Talk Cancer

Question:

Hi,         my name is Alain Forcier and one of my friend learned few months that she have cancer,  this summer she was pregnant, so they do nothing.  After sh got her baby, they made a surgery to know exactly what kind of cancer sh have.  Two specialist have different diagnostics, one said the CARCINOM…. and the other said it’s the ESTHESIO…..         They sent blood part at Boston to have another advice.           Depending of what cancer sh have, some doctors asked her to start radiotherapy, others advice to wait.         few weeks ago, they remove all the cancer stuff, that was inside her nose and last week they check it and no others bad stuff reappears.         Are there someone who  could help or giving me place where we could find additionnal infos? thanks — Alain Forcier

Response:

- Hide quoted text — Show quoted text – Can you give us a bit more information? Where was the cancer? Was there a specific kind of carcinoma they thought she had? Is the other possibility esthesioneuroblastoma? esthesioneurocytoma? esthesioneuroepithelioma? All the information you can get would be helpful. Helen Stanbro Helen,         Thank you very much for your reply .         They found it inside her nose.  She never had bad symptomes. I mean that the way they discovered it is one year ago (when she was pregnant), her nose was jam.  After several days, sh went to hospital because that was very uncomfortable for her, she had no pain.  They clean the nose, doing this , they made analysis of what it could be and they discover it could be cancerous.         On their advice, they did not see that type very often in Canada.  Being pregnant, she could not go on radiotherapy because her baby inside. After sh got her baby, they made a surgery to remove all it.  two weeks ago, they check it and there was no other trace of it.         At this time, Doctors said that there two possibility:         CARCINOME ANAPLASIC                 or         ESTHESIONEUROBLAFTOM         Doctors are speaking french, so we don’t know if it in french, english or it’s name as Universal language.         Depending of the type of Cancer sh have, the treathment is different.  A doctor is for the radiotherapy either the type she have,  but I guess there have a lot of secondary effect with that.         Thank you very much.         Alain Forcier         Drummondville, QC PS.  Is it important to answer on the newsgroup or only in private ?

Thanks for the extra information–it helped a lot. I would certainly post it on the newsgroup so that one of the real doctors who often give more professional answers and know of various centers that might review your friend’s pathology slides may see it and hopefully reply.    Esthesioneuroblastoma is a rare tumor of the upper nasal cavity. It has small round cells that are hard to distinguish from carcinoma cells. This is probably why your friend’s pathologists are having trouble deciding what she has. If at all possible, someone who can do immunohistochemical staining and maybe electron microscopy should look at her slides. There are some subtle features that distinguish esthesioneuroblastoma from a very similar thing called neuroendocrine carcinoma and from anaplastic or undifferentiated carcinoma. Although all these things have small, round cells, esthesioneuroblastoma cells often have little projections called dendrites, as if they were trying to turn into nerve cells (which they are related to) whereas carcinoma cells are epithelial cells and they don’t have dendrites. Also in esthesioneuroblastoma, there are often a special kind of cell called sustentacular cells mixed in or around the edges. These are not seen in carcinomas. The dendrites in esthesioneuroblastoma have little tubules and granules inside them. There are even sometimes little synapses, as if they were real nerve cells. Esthesioneuroblastoma cells contain certain chemicals and proteins that can be stained and detected–these include chromogranin A, synaptophysin, neuron-specific enolase, MIC-2, somatostatin receptors, and nerve tissue protein S-100. None of these things should be found in regular carcinomas. The somatostatin receptors are especially useful because there is a radioactive tracer (Indium-111-labeled octreotide) that will only bind to things with this receptor. It can be used to search for residual tumor cells that might still be alive after the surgery and it can also look for any tumor cells that may have spread to lymph nodes in the neck (rather common with this kind of tumor) or even to distant places in the brain, lungs, heart, etc.    Surgery plus radiotherapy is the usual treatment and has fairly good results, although this tumor can come back later–as many as 39% of the recurrences in one study occured more than 5 years after supposedly successful therapy. Also, of course, it can have spread somewhere else in the body where the local radiotherapy won’t touch it. A lot of places are recommeding chemotherapy now, even for people that they think are "cured" by just the surgery and radiotherapy. A recent paper in Acta Cytol 41(#) 802-10, 1997 suggests cisplatin and etoposide plus fractionated stereotaxic proton radiotherapy. They have had good results.        I think since your address indicates that you live in Quebec, you might want to contact McGill University Hospital in Montreal. That is a good place with a lot of excellent doctors. You can find links to other Canadian hospitals at http://neuro-www2.mgh.harvard.edu/hospitalwebworld.html#CANADA Good luck and let us know what happens–Helen Stanbro

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