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Robotic-Assisted Surgery Performed On Rare Endocrine Tumor

Many of us don’t give much thought to our body’s endocrine system. Yet this vital network of glands affects just about every function of the body, from mood and growth to metabolism and reproductive processes.

Tumors of the endocrine system come in many types, and they can cause an overproduction of hormones, throwing the body’s system out of kilter and causing long-term physiologic problems.

One such endocrine tumor – pheochromocytoma – can be particularly challenging to treat. Because of potential complications associated with pheochromocytoma surgery, expertise in this area is critical, notes W. Bradford Carter, M.D., program leader, Endocrine Tumor Program at Moffitt.

Pheochromocytomas are rare tumors that are usually found in the adrenal glands, the orange-colored endocrine glands located on top of both kidneys. Numerous blood vessels feed into the adrenal glands, which also are near the vena cava, one of the body’s major blood vessels. Additionally, the adrenal glands also are near the spleen and the pancreas, two important organs. Pheochromocytomas often cause the adrenal glands to produce too much of certain hormones that regulate heart rate and blood pressure.

Robotic-Assisted Surgery Is Beneficial For Pheochromocytoma
Most pheochromocytomas are not cancerous, but they do require treatment. Whether malignant or benign, “they can become deadly because they cause a severe elevation in blood pressure, and then when the tumor is removed, the blood pressure can crash,” says Dr. Carter, who performs most of the adrenal surgeries and all of the robotic-assisted adrenal surgeries at Moffitt.

Another potential complication of pheochromocytoma surgery is that the tumor can “seed” if it is damaged. “This can cause tiny recurrences of the tumor in the area where it was dissected,” Dr. Carter says.

Moffitt surgeons have been performing minimally invasive laparoscopic surgery for the removal of endocrine tumors, including pheochromocytomas. In October 2009, thanks to a breakthrough surgical technology, Dr. Carter began using the da Vinci® Surgical System – a minimally invasive alternative to both open surgery and laparoscopy – for removing pheochromocytomas at Moffitt. “An advantage of using robotic-assisted surgery for these kinds of cases is that the surgeon has so much control of the instruments,” he says. “The tumor can be removed with minimal manipulation in order to get control of the blood vessels, and, therefore preventing the patient from experiencing wide blood pressure swings.”

The key benefit of robotic-assisted surgery for pheochromocytoma tumors is that the system allows surgeons to perform the most complex and delicate procedures through very small incisions with unmatched precision.

“The robotic-assisted surgery gives us better visualization (3-D versus 2-D) on the screen and much better instrumental control with what we call 7 degrees of freedom,” says Dr. Carter. “This means we can get better, precise dissection.”

Endocrine Tumors Come In Many Types:
Moffitt’s Endocrine Tumor Program also targets tumors of the thyroid, pituitary, adrenal and parathyroid glands, as well as the gastrointestinal tract and islet cells of the pancreas. Moffitt physicians have designed protocols for each type of endocrine tumor, whether benign or malignant. Surgery is the best option for most patients, depending on the size of the tumor and whether the tumor has invaded sensitive areas.

A Control System of Chemical Messengers:
The human endocrine system is a control system of glands that secrete hormones, chemical messengers from one cell to another, that circulate within the bloodstream to affect cells within specific organs. These hormones are instrumental in regulating mood, growth and development, tissue function, metabolism, sexual function and reproductive processes, as well as sending messages to other cells and acting on them. Although many different hormones circulate in the bloodstream, each one affects only the cells that are genetically programmed to receive and respond to them.

Endocrine glands release more than 20 different hormones directly into the bloodstream, where they can be transported to cells in other parts of the body.

Thyroid Surgery Services To Expand:

While most endocrine tumors are rare, the incidence of endocrine cancers, especially thyroid cancer, is on the rise. The most common endocrine cancer, thyroid cancer, is a disease in which malignant cells are found in the tissue of the thyroid gland. Found at the base of the throat, the thyroid gland produces hormones that control how quickly the body burns energy and determines how sensitive the body should be to other hormones.

Moffitt is planning to expand its surgery services to include robotic-assisted surgery for the removal of thyroid tumors in 2010. The Cancer Center will be one of a few centers offering robotic-assisted surgery for thyroid cancer. “Robotic-assisted thyroid surgery will be performed through a transaxillary approach that will not require any neck incisions,” says Dr. Carter. “One of the advantages of this approach is cosmetic, as the patient will not have any visible scars on the neck,” says Dr. Carter.

Currently four Moffitt programs are performing robotic surgery on patients with prostate and other urologic cancers, uterine and other gynecologic cancers and lung (thoracic) cancers, as well as certain endocrine tumors.

