Message Number: FHL13780 | New FHL Archives Search

From: Sukie Crandall
Date: 2011-08-08 17:07:07 UTC
Subject: Re: [ferrethealth] Insulinoma...
To: ferrethealth@yahoogroups.com

BTW, there is a very exciting article in the August Sci Am beginning on page 32 of new info indicating that at least some types of tumors follow a different stem cell model than had been thought. It appears that at least for thise types only a handful of the cells in a tumor are the malignancy stem cells, but the rest are a modified mix of altered cells derived from the malignancy stem cells with a finite lifespan. That appears to be how meds like imatinib work, BTW, because such meds can tackle the modified mix which are not daughter malignancy stem cells.

I'll send a second email with part of a 2010 conversation I was having to include some of the refs that may be relevant, but I lack time to find more recent one, or even all of the ones that came up in conversation.

For me this is also POSSIBLY intriguing for insulinoma despite it not usually being a malignancy, because some past work showed that in at least some mammal species Beta Cells are produced in waves (which might explain how insulinomae seed widely in the pancreas often if the actual stem cell modification is to the cells which generate the Beta Cells rather than to the Beta cells themselves.

Yes, both "cancer" and "tumor" are rather nebulous terms.

Note these especially below:

>>
>> Insulinomas are generally not malignant tumors as they only very rarely
>> metastasize. The presence of multiple tumors in the same organ over
>> time is not metastasis. We do not understand the mechanism behind the
>> generation of these tumors, and when we do surgery to remove them, we
>> really are only treating the end point of this process, without address
>> the cause. Thus it is really no surprise that the rate of recurrence
>> is about 40% within 10 months.

and

>> Now this neoplasm may be benign - without the ability for cells to
>> detach into the bloodstream or lymph, move to another tissue, and set up
>> shop - or malignant (where they can do this.) The process of microscopic
>> piece of a tumor moving to another organ is called metastasis.

and

>>
>> cancer: Any MALIGNANT TUMOR; carcinoma; a carcinoma or sarcoma
>>
>> malignant: pertaining to or denoting progressive growth of CERTAIN tumors
>> which if not checked by treatment spread to DISTANT sites, terminating in
>> death; a tendency to progress in virulence, cancer is the best known example

and be sure to see:

http://www.afip.org/consultation/vetpath/ferrets/PDF/neoplasia.pdf

The best explanation I have found comes from exactly the right person in exactly the right specialty, Dr. Bruce Williams, a star ferret pathologist, and has become a Golden Oldie which answers a lot about terminology, definitions, insulinoma, and adrenal neoplasia. Here it is included as part of another post with further info BUT know that it pre-dated ready availability of Suprelorin:

