Medical oncologist Dr. Alda Aleksi explains the importance of knowing about this lesser-known cancer.
By Fabian Mayer
Photographs by Jared Sych
The neuroendocrine system plays a crucial role in producing and releasing hormones that regulate essential bodily functions, such as breathing, digestion, growth, reproduction and metabolism. Neuroendocrine and endocrine tumours (NETs and ETs) arise from specialized neuroendocrine cells, which are found throughout the body. Therefore, these tumours can develop in various organs rather than being confined to a single location. Dr. Alda Aleksi, a medical oncologist at the Arthur J.E. Child Comprehensive Cancer Centre (Arthur Child) and a clinical assistant professor at the University of Calgary’s Cumming School of Medicine, specializes in NETs and ETs. She’s working to increase awareness and dispel misconceptions about this lesser-known form of cancer. Here, we chat with Dr. Aleksi to learn more.
What are NETs and ETs, and what makes them different from other kinds of cancer?
“NETs and ETs can develop anywhere endocrine cells are present. Given neuroendocrine cells are distributed throughout the body, these tumours can arise in any organ. That is different from all other tumours that you’ve probably heard of. Breast cancer, for example, comes from the breast, lung cancer comes from the lung, etc. NET and ETs are very unique in this respect.”
Where in the body are they typically found?
“By far, the most common site of origin for NETs and ETs are the gut and the pancreas, followed by lung NETs and thyroid tumours. These tumours have another unique capability in that they can secrete unwanted hormones that disrupt the normal functioning of the endocrine system. However, only a minority of NETs do this.”
Are there symptoms people should watch out for?
“Unfortunately, for most of these tumours, the onset is very insidious, so patients might not have any symptoms. Furthermore, because these tumours might not cause any symptoms at all during their initial phases, they are usually diagnosed at a later stage, when patients start feeling sick. There are no screening tests for NETs or ETs, so we are unable to predict who is going to develop one. Most NETs and ETs are sporadic, but a small percentage could be hereditary. Often, these tumours are diagnosed incidentally during routine investigations or through imaging done for other reasons. The imaging technology available today is so sensitive that it can pick up tumours and masses less than 0.5 centimetres in size. Imaging remains our main diagnostic tool in detecting these tumours.”
People may not have heard about this category of tumours before; are they rare?
“I call NETs the ‘forgotten tumour site,’ but these tumours are not rare. They are currently the fastest-growing tumours in Canada and worldwide. Globally, NET incidence has doubled from 4.90 per 100,000 in 2000 to 8.19 per 100,000 in 2018. I have seen more than 100 new cases this past year alone. This is mostly because of technological advancement and increased detection rates. That’s why NETs and ETs deserve public attention.”
What are the latest treatment strategies and are they available in Alberta?
“Treatment will depend on a variety of factors such as the organ of origin, if it can be resected surgically and the aggressiveness of the tumour. For early-stage NETs, the treatment of choice is surgery. For advanced NETs, the initial treatment is typically an injected hormone therapy agent. These agents are the treatment backbone for advanced NETs. Depending on the aggressiveness of the tumour, we employ other systemic treatments such as molecular agents, chemotherapy and recently approved peptide receptor radionuclide therapy (PRRT).
“As of February 2025, Albertans have access to PRRT as standard of care for NETs and a targeted radiotherapy, Lutathera, is now provincially funded. Approval of Lutathera for NETs marks a historic milestone in advancing cancer care in Alberta. We are excited to offer these NET treatments at the Arthur Child.”
Globally, NET incidence has doubled from 4.90 per 100,000 in 2000 to 8.19 per 100,000 in 2018.
What is being done to change misconceptions and advance therapies?
“The Calgary NET Group and I launched the first Provincial NET Awareness Campaign in 2024. This multi-pronged initiative includes: the creation of the Canadian Cancer Theranostic Foundation, the establishment of the first comprehensive NET and ET provincial database, the formation of the first NET Patients’ Advocacy Committee and the organization of the annual NET Fundraising Gala. Public awareness of NETs and ETs remains limited. Therefore, education and outreach are our top priorities.”
