The endocrine neoplasia multidisciplinary disease group includes endocrine surgeons, endocrinologists, head and neck (ENT) surgeons, medical oncologists, radiation oncologists, a dedicated endocrine diagnostic radiology and pathology group, specialized advanced practice providers, nurses, social workers, nutritionists, genetic counselors, and others.
Visit DukeHealth.org for more information about endocrine cancer.
Our team offers personalized therapies based on biopsies and molecular testing, which means that treatments are tailored to the specific type of cancer.
Our surgeons have performed thousands of neck and abdominal endocrine-specific surgical procedures, ranging from minimally invasive to complex. Novel surgical techniques are employed, including minimally parathyroid and thyroid surgery and minimally invasive laparoscopic and robotic adrenal surgery. Endocrinologists are sub-specialized, focusing their entire clinical practice on treating all forms of endocrine neoplasia disease and working alongside surgeons to ensure optimal treatment pre-operatively, during surgery, and post-operatively.
Goals include lower complication rates, shorter hospital stays, lower overall costs, less likelihood of cancer recurrence, and fewer repeat operations as compared to nationally published data.
Challenging cases are discussed in a multidisciplinary fashion at a weekly tumor board attended by experts from surgery, endocrinology, pathology, radiology, and oncology.
Patient support services assist patients in maintaining quality of life throughout treatment and recovery. Adult and pediatric patients are seen at Duke Cancer Centers in Durham and Raleigh.
As a National Cancer Institute-designated Comprehensive Cancer Center, the endocrine neoplasia group is recognized for exploring new treatment opportunities. They work with the American Thyroid Association, the American Association of Endocrine Surgeons, and the National Comprehensive Center Network to help set the national standards for best practice treatment guidelines. Duke was also one of the first institutions to work with the Collaborative Endocrine Surgery Quality Improvement Program to improve quality in endocrine surgery.
The endocrine cancer disease group specializes in:
Our research encompasses the different diseases of the thyroid, parathyroid, pancreas, and adrenal glands.
Our Focus
Health Services Research
Patient-Reported Outcomes
Translational Research: The endocrine neoplasia group has an encompassing interest in cross-disciplinary translational research, including parathyroid thyroid disease.
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Breast surgical oncologist and Mary and Deryl Hart Distinguished Professor of Surgery Eun-Sil Shelley Hwang, MD, MHS, with Oluwadamilola "Lola" Fayanju, MD, MA, MPHS, FACS, in early 2020.
Dr. Hwang was Chief of Breast Surgery at Duke at that time and Dr. Fayanju was an assistant professor of Surgery, Division of Surgical Oncology. Dr. Fayanju is currently Chief of the Breast Surgery Division at Penn Medicine.
On Thursday, April 14, 2022, Duke Cancer Institute clinical providers, researchers, staff, and leadership came together to celebrate the 50th anniversary of the Duke Comprehensive Cancer Center (now called Duke Cancer Institute).As the DCI 50th kickoff celebration was gearing up on the grassy circle in front of Duke Cancer Center building in Durham, a few patients stopped by the adjacent Seese-Thornton Garden of Tranquility for some respite.A breast cancer patient of Susan Dent, MD, braced for a long day of chemotherapy infusions. A man with stage 3 melanoma, being treated by Brent Hanks, MD, chatted in the shade of a tree with his wife ahead of his next appointment. A woman on her way to the Duke South clinics, meanwhile, shared her worries over her brother’s recent esophageal cancer diagnosis, their strong family history of cancer, and the importance of keeping up with her mammograms.Joe Moore, MD — who hung up his DCI lab coat in 2019 after a 44-year Hematology /Oncology career — was admiring the newly-installed Sound of Hope bell (a gift of the J. Gordon Wright family in honor of Nancy Wright, a pancreatic cancer survivor) before Jana Wagenseller, RN, escorted him across the grass to a front-row seat, stage right. (Moore had begun his medical career at Duke in 1975 as a fellow and Wagenseller had begun her nursing career at Duke in 1976 and served in multiple leadership roles before retiring in 2004).The Duke University Marching Band made a jubilant entrance onto the green and briefly performed in front of a big-screen slideshow showcasing moments in DCI history before the official program began.
Duke Cancer Institute Blog
Terence Wong, MD, PhD, right, meets with a patient before his PSMA PET/CT scan. Duke is a leader in this type of imaging, which is used in combination with a radiotracer to identify if there's a druggable molecular target. (A version of this photo originally appeared in a Duke Health article in February 2022: "PSMA PET/CT Scan Improves Prostate Cancer Detection and Treatment")
The Society of Nuclear Medicine & Molecular Imaging has designated the Division of Nuclear Medicine and Radiotheranostics at Duke Health as a Comprehensive Radiopharmaceutical Therapy Center of Excellence. A national leader in radiopharmaceutical therapy (RPT), the Division is currently one of only 14 Centers in the U.S. to receive this recognition.
In addition to having technical expertise and appropriate treatment facilities, Centers must meet rigorous training, regulatory, and performance criteria, and are required to provide education and scientific contributions to this growing field. They must administer more than 40 RPT treatments per year in at least two of these disease-specific therapy areas — thyroid, neuro-endocrine tumor, and prostate.