> The mistake of calling any adrenal growths or any pancreatic growths "cancer" is a common one.
>
> In the following you also will learn why and learn what the terms mean as well as learning tidbit like most adrenal growths being benign neoplasia which still need care:
> http://www.afip.org/consultation/vetpath/ferrets/PDF/neoplasia.pdf
>
> Note that sometimes -- rarely for the pancreas -- carcinoma or lymphoma can occur in adrenals or in the pancreas. Those are malignancies although carcinomas of the adrenal often do not spread. In the pancreas carcinoma is usually more aggressive than lymphoma. In the adrenals lymphoma is usually more aggressive than carcinoma.
>
> In here you will learn why adrenal disease needs treatment. This post preceded some current forms of treatment. These days a person can suit the treatment choice to the needs of the individual ferret so surgery, surgery with preventive approaches following, Lupron DEPOT AND Ferretonin IMPLANT, or Suprelorin IMPLANT AND Ferretonin IMPLANT for the three most effective choices:
> http://ferrethealth.org/archive/SG5054 (not treating adrenal disease)
>> Actually tonight I am working on a promised article to Ferrets Mag about adrenal disease. But I think that Melissa and Sukie have covered the dire possibilities very well (and they are very real.)
>>
>> However, even under the best conditions, when there is no malignancy, there is no bone marrow toxicosis, there is no prostatic cystic disease - even the most mild prediction is a sad one. Ferrets with adrenal disease have a diminished quality of life - they have progressive muscle loss, low grade anemia, they tend to redistribute weight to the abdomen, further making it difficult to walk, they have an increased incidence of gastric ulcers as a result of the stress of chronic illness, decreased bone density - none life-threatening, but all life-compromising. Even medical treatment, which is not my preferred way of treating adrenal disease, gives slight releif to symptoms. Doing nothing is not kind and not in a ferret's best interest.
>>
>> With kindest regards,
>>
>> Bruce Williams, DVM
>
> Here is the IMPORTANT Golden Oldie for all to keep and use as a learning tool:
>
> Subject: FHL golden oldies: insulinoma and adrenal disease usually NOT
> "cancers"
>
> Sukie notes: Insulinoma and adrenal disease usually are NOT "cancers":
> most adrenal growths are benign neoplasia and some others tend to not
> spread; insulinomae tend to not spread. There is yet more on that
> aspect and on why blood tests do not diagnose lymphoma/lymphosarcoma at
> http://www.afip.org/ferrets/Clin_Path/ClinPath.html and elsewhere.
>
> There are multiple pieces of info on the misuse of the term "cancer";
> here's one which combines the marvelous post of a veterinary pathologist
> who is a ferret expert (Dr. Bruce Williams) and some dictionary definitions
> from veterinary/medical dictionaries.
>
> FHL message 6510 (There ARE others with more info):
>
> Dr. Bruce Williams wrote:
>> The thread on this is pretty good, and both Sukie and Stephanie have
>> very valid points. The terminology of neoplasms can be confusing,
>> and I'm sure even vets can be confused from time to time.
>>
>> The proper term for what you are talking about is neoplasm (or
>> literally "new growth). For one reason or another, a clone of cells
>> begins to grow uninhibited by normal substances or mechanisms. The
>> word "tumor" may be technically correct, but it is actually non-
>> specific - tumor is Latin for a swelling, but it could also be an
>> abscess, or anything else that causes swelling - so I try to stay
>> away from it.
>>
>> Now this neoplasm may be benign - without the ability for cells to
>> detach into the bloodstream or lymph, move to another tissue, and set up
>> shop - or malignant (where they can do this.) The process of microscopic
>> piece of a tumor moving to another organ is called metastasis.
>>
>> Metastasis is the hallmark of malignancy. The worst tumors have the
>> propensity to go anywhere and start growing (like lymphoma). However,
>> we can recognize malignant tumors even before they metastasize, often by
>> characteristic features seen under the microscope.
>>
>> Adrenal carcinomas (malignant adrenal tumors) are interesting neoplasms.
>> Although they possess the ability to metastasize, only a small number
>> do, and usually only late in the course of disease. It is likely that
>> they do metastasize a lot, but have trouble gaining a foothold in
>> distant tissues, so it takes a long time and many attempts if they ever
>> truly metastasize.
>>
>> Insulinomas are generally not malignant tumors as they only very rarely
>> metastasize. The presence of multiple tumors in the same organ over
>> time is not metastasis. We do not understand the mechanism behind the
>> generation of these tumors, and when we do surgery to remove them, we
>> really are only treating the end point of this process, without address
>> the cause. Thus it is really no surprise that the rate of recurrence
>> is about 40% within 10 months.
>>
>> With kindest regards,
>> Bruce Williams, DVM
>
> AND:
>> Treat this as an supporting document to Bruce William's excellent post
>> above taken from FHL digest 348. I especially liked his providing the
>> direct translation of "tumor" as "swelling", and his explanation that
>> not all growths which can metastasize do so readily.
>>
>> These definitions are combined ones from medical, veterinary, and biology
>> dictionaries, but emphases are mine and i am willing to be corrected if I
>> blew it...
> ( In years and of running these past vets none have suggested changes.)
>>
>> Important Note: some more recent dictionaries don't even include the term
>> cancer, and I have heard vets who won't use it due to the widespread
>> confusion out there, and even some vets who won't use "tumor' due to
>> too many assuming that any tumor is malignant.
>>
>> Tumor: ANY abnormal mass resulting from the excessive multiplication
>> of cells; a swelling, especially that resulting from the growth of new
>> tissue; a neoplasm
>>
>> cancer: Any MALIGNANT TUMOR; carcinoma; a carcinoma or sarcoma
>>
>> malignant: pertaining to or denoting progressive growth of CERTAIN tumors
>> which if not checked by treatment spread to DISTANT sites, terminating in
>> death; a tendency to progress in virulence, cancer is the best known example
>>
>> benign: not malignant, as in CERTAIN TUMORS; not recurrent, favorable for
>> recovery
>>
>> neoplasm: a tumor; ANY new growth, specifically one in which cell
>> multiplication is uncontrolled and progressive, neoplasms may be benign
>> or malignant
>>
>> (Subsets from Saunders:
>>
>> neoplasm, benign: a neoplasm having none of the characteristics of a
>> malignant neoplasm (see below), i.e.it grows SLOWLY, expands WITHOUT
>> METASTASIS, and USUALLY does not reoccur [See the notes of Dr. Bruce
>> Williams above in relation to why LOCAL reoccurance is NOT metastasis.]
>>
>> neoplasm, malignant: a neoplasm with the characteristics of anaplasia,
>> invasiveness and metastasis
>>
>> There are several other subsets of neoplasia in this dictionary.
>>
>> metastasis: the transfer or disease from one organ or part to another
>> NOT DIRECTLY CONNECTED WITH IT
>>
>> anaplasia: loss of differentiation of cells
>>
>> Those who have the _Saunder's Comprehensive Veterinary Dictionary_ will
>> find that this resource often provides details beyond these bare-bones
>> descriptions, (though certainly there also will be nuances in practise
>> that those of us who are not medical professionals simply won't
>> understand). It is a marvelous resource; I love it. If I had a rating
>> for refs around here it would be among the best buys. It's better than
>> any of my other medical dictionaries, even for sorting through things too
>> technical for me in the _PDR_ books on herbs and on supplements that i
>> have at home. Marvelous book: clearly written and very inclusive; more
>> than worth what it cost.
>> [Posted in FML issue 4392]
> -------
> http://listserv.cuny.edu/Scripts/wa.exe?A2=ind0309&L=FERRET-
> SEARCH&P=R8359&I=-3
>
> ---
> If both adrenals come out partially Prednisolone may still be needed afterward for fluid maintenance. If both adrenals come our fully or if only the tiniest amount remains then besides the Prednisolone survival (avoiding an Addisons Crisis) will also necessitate EITHER Percorten injections about every 21 days or daily Fludrocort/Florinef to maintain correct electrolyte balance.



