Roswell Park Comprehensive Cancer Center provides comprehensive diagnostic and treatment services to patients with benign and malignant endocrine tumors and conditions affecting the endocrine system. We manage and investigate a wide spectrum of hormone-producing tumors and related diseases of the thyroid, adrenal, parathyroid, pituitary and pancreas. Tumors of these organs sometimes result in excessive and unregulated hormone secretion and require attentive diagnosis and therapy.
Listen as Rajeev Sharma, MBBS, MD, discusses the role of an endocrinologist in cancer care as they collaborate with surgeons, oncologists, radiologists and pathologists to provide the best possible care for patients with endocrine tumors.
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The Role of Endocrinology in Cancer Care
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Learn more about Rajeev Sharma, MBBS
Rajeev Sharma, MBBS, MD, FACE
Rajeev Sharma, MBBS, MD is an Assistant Professor of Oncology at Roswell Park Comprehensive Cancer Center.Learn more about Rajeev Sharma, MBBS
Transcription:
The Role of Endocrinology in Cancer Care
Bill Klaproth (Host): The body’s endocrine system, which controls the body’s hormones can become compromised and disrupted when cancer invades part of the endocrine system. Here to talk with us about endocrinology and cancer care is Dr. Rajeev Sharma, head of the Endocrine Oncology Department at Roswell Park Comprehensive Cancer Center. Dr. Sharma, thanks for being on with us. First off, what does an endocrinologist do?
Dr. Rajeev Sharma (Guest): Thanks, Bill. Good morning, and thank you for having me here. The endocrine system is actually a collection of different glands that secrete hormones directly into the blood, which are then carried to distant organs. Major endocrine glands include pituitary gland, thyroid, parathyroid, pancreas, testicles, and adrenal glands. The endocrine system – to just make people understand – is it’s quite different from something called an exocrine gland where the secretions are secreted into the duct, whereas the endocrine gland secretes hormones directly into the blood system. For example -- I’ll give you a very good example, is the pancreas, which is actually both endocrine and exocrine gland, where the endocrine function is insulin, and the exocrine function is pancreatic secretions. In general, an endocrinologist is concerned about any abnormality in these glands arising out of either excess hormones or deficiency in these hormones.
Bill: And how are endocrinology and cancer connected, then?
Dr. Sharma: Well, there are two different ways an endocrinologist would be involved in cancer care. One is – the first way, there is some tumor of the endocrine glands, and the second way in which an endocrinologist is involved is when you have a cancer patient who has some kind of endocrine problems going on at the same time. For example, there is a cancer patient that has diabetes. In both cases, an endocrinologist involvement is very, very important.
Bill: What types of cancers, then, do you treat?
Dr. Sharma: The most common cancers that, as an endocrinologist, I see is thyroid cancer, and these are malignant thyroid cancers. But I also see a lot of benign tumors of endocrine tissues like a pituitary tumor, which is mostly benign, adrenal tumors – we see a lot of adrenal tumors, which are benign, but could be malignant, as well. And then we see a lot of other tumors like parathyroid gland tumors, pancreatic neuroendocrine tumors, testicular tumors. These are some of the commonly seen tumors by an endocrinologist.
Bill: Is thyroid cancer one of the more common types of cancer that you treat?
Dr. Sharma: Yeah, I see – the bulk of my patients with endocrine tumors or cancers are thyroid cancers. We have a flourishing Head and Neck Service here, so a lot of the referral base is from them, but yes, thyroid cancer is the most common cancer I see.
Bill: Now, are there different types of thyroid cancer, and what would the symptoms be?