Moffitt Patient/Family Testimonial

      Three years ago, the active lifestyle of 58-year-old Kathleen Wozniak came to a pivoting halt when a string of headaches and exhaustion prohibited her from doing the things she loved. “I was always tired or fatigued, happy then sad,” she said. When her weakness took over her body, life as she knew it stopped, and it also affected the people around her.

      “My husband would tell me I was changing,” she said. “Mentally, I would want to do things, but I was so tired I could not do anything.” Her world was moving faster than she could. “It was frustrating.”

      Wozniak’s sudden health changes concerned her doctor, who administered several exams. When he found a rare 3.11 x 2.66 centimeter tumor resting on her left adrenal gland, she was shocked. It was a diagnosis she hadn’t considered, but she says that in a way, she was relieved. It brought resolution to her unanswered questions.

      Although Wozniak was fearful, she did not let it hold her back. She was referred to an oncologist who shared the news that would change her life – cancer. Her entire world was turned upside down, and all she could think about was her father, who passed away from cancer a few years earlier. But, she stayed positive and looked to the Internet for more information on her diagnosis, pheochromocytoma, an overactive tumor that was producing too much adrenaline.

      Wozniak’s search led her to Moffitt Cancer Center and W. Bradford Carter, M.D., program leader of the Cancer Center’s Endocrine Tumor Program. When she reached out to Dr. Carter, he responded with encouraging words of hope. She knew he could help her win her battle against cancer. 

      She quickly made arrangements at Moffitt. During her evaluation, Dr. Carter discovered something that would change her life yet again – her previous cancer diagnosis was a mistake; her tumor was benign – not cancer! Wozniak slowly felt her life piecing back together. “I thank God I was so lucky.”

      But her time to celebrate was short-lived – the benign tumor was dangerous and could lead to serious health problems if left untreated. Immediately an operation was scheduled remove the tumor – which would reduce her weakness, headaches and changes in hormones. Because Wozniak’s tumor was small, she had the opportunity to undergo a robotic-assisted surgery for the removal of her adrenal gland.

      “My thinking was, ‘O.K., we are going to take out an adrenal gland. How is my body going to react?’” she said. “Dr. Carter was great and made me feel comfortable, and I really had confidence in him.” So, with the help of Dr. Carter’s expertise and the dexterous “fingers” from a robotic machine, Wozniak was on her way to a healthy, active life.

      When her operation day in October 2009 arrived, Wozniak was prepared and ready to win her life back. Through slightly fearful, overall she felt confident. “I am a worrywart,” she said, “but Dr. Carter made me feel at ease and comfortable.”

      Before she knew it, the surgery was over. Her recovery time was short, thanks to the minimally invasive surgery. “Looking back, it was not that bad,” she said. “The worst thing was lying in bed for two days because I love being active.” Her positive thinking kept her spirits high, and every few hours she felt better. “The Lord was with me when they led me to Moffitt,” she said.

      The robotic surgery gave Wozniak a second chance at life. Today, she is back to her active lifestyle and living the life she might not have had. “Even though I have lost a parent to cancer, you don’t really know what it is like until you go through it yourself,” she said. “Now, I try not to let the little things upset me….Those little things in life, I try to let it go.”  

Endocrine System Quiz:

True or False: Most endocrine tumors are malignant.

And The Answer Is… “False.”
Like other cells in the body, cells in the endocrine system can become cancerous. Most endocrine tumors are not cancerous, but they all require an accurate diagnosis to determine what treatment is necessary.

Cancer Answers:

Q&A: Facts About Pheochromocytoma

Question: How is pheochromocytoma diagnosed?

Answer: If pheochromocytoma is suspected, there are some standard tests that are initially performed, including the 24-hour urine and blood tests to measure the levels of catecholamines or their degradation products. Now there is also a biochemical analysis that tests plasma metanephrines. Traditionally there are three major imaging studies to locate a pheochromocytoma: CT scan, MRI and metaiodobenzylguanidine (MIBG) scanning.

Question: What are the symptoms of pheochromocytoma?

Answer: Most patients with pheochromocytoma experience hypertension (blood pressure of 140/90 or higher). Only 15 to 20 percent of patients have normal blood pressure. Many patients experience headache, profuse sweating and palpitations. Other symptoms include anxiety, chest pain, abdominal pain, fatigue, weight loss, vision problems and seizures.

Symptom Checker:

Many noncancerous conditions (as well as some other cancers of the neck area) cause some of the same symptoms. Thyroid nodules are common, and, fortunately, they usually are benign. However, it is essential to pay prompt attention to the following signs and symptoms that could be caused by thyroid cancer so that an early, accurate diagnosis can be made, leading to rapid treatment.

