomography scans (CT)
• CT enteroclysis
• Endoscopy
• Double Balloon Enteroscopy
• Capsule Endoscopy
• Magnetic Resonance Imaging (MRI) scans
• Nuclear Medicine Imaging (including Metaiodobenzylguanidine (MIGB) imaging)
• Positron Emission Tomography (PET) scans
• Gallium 68 PET scans
• Inferior vena Cava hormone levels sampling
• Specialized laboratory hormone and peptide tests
• Stains and laboratory studies indicated in the workup of neuroendocrine tumors

The physicians of The Neuroendocrine Tumor Center at Mercy create individualized care treatment plans. The treatment plans are tailored for a cure, slowing disease progression and/or providing symptomatic relief as appropriate with the cancer stage. With involvement in ongoing clinical research, the physicians of The Neuroendocrine Tumor Center at Mercy work tirelessly to contribute to the medical advances that lead to medical breakthroughs for the best treatment options for a variety of neuroendocrine tumors.

General treatment options for neuroendocrine tumors include surgery, radiation therapy, liver directed therapies such as chemoembolization, hormonal agents and chemotherapy. The Neuroendocrine Tumor Center at Mercy provides comprehensive, state-of-the-art treatment, including:

• Surgery - Traditional, Minimally Invasive Laparoscopic, Robotic, and Radioguided techniques
• Chemoembolization/Liver Directed Therapy
• Drug Therapy (Somatostatin Analogues, Targeted Drugs, Chemotherapy)
• Nutritional Modification for Symptom Management
• Peptide Receptor Radionuclide Therapy (PRRT) or Targeted Radiation

Our program includes a dedicated nurse navigator as well as social work, nutritional services and quarterly support group meetings to help patients throughout their treatment. 

The physicians of the Neuroendocrine Tumor Center at Mercy work collaboratively with physicians from a wide variety of Centers of Excellence at Mercy to help assure patients get the best treatment options possible to meet their specific diagnosis. These Centers include:

• Medical Oncology and Hematology at Mercy
• The Melissa L. Posner Institute for Digestive Health and Liver Disease at Mercy
• The Center for Endocrinology at Mercy
• The Center for Interventional Pain Medicine at Mercy
• The Lung Center at Mercy
• The Minimally Invasive Brain and Spine Center at Mercy
• Interventional Radiology at Mercy
• Radiation Oncology at Mercy
• Surgical Oncology at Mercy
• Department of Pathology at Mercy

Dr. Sandy Kotiah, Director

Dr. Debashish Bose

Dr. Kurtis Campbell

Dr. Vadim Gushchin

Dr. Anurag Maheshwari

Dr. Allen Missoi

Dr. Amit Raina

Dr. Armando Sardi

Holly Freeman, Nurse Navigator