Dr. Sharma: Well, it could be completely asymptomatic, so most of the time, what we see is It’s an incidental finding. An incidental finding means that somebody has a CT scan or some kind of MRI done for the head and neck area, say for some back pain or neck pain, and then the radiologist finds that somebody has a nodule, which is a growth in the thyroid gland. When you find a nodule in the neck – in the thyroid tissue, then we evaluate that nodule and see how it looks on the imaging studies like ultrasound, and then advise patients to undergo a biopsy of those nodules. The majority of the time it’s benign, but there is a certain percentage – like two to three percentage of the time where these nodules might be malignant or cancerous. The treatment is to take the thyroid gland out, and that is done by the surgical service. The most common thyroid cancer is something called papillary thyroid cancer, which constitutes about 85% of the thyroid cancers. The second most common thyroid cancer is follicular thyroid cancer, and then, very rarely, you could have something called anaplastic thyroid cancer. There is a special type of thyroid cancer, which is different from the papillary and follicular thyroid cancer, and that’s called medullary thyroid cancer. That has a different morphology and pathology than the more common thyroid cancers.
The symptoms, in general, are absent, but rarely, patients might complain of some swelling in the neck, they might complain of problems with swallowing. If it’s too big, it can cause problems with the nerve that supplies your vocal cords, then they might have a bit of hoarseness, but a majority of my patients are asymptomatic.
Bill: Okay, and what other types of endocrine disorders to you treat?
Dr. Sharma: I treat patients with pituitary tumors or pituitary dysfunction. For example, if you have a tumor in the pituitary gland – basically the pituitary gland is the master gland and produces a lot of hormones, which controls other organs. If there's any issue with that, then I treat them with either the replacement of that hormone or if there's a tumor, evaluate and send them to the neurosurgeon. The same way, a lot of patients come to me with high calcium, and they may have a tumor of the parathyroid gland, and we evaluate them, and if we find there's a gland which is overactive, then we take it out, and it cures the patient of hypercalcemia – high calcium.
We do see a lot of patients with adrenal tumors, and the same – as I told you about the thyroid cancers, these are also something called adrenal incidentalomas because it’s incidentally found. We want to make sure that these tumors are not overproducing or under-producing any hormones. We check them for overproduction or underproduction, and if there’s anything abnormal, surgery is always a cure. Some of these patients might not be good candidates for surgery, so then we have medications for them, and they do well on that.
Bill: Okay, speaking of treatment, when cancer invades part of the endocrine system, what are the normal ways that you go about treating it?
Dr. Sharma: It depends on which endocrine organ is involved. So sometimes – let's say you have cancer in the abdomen and it invades the pancreas, if the surgical team can take care of the pancreas – they usually take it out. Once you take it out, the patient would develop diabetes, and then my role of managing the patient for diabetes would come. Similarly, a patient has a thyroid cancer, so they take it out and then the patient has no thyroid gland of their own. I would replace them with the thyroid hormone for life-long.
Bill: Those are long-term side-effects, then, of having the thyroid removed or the pancreas removed, is that right?
Dr. Sharma: Right, so long-term – well, if they don’t have the organ, which is producing their own hormones, they would require additional hormones from outside. This is not a perfect system compared to what the body does by itself, so you do tend to have patients who would have some kind of side-effects. If they get too much thyroid hormone, they could get palpitations, and they can feel weight loss, anxiety. If it's too low or under replacement, they can feel weight gain, not feeling well, sleepy. Similarly, for diabetes, if you get too much of insulin or diabetic medication your sugar would drop too much and cause hypoglycemia. If you don't give good treatment, then you can get into hyperglycemia or high sugar, and quite a bit of these patients might be difficult to control, as well.
Bill: Is removal the only method of treatment? Do you ever use radiation or chemo when it comes to the endocrine system?
Dr. Sharma: Well, the majority of the time surgical option is the cure. If I find something in the endocrine gland – there's a tumor – I would suggest that these tumors should be taken out. There are instances when a patient might not be a good surgical candidate, and then they might need different treatment. Chemo is usually not the first treatment for endocrine gland tumors; the same way radiation is not the first-line treatment. The first-line treatment is always surgical followed by the hormone replacement.
Bill: So definitely on a case-by-case basis depending on how you treat that endocrine cancer when you find it?