The following local signs or symptoms could be caused by thyroid cancer:

• a nodule, lump, or swelling in the neck, sometimes growing quickly
• a pain in the front of the neck, sometimes going up to the ears
• hoarseness or other changes in voice that do not go away
• trouble swallowing
• breathing problems
• a continuing cough not due to a cold

Source:
American Cancer Society

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ForkWise^™

Ideas For Healthy Living: Fiber Tips
How much fiber do you need every day? Many health experts suggest 30 to 35 grams of dietary fiber each day for the average adult. Five or six servings of high-fiber foods, such as the ones listed below, should provide that much fiber. Here we’ve listed the number of grams of fiber in parenthesis.

• A serving of oat bran or wheat bran cereal (6 to 8 grams)
• A serving of pinto beans, lentils or black beans (6 to 10 grams)
• A medium apple, pear or peach (4 grams)
• A cup of blackberries or raspberries (6 grams)
• Two slices of whole grain bread, such as whole wheat or rye (4 grams)
• A cup of whole wheat macaroni or spaghetti (5 grams)
• One broccoli spear with stalk (5 grams)
• A baked potato with skin (5 grams)

Fiber Tips Source:
From ForkWise: Diet and the Prevention of Cancer ©1998 H. Lee Moffitt Cancer Center and Research Institute, Inc.

The creative soup recipes, below, are both delicious and high in fiber.

Butternut and Ginger Soup:

Ingredients:

1 tsp mild olive oil
1-1/2 cups chopped onion
3 cloves garlic, crushed
2 tsp chopped fresh ginger
1-1/2 lbs (6 cups) peeled raw butternut or other winter squash
½ lb (1 cup) new potatoes, peeled and chopped
1 cup unsweetened apple juice
3 cups water
½ cup skim milk
½ tsp salt

Garnish
½ cup chopped Granny Smith apple
2 Tbsp chopped parsley

Instructions:

Heat the oil in a high-sided skillet or large saucepan on medium high. Sauté the onions 3 minutes or until tender. Add the garlic and ginger and cook 1 minute longer. Add the squash, potatoes, apple juice and water or broth. Bring to a boil. Reduce the heat and simmer 35 to 40 minutes or until very soft. Puree in a blender or processer, in batches, until smooth. Pour back into the pan and stir in the milk and salt. Reheat and serve topped with chopped apple and parsley garnish.

Nutritional Information:

Makes 6 servings. Per serving: 190 calories, 1 g total fat (0 g saturated fat), 45 g carbohydrates, 6 g dietary fiber, 14 g sugar, 5 g protein.

Recipe Source:

www.fruitsandveggiesmatter.gov.

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Chestnut Soup:

Ingredients:

2 tsp. canola oil
2 large shallots, chopped
1 jar, can or plastic pouch (12-14 oz.) unsweetened cooked chestnuts, vacuum-sealed
1 small potato, peeled and chopped
2 cups fat-free, reduced-sodium chicken broth
1 tsp. dried thyme
1 cup reduced fat (2%) milk
Salt and freshly ground white pepper, to taste
1/2 cup chopped pecans, for garnish (optional)

Instructions:

In a large saucepan, heat the canola oil over medium-high heat. Sauté the shallots for about 4 minutes until the shallots are translucent and soft. Add the chestnuts, potato and broth. Add the thyme and cook for about 40 minutes, partially covered, until the potatoes and chestnuts are very soft. Transfer soup to a blender and puree. Return to the saucepan and add the milk. Heat through over medium heat. Season to taste with salt and pepper.
Ladle into in individual bowls and garnish with pecans, if desired. This soup keeps for up to 3 days in the refrigerator. (Once refrigerated, soup becomes very thick. To achieve the consistency of a creamy soup, add equal amounts of milk and water, or broth.)

Nutritional Information:

Makes 4 servings. Per serving: 205 calories, 5 g total fat (1 g saturated fat), 36 g carbohydrate, 6 g protein, 5 g dietary fiber, 419 mg sodium. 

Recipe Source:

American Institute for Cancer Research

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Broccoli Soup:

Ingredients:

3 cups chopped broccoli (or 2 10-ounce packages frozen broccoli)
½ cup diced celery
½ cup chopped onion
1 cup low sodium chicken broth
2 cups nonfat milk
2 Tbsp cornstarch
¼ tsp salt
Dash pepper
Dash ground thyme
¼ cup grated Swiss cheese

Instructions:

Place vegetables and broth in saucepan. Bring to boil, reduce heat, cover, and cook until vegetables are tender (about 8 minutes). Mix milk, cornstarch, salt, pepper, and thyme; add to cooked vegetables. Cook, stirring constantly, until soup is lightly thickened and mixture just begins to boil. Remove from heat. Add cheese and stir until melted.

Nutritional Information:

Makes 4 servings. Per serving: 140 calories, 3 g total fat (2 g saturated fat), 20 g carbohydrate, 5 g dietary fiber, 9 g sugar, 11 g protein.

Recipe Source:

www.fruitsandveggiesmatter.gov

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