Timing of surgery (especially with small disease)

I have pretty strong feelings about the timing of surgery.  I understand that when people hear about having ANY kind of cancer they want to have it removed as soon as possible, but that’s not always the case for neuroendocrine.  In general, neuroendocrine tumors are very slow growing and you’ve probably had the tumors for a while.  In a truly newly diagnosed patient, it’s always best to take a deep breath, understand what’s happening, do ALL the tests necessary for the work-up, and then decide what to do.  Maybe that includes getting a second opinion.  Maybe surgery is the best next step.  But at least you’ll have done the proper evaluation and work-up.  

For those who have had prior surgery, maybe been living with disease for some time, and are re-evaluating the possibility of surgery, then it is absolutely imperative to think about the timing.  Remember, surgery is a big deal with associated risks.  We only like to do it when it can provide the best benefit.  In my opinion, if you’re symptomatic and surgery will help, then go for it to relieve the suffering.  If there are no symptoms, then how can you maximize the benefit with one single operation?  Maybe wait until tumors are even a little larger before surgery?  Maybe decide which ones are growing fastest and need to be removed?  See, it’s not so simple, so I always encourage people to think about it and make sure you’re comfortable with the decision.