Endocrine Cancer Program

INCIDENCE AND PREVALENCE

Thyroid cancer is the most common of the endocrine cancers, affecting an estimated 13,090 men and 40,900 women in the United States annually.1 This incidence is also rapidly rising.

There are fewer than 100 cases per year of parathyroid cancer in the United States.2

An estimated 200-500 individuals in the U.S. are diagnosed with adrenal cortical cancer annually.2 This qualifies as a rare tumor requiring expert management.

While approximately 13,000 individuals in the U.S. require surgery for pituitary tumors each year, fewer than 1% are malignant.2

Neuroendocrine tumors are also considered rare, affecting approximately 12,000 individuals in the U.S. every year. Like other rare cancers, they are best managed by an experienced, multidisciplinary team.2

PROGRAM OVERVIEW

Endocrine cancers are a complex related set of diseases that warrant subspecialized care to achieve the best outcomes. Hoag Family Cancer Institute’s multidisciplinary team of endocrine cancer experts developed a subspecialized, programmatic approach to the treatment of thyroid and parathyroid cancers, adrenal cancers, pituitary tumors, neuroendocrine cancer and carcinoid tumors that offers patients the latest imaging technologies, surgical techniques, genetic evaluations, therapeutic regimens, and investigational trials evaluating novel treatments.

The Endocrine Cancer team is comprised of specialists in endocrine, pancreatic, hepatobiliary, and pituitary surgery, medical oncology, radiation oncology, endocrinology, radiology, nuclear medicine, advanced endoscopy, and medical genetics.

Robert Selby, M.D., program director of Hoag’s Pancreas & Hepatobiliary Program takes an active role in the surgical management of patients with neuroendocrine tumors, pancreatic neuroendocrine tumors, and gastrointestinal carcinoid tumors.

Robert Louis, M.D., a fellowship-trained neurosurgeon specializing in minimally invasive pituitary surgery, is the director of Hoag’s Skull Base and Pituitary Tumor Program.

Michael Demeure, M.D., M.B.A., F.A.C.S., F.A.C.E., a fellowship-trained endocrine surgeon and internationally recognized expert in cancer surgery and research, focuses on programmatic development and the treatment of patients with tumors of the thyroid, parathyroids, adrenal glands as well as pancreatic neuroendocrine cancers and carcinoid tumors.

DIAGNOSTICS

Hoag offers the full spectrum of advanced imaging capabilities for endocrine tumors.

In collaboration with Hoag’s Radiology and Nuclear Medicine specialists, the team recently implemented several new imaging protocols that adds to Hoag’s range of imaging options for parathyroid tumors. Fusing the nuclear parathyroid imaging scan to a CT scan image provides significantly improved anatomic detail and better localization of parathyroid tumors prior to surgery over the previously used planar imaging. The program also offers a parathyroid imaging protocol that uses 4D CT scans, which is beneficial for tumors that are difficult to locate.

Thyroid cancers are now evaluated using a new radioiodine imaging protocol with SPECT-CT (single photon emission computed tomography). This powerful diagnostic imaging tool for thyroid cancer provides more precise assessment of tumors.

Patients with neuroendocrine cancers seen at Hoag now have the advantage of Gallium-68 Dotatate PET/ MR scanning, available at only few select institutions, and Gallium-68 Dotatate PET/CT scanning, both of which provide enhanced images for the detection and staging of neuroendocrine tumors over octreotide scans.

PET/MR post Yttrium 90 radioembolization to evaluate precise targeted treatment
Gallium-68 Dotatate PET-CT imaging of patient with neuroendocrine
tumor of the pancreas with multiple liver metastases.

Gallium-68 Dotatate scanning was approved by the FDA in 2016 and implemented at Hoag shortly thereafter.

In addition, Hoag’s interventional gastroenterologists are highly trained and skilled in the use of endoscopic ultrasound (EUS) for the diagnosis and staging of neuroendocrine tumors.

TREATMENT

Tumor Boards

Thyroid/Endocrine Case Conference

The multidisciplinary thyroid case conference initiated and led by Sandra Kwak, M.D., is attended by endocrinologists, surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, nuclear medicine specialists, certified genetic counselors, and the thyroid cancer nurse navigator. The Thyroid Case Conference meets the first Tuesday of every month at 7:30 a.m. at the Patty & George Hoag Cancer Center Newport Beach and via videoconferencing at Hoag Cancer Center Irvine.

To submit a case for the Thyroid/Endocrine Case Conference, contact Thyroid Nurse Navigator, Rhonda Hjelm, M.S.N., R.N., O.C.N., at 949-764-1945 or [email protected] or Rosana Figueroa at 949-764-7044 or [email protected]

Neuro-Oncology Tumor Board

Pituitary tumor cases are discussed at the Neuro-Oncology Tumor Board, which meets every Friday at 11:30 a.m. at the Patty & George Hoag Cancer Center Newport Beach and via videoconferencing at Hoag Cancer Center Irvine. It is moderated by Christopher Duma, M.D.

To submit a pituitary case for the Neuro-Oncology Tumor Board, contact Brain, Skull Base & Pituitary Tumor Nurse Navigator, Lori Berberet, R.N., M.S., at 949-764-6656 or [email protected] or Rosana Figueroa at 949-764-7044 or [email protected]

GI Tumor Board

Neuroendocrine tumors of the pancreas and carcinoid tumors are discussed at the GI Tumor Board, which is held on the 2ND and 4TH Monday of every month at 12:30 p.m. at the Patty & George Hoag Cancer Center Newport Beach and via videoconferencing at Hoag Cancer Center Irvine. It is moderated by John Lipham, M.D., James & Pamela Muzzy Endowed Chair in GI Cancer.