On Aug 8, 2011, at 5:34 AM, Tressie wrote:

> 'Cancer' has come to have many meanings in the vernacular and is a catch-all term that can create confusion. One will find it used to mean just about any abnormal growth. I spent a year in graduate school studying and researching what the term 'cancer' means within the culture.
>
> So you are both correct in that, whatever meaning you have given to the term 'cancer'- it holds true for you.
>
> In the field of oncology the various diseases we come to think of as a cancer are referred to specifically by the type of 'cancer' it is.
>
> Technically insulinoma is the tumor/s that results from the uncontrolled
> growth of the insulin-secreting cells of the endocrine pancreas.
>
> Vets will often refer to removing insulinomas from the pancreas. Therefore, stating that a ferret has an insulinoma or has insulinomas would be semantically more accurate. However, we use the term to refer to the cluster of symptoms and the disease process that results from an insulinoma, and that is now what the term has come to mean within the ferret community.
>
> Tressie

Sukie (not a vet)

Recommended ferret health links:
http://pets.groups.yahoo.com/group/ferrethealth/
http://ferrethealth.org/archive/
http://www.afip.org/ferrets/index.html
http://www.miamiferret.org/
http://www.ferrethealth.msu.edu/
http://www.ferretcongress.org/
http://www.trifl.org/index.shtml
http://homepage.mac.com/sukie/sukiesferretlinks.html
all ferret topics:
http://listserv.ferretmailinglist.org/archives/ferret-search.html

"All hail the procrastinators for they shall rule the world tomorrow."
(2010, Steve Crandall)










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