Episode 30: Bone & Brain Metastases in Neuroendocrine Cancer

The LACNETS Podcast - Top 10 FAQs with neuroendocrine tumor (NET) experts

When and how often do NETs spread to the bones or brain? How are they found? What is the treatment? Dr. Robert Ramirez of Vanderbilt University addresses concerns surrounding bone metastases (or “mets”) as well as rare brain metastases.
MEET DR. ROBERT RAMIREZ, DO, FACP

Dr. Robert Ramirez is a medical oncologist specializing in the treatment of thoracic and neuroendocrine malignancies and an Associate Professor of Medicine at Vanderbilt University Medical Center in Nashville, TN. He earned his medical degree from the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine. He completed an internal medicine residency at Cooper University Hospital in Camden, New Jersey. He then completed a hematology and medical oncology fellowship at the University of Tennessee Health Sciences Center in Memphis, Tennessee and served as chief fellow. He is a Fellow of the American College of Physicians, and a member of American Society of Clinical Oncology, the International Association for the Study of Lung Cancer (IASLC), and the North American Neuroendocrine Tumor Society (NANETS). He serves on the Board of Directors for NANETS as well as the Scientific Review and Research Committee.
His clinical and research interests include neuroendocrine tumors (NETs) and lung cancer. He has a specific interest in NETs of the lung ranging from diffuse idiopathic pulmonary neuroendocrine tumor cell hyperplasia (DIPNECH) and carcinoid tumors to small cell lung cancer and other high-grade neuroendocrine carcinomas. He is active in clinical trial design including investigator-initiated trials. He enjoys teaching residents and fellows and has multiple publications and given many lectures for the scientific community on the topics of NETs and lung cancers.
TOP TEN QUESTIONS

Bone mets:
1. When and how often do NETs spread to the bones?
2. Where in the bones are tumors? What does it mean when NETs spread to the bones? How does this compare to other cancers?
3. How are bone spots found and monitored? Should they be biopsied?
4. What is the treatment for bone mets? Should I have radiation? Would radiation limit my ability to get PRRT?
5. Should I be on bone strengthening medication? Am I at higher risk for fractures (or breaking my bones) if I have NETs in the bones?
6. Do bone mets respond to PRRT?
7. Does having bone mets put me at a higher risk of MDS?
Brain mets:
8. When and how often do NETs spread to the brain? Do all types of NETs have the potential to spread to the brain?
9. How are brain mets found and monitored? When should I suspect this?
10. How are brain mets treated? What does having brain mets mean for my life?
*Bonus: What final words of hope do you have for the neuroendocrine cancer community?
For more information, visit LACNETS.org.