WARNING: WHAT FOLLOWS IS PURE SPECULATION. IT IS NOT MEDICAL FACT. IT IS ME–THE ENGLISH MAJOR–THINKING ABOUT THE LOGIC OF SOME OF WHAT I HAVE BEEN READING.

I put that all in capitals because I don’t want anyone to get confused by this piece. I am not a doctor. I have read a lot about NET and Carcinoid Syndrome in the year and four months since my wife was first diagnosed with the disease–and particularly in the year since her death. But my opinions and questions are only those of a layman who knows just enough to ask what may be truly dumb questions.

A few weeks ago I read a paper linking some aggressive forms of prostate cancer to neuroendocrine tumors that were in close proximity to the prostate cancer tumors. The writer argued that the aggressiveness of those cancers was because of the NETs.

This got me wondering about how many deaths attributed to prostate cancer were actually attributable to NET. I have written before about the relationship between NET and idiopathic right side heart valve disease and wondered how many cases of it were NET-related. And I have asked more than once how many cases of NET there really are as opposed to how many we are diagnosing. I have written about the autopsy study that indicates the possibility of as many as three million cases of NET in the US. But I also know that many cases of NET seem to be totally benign insofar as they are inactive–meaning they do not produce hormones.

The medical community has long known that some cancers are more aggressive than others. For example, some breast cancers move at a faster pace than others. Exactly why is not entirely clear. Some of it may have to do with human genetics. Some of it may have to do with the genetics of the cancer. And some of it may be hormone driven.

That last possibility gave rise to this speculation: If the level of aggression in some cancers is hormone driven, and NETs produce hormones, how many cancers are made more aggressive by the presence of even very small active NETs?

If a large primary NET is the size of a lentil–and it is sitting next to a large “normal” tumor, does the pathologist biopsy both tumors–or does he biopsy only what, by size,  appears to be the primary tumor?

I know from a video I watched two weeks ago of one session at the NET Patient conference in November that much of the time only one NET is biopsied when several may exist because of the mistaken belief that a metastases will be the same as the primary tumor.  The presenter argued that the primary and the metastases in NET  might be different–might be producing different hormones–and might require different therapeutic approaches.

Here’s my dumb question: How many of the relatively aggressive  general cancers we see are aggressive because of their proximity to an undiagnosed or unrecognized NET? Does the aggression shown by prostate cancers that are accompanied by NETs apply to cancers of other organs as well? Logic tells me it might. But we need data to prove or disprove the logic.