“Duke has a long history of research and clinical experience with radiopharmaceutical therapies; dating back to the late 1990s when radio-labeled antibodies were developed at Duke by Darell Bigner (Preston Robert Tisch Brain Tumor Center) and Michael R. Zalutsky (Department of Radiology) to treat malignant brain tumors,” notes Duke Cancer Institute nuclear radiologist Terence Z. Wong, MD, PhD, FACR, chief of the Division of Nuclear Medicine and Radiotheranostics, a clinical division of Duke Radiology. “The designation as a Comprehensive Radiopharmaceutical Therapy Center of Excellence reflects the culmination of many years of teamwork.”
The Division has utilized radioiodine to treat thyroid diseases (including cancer) for decades and has been one of the leaders in the field using 131I-MIBG (a drug containing a form of radioactive iodine, also called AzedraTM and iobenguane I 131) to treat pheochromocytomas (cancer of the adrenal gland) and carcinoid tumors (a type of neuroendocrine tumor). Duke has been a national leader in treating patients with neuroendocrine tumors using LutatheraTM (177Lu-DOTATATE) since 2018, when it was approved by the FDA. More recently, Duke was one of the first cancer centers to offer PluvictoTM (177Lu-PSMA) to treat metastatic prostate cancer following its FDA approval in March 2022, and is currently the leading site in the U.S. for treating prostate cancer patients with this new radiopharmaceutical therapy.
“Large clinical trials have shown that the radiotheranostic approach can provide clinical benefit for patients with neuroendocrine tumors and prostate cancer, even in patients with advanced disease that is refractory (unresponsive) to other treatments,” explains Wong, who has a secondary faculty appointment as a professor in the Duke Department of Medicine, Division of Medical Oncology. “As a National Cancer Institute-Designated Comprehensive Cancer Center, Duke Cancer Institute is well-equipped to provide these novel treatments.”
“Radiotheranostics” is the concept of using a molecular probe directed at cancer cells to both identify and treat that cancer. Azedra, Lutathera, and Pluvicto are all delivered this way.
First the molecular probe is labeled with a small amount of radioactivity called a radiotracer, which allows the potential treatment sites to be identified by imaging. Duke has been a leader in this type of imaging; 68Ga-DOTATATE PET/CT for neuroendocrine tumors and PSMA PET/CT in prostate cancer.
If the imaging shows that the tumor cells have a druggable molecular target, the area can then be treated with the targeted radiopharmaceutical therapy using the same or similar molecular probe — delivering a high radiation dose to the specific tumor sites while sparing adjacent normal tissue.
Radiotheranostics has progressed rapidly over the last decade and is moving quickly into the mainstream of cancer therapeutics. It was this “recognition of the present and future potential of radiolabeled targeted therapy,” notes Wong, that led to the Division of Nuclear Medicine being renamed the Division of Nuclear Medicine and Radiotheranostics in 2020.
On February 2016, Tara Wilkes left her job as a decorator and furniture sales associate, locked the door of she and her husband's second home on Lake Waccamaw and moved back inland to the family home in Rockingham, North Carolina, for good.
The then-54-year-old was tired all the time. She could no longer wear her rings because her fingers were always swollen and one of her shoulders hurt. She attributed this to walking a 40,000-square-foot showroom, daily, and she figured she’d pulled her rotater cuff carrying heavy fabrics up and down the stairs of her clients’ coastal homes. But her local physician couldn't find anything wrong with her shoulder.
Not long after, while out shopping in Pinehurst, NC, and her shoulder still ailing, she turned jaundiced — her pale skin was suddenly noticeably yellow. She went straight to the ED. An astute doctor had connected her shoulder pain to a possible gallbladder problem and ordered an endoscopy — a nonsurgical procedure used to examine the digestive tract. Her gallbladder as it turned out, was indeed damaged. It was due to the pancreatic tumor nearby pressing against it.
Tara was referred to Duke surgeon Sabino Zani Jr., MD, and Duke Cancer Institute oncologist Niharika Mettu, MD, PhD. She underwent five-and-a-half weeks of radiation and chemotherapy (in pill form), and in June that year underwent Whipple surgery (a pancreaticoduodenectomy) — a complex procedure during which the head of the pancreas is removed along with a portion of the bile duct, gallbladder, and the first portion of the small intestine. After 13 once-a-week IV chemotherapy treatments after surgery, Tara was told, just in time for Christmas 2016, that there was no evidence of disease.
“One of the things that Dr. Mettu said to me, when I was cleared, was that it was time to start living my life again,” recalled Tara. The young grandmother, who turned 55 that October, went out and did that.
She spent the next year, 2017, doing what she loved, including going to the beach, taking walks, playing with her grandchildren, visiting elderly shut-ins, restoring furniture, and painting. She painted a giant sunflower onto a barn door on her property, and hand-painted pillows and oven mitts as Christmas gifts for family and friends that have taken care of her and prayed with her through her cancer “ordeal.” She and her devoted husband and designated caregiver Neal hosted a Christmas party at their house that year.
Cured
That was the abridged version of Tara Wilkes' cancer story (written for the Duke Cancer Institute blog in January 2018), the genesis of which