Dr. Sharma: Right, exactly. I will give you an example of something called neuroendocrine tumors. These are highly specialized tumors of usually the pancreatic gland. Sometimes these tumors, when they prevent, they are very small and difficult to find, but by the time we start to look at them in imaging studies, they have already progressed to other organs. At that time, it's difficult for the patients to be sent to surgery. In those cases, I would not call that chemotherapy, but there are treatments that control the hormones that are a pretty standard treatment, now. I, in conjunction with other services like GI Oncology or Head and Neck Service, manage the patient in a multidisciplinary way.
Bill: Right, well, Dr. Sharma, thank you, so much, for your time today and talking to us about endocrinology and cancer. For more information, visit RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth, thanks for listening.
The Role of Endocrinology in Cancer Care
Bill Klaproth (Host): The body’s endocrine system, which controls the body’s hormones can become compromised and disrupted when cancer invades part of the endocrine system. Here to talk with us about endocrinology and cancer care is Dr. Rajeev Sharma, head of the Endocrine Oncology Department at Roswell Park Comprehensive Cancer Center. Dr. Sharma, thanks for being on with us. First off, what does an endocrinologist do?
Dr. Rajeev Sharma (Guest): Thanks, Bill. Good morning, and thank you for having me here. The endocrine system is actually a collection of different glands that secrete hormones directly into the blood, which are then carried to distant organs. Major endocrine glands include pituitary gland, thyroid, parathyroid, pancreas, testicles, and adrenal glands. The endocrine system – to just make people understand – is it’s quite different from something called an exocrine gland where the secretions are secreted into the duct, whereas the endocrine gland secretes hormones directly into the blood system. For example -- I’ll give you a very good example, is the pancreas, which is actually both endocrine and exocrine gland, where the endocrine function is insulin, and the exocrine function is pancreatic secretions. In general, an endocrinologist is concerned about any abnormality in these glands arising out of either excess hormones or deficiency in these hormones.
Bill: And how are endocrinology and cancer connected, then?
Dr. Sharma: Well, there are two different ways an endocrinologist would be involved in cancer care. One is – the first way, there is some tumor of the endocrine glands, and the second way in which an endocrinologist is involved is when you have a cancer patient who has some kind of endocrine problems going on at the same time. For example, there is a cancer patient that has diabetes. In both cases, an endocrinologist involvement is very, very important.
Bill: What types of cancers, then, do you treat?
Dr. Sharma: The most common cancers that, as an endocrinologist, I see is thyroid cancer, and these are malignant thyroid cancers. But I also see a lot of benign tumors of endocrine tissues like a pituitary tumor, which is mostly benign, adrenal tumors – we see a lot of adrenal tumors, which are benign, but could be malignant, as well. And then we see a lot of other tumors like parathyroid gland tumors, pancreatic neuroendocrine tumors, testicular tumors. These are some of the commonly seen tumors by an endocrinologist.
Bill: Is thyroid cancer one of the more common types of cancer that you treat?
Dr. Sharma: Yeah, I see – the bulk of my patients with endocrine tumors or cancers are thyroid cancers. We have a flourishing Head and Neck Service here, so a lot of the referral base is from them, but yes, thyroid cancer is the most common cancer I see.
Bill: Now, are there different types of thyroid cancer, and what would the symptoms be?
Dr. Sharma: Well, it could be completely asymptomatic, so most of the time, what we see is It’s an incidental finding. An incidental finding means that somebody has a CT scan or some kind of MRI done for the head and neck area, say for some back pain or neck pain, and then the radiologist finds that somebody has a nodule, which is a growth in the thyroid gland. When you find a nodule in the neck – in the thyroid tissue, then we evaluate that nodule and see how it looks on the imaging studies like ultrasound, and then advise patients to undergo a biopsy of those nodules. The majority of the time it’s benign, but there is a certain percentage – like two to three percentage of the time where these nodules might be malignant or cancerous. The treatment is to take the thyroid gland out, and that is done by the surgical service. The most common thyroid cancer is something called papillary thyroid cancer, which constitutes about 85% of the thyroid cancers. The second most common thyroid cancer is follicular thyroid cancer, and then, very rarely, you could have something called anaplastic thyroid cancer. There is a special type of thyroid cancer, which is different from the papillary and follicular thyroid cancer, and that’s called medullary thyroid cancer. That has a different morphology and pathology than the more common thyroid cancers.
The symptoms, in general, are absent, but rarely, patients might complain of some swelling in the neck, they might complain of problems with swallowing. If it’s too big, it can cause problems with the nerve that supplies your vocal cords, then they might have a bit of hoarseness, but a majority of my patients are asymptomatic.
Bill: Okay, and what other types of endocrine disorders to you treat?
Dr. Sharma: I treat patients with pituitary tumors or pituitary dysfunction. For example, if you have a tumor in the pituitary gland – basically the pituitary gland is the master gland and produces a lot of hormones, which controls other organs. If there's any issue with that, then I treat them with either the replacement of that hormone or if there's a tumor, evaluate and send them to the neurosurgeon. The same way, a lot of patients come to me with high calcium, and they may have a tumor of the parathyroid gland, and we evaluate them, and if we find there's a gland which is overactive, then we take it out, and it cures the patient of hypercalcemia – high calcium.
We do see a lot of patients with adrenal tumors, and the same – as I told you about the thyroid cancers, these are also something called adrenal incidentalomas because it’s incidentally found. We want to make sure that these tumors are not overproducing or under-producing any hormones. We check them for overproduction or underproduction, and if there’s anything abnormal, surgery is always a cure. Some of these patients might not be good candidates for surgery, so then we have medications for them, and they do well on that.
Bill: Okay, speaking of treatment, when cancer invades part of the endocrine system, what are the normal ways that you go about treating it?
Dr. Sharma: It depends on which endocrine organ is involved. So sometimes – let's say you have cancer in the abdomen and it invades the pancreas, if the surgical team can take care of the pancreas – they usually take it out. Once you take it out, the patient would develop diabetes, and then my role of managing the patient for diabetes would come. Similarly, a patient has a thyroid cancer, so they take it out and then the patient has no thyroid gland of their own. I would replace them with the thyroid hormone for life-long.
Bill: Those are long-term side-effects, then, of having the thyroid removed or the pancreas removed, is that right?
Dr. Sharma: Right, so long-term – well, if they don’t have the organ, which is producing their own hormones, they would require additional hormones from outside. This is not a perfect system compared to what the body does by itself, so you do tend to have patients who would have some kind of side-effects. If they get too much thyroid hormone, they could get palpitations, and they can feel weight loss, anxiety. If it's too low or under replacement, they can feel weight gain, not feeling well, sleepy. Similarly, for diabetes, if you get too much of insulin or diabetic medication your sugar would drop too much and cause hypoglycemia. If you don't give good treatment, then you can get into hyperglycemia or high sugar, and quite a bit of these patients might be difficult to control, as well.
Bill: Is removal the only method of treatment? Do you ever use radiation or chemo when it comes to the endocrine system?
Dr. Sharma: Well, the majority of the time surgical option is the cure. If I find something in the endocrine gland – there's a tumor – I would suggest that these tumors should be taken out. There are instances when a patient might not be a good surgical candidate, and then they might need different treatment. Chemo is usually not the first treatment for endocrine gland tumors; the same way radiation is not the first-line treatment. The first-line treatment is always surgical followed by the hormone replacement.
Bill: So definitely on a case-by-case basis depending on how you treat that endocrine cancer when you find it?
Dr. Sharma: Right, exactly. I will give you an example of something called neuroendocrine tumors. These are highly specialized tumors of usually the pancreatic gland. Sometimes these tumors, when they prevent, they are very small and difficult to find, but by the time we start to look at them in imaging studies, they have already progressed to other organs. At that time, it's difficult for the patients to be sent to surgery. In those cases, I would not call that chemotherapy, but there are treatments that control the hormones that are a pretty standard treatment, now. I, in conjunction with other services like GI Oncology or Head and Neck Service, manage the patient in a multidisciplinary way.
Bill: Right, well, Dr. Sharma, thank you, so much, for your time today and talking to us about endocrinology and cancer. For more information, visit RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth, thanks for listening.