To submit a case for the GI Tumor Board, please contact Nurse Navigator, Shelley Morrison, A.C.N.P., at 949-764-5316 or [email protected], or GI Cancer Nurse Navigator, Diane Eadie, R.N., at 949-764-8267 or [email protected]

Thyroid and Parathyroid Cancer Treatment

Experienced thyroid surgeons at Hoag are experts in advanced surgical techniques. They recently began performing transoral thyroidectomies, a new minimally invasive technique, well-suited to early stage papillary thyroid cancer and small nodules that spares the patient a scar on his or her neck by making the incisions on the inside of the lower lip. Surgeons at Hoag were the first in Southern California to perform this procedure.

Thyroid cancer patients at Hoag also have the advantage of new treatment protocols through clinical trials. Hoag Family Cancer Institute can open innovative thyroid cancer trials before they are widely available through participation in the International Thyroid Oncology Group (ITOG), a group of leading thyroid physicians and scientists who design, coordinate, and prioritize state-of-the-art clinical trials and correlative science. In fact, Hoag is currently the only non-academic medical center in ITOG, and the only hospital in California participating in a phase II ITOG study testing the efficacy of iodine I-131 in combination with the MEK inhibitor, selumetinib, for patients with recurrent or metastatic thyroid cancer.

Adrenal Cancer

Adrenal cortical carcinoma (ACC) is extremely rare. With the addition of Dr. Demeure, Orange County patients now have access to a fellowship-trained endocrine surgeon who has particular expertise in these rare tumors. He has had a long-standing clinical interest and research effort directed at identifying new treatments for ACC based on the study of tumor genomics.

Hoag recently became a member of the A5 Alliance, an international consortium that facilitates adrenal cancer research and collaboration. Our team is focused on bringing the right clinical trials to Hoag Family Cancer Institute that may expand treatment options for patients with this rare cancer.

Neuroendocrine Tumors and Carcinoid Tumors

Though neuroendocrine tumors are rare, their incidence is on the rise and is predicted to increase at a faster rate than most other malignancies. Effectively treating neuroendocrine tumors requires multidisciplinary, sub-specialized care.

Advances in precision treatments for endocrine cancers are expanding treatment options for some patients with neuroendocrine and pancreatic neuroendocrine tumors and Hoag’s physicians are on the forefront of the clinical adoption of these new therapies. In January 2018, the FDA approved Lutathera (lutetium Lu 177 dotatate) for the treatment of gastroenteropancreatic neuroendocrine tumors. Under the direction of Dr. Giuliano and Dr. Demeure, Hoag became the first hospital in Southern California to treat patients with Lutathera under the new FDA approval and offers this therapy to patients with metastatic carcinoid and pancreatic neuroendocrine tumors.

An ongoing focus of the program is opening additional clinical trials that will further expand treatment options for patients with carcinoid and pancreatic neuroendocrine tumors.

Yttrium 90 radioembolization, often an effective treatment modality for patients with carcinoid tumors, delivers radioactive Y90 via resin microspheres to the blood vessels feeding the tumor. The outpatient procedure is a two-step process that begins with arterial mapping. A post-treatment scan utilizing Hoag’s PET/MR significantly enhances the interventional radiologists’ ability to see the distribution of the Y90, providing the clearest picture possible to immediately determine if the dose was distributed accurately or if additional treatment is needed.

Pituitary Carcinoma

Very rarely are pituitary tumors malignant. When a patient presents with a pituitary carcinoma at Hoag, they benefit from a team of subspecialists and the most advanced technology for surgical resection. The program combines the latest advanced and emerging technology with minimally invasive techniques to offer the best possible outcomes to patients with these rare and complex tumors.

The Surgical Navigation Advanced Platform (SNAP) by Surgical Theater allows for Virtual Reality 360-degree reconstruction, planning, rehearsal and navigation for complex neurosurgical procedures. By performing a Virtual Reality “fly-through” on each case, Hoag’s neurosurgeons can practice an operation in 3-D prior to surgery. The tool optimizes minimally invasive approaches with smaller incisions, fewer complications, and better overall outcomes.

CLINICAL RESEARCH

Access to innovations in care including clinical trials is a priority of the Endocrine Cancer Program. The portfolio of clinical trials for these patients is growing through Hoag Family Cancer Institute’s Developmental Therapeutics Program, in alliance with USC Norris Comprehensive Cancer Center as well as Hoag’s participation in consortiums like ITOG and A5 Alliance. For a list of trials currently open, please contact Leila Andres, M.S., at 888-862-5318.

SCREENING AND HIGH RISK SERVICES

While the cause of most endocrine tumors is unknown, certain germline mutations and familial syndromes such as multiple endocrine neoplasia (MEN) Types 1 and 2, Cowden Syndrome, and other inherited conditions are associated with an increased risk of endocrine and neuroendocrine tumors.

Hoag’s Hereditary Cancer Program offers risk assessment counseling and genetic testing to individuals with a personal or family history of cancer.

SUPPORT AND EDUCATION

Hoag Family Cancer Institute offers a range of integrated cancer support services that benefit patients with endocrine cancer including nutrition support, educational classes and interactive workshops, one-on-one counseling with an oncology social worker, specialized exercise and fitness classes, and rehabilitation services including speech and language pathology.

Hoag Family Cancer Institute’s nurse navigators are a unique resource, providing guidance and navigation through complex treatment plans and the healthcare system, emotional support, and education to patients and their families.

1 Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, https://seer.cancer.gov/statfacts/html/thyro.html
2 Cancer.net, The American Society of Clinical Oncology (ASCO)2 Cancer.net, The American Society of Clinical Oncology (ASCO)

For more information call: 949-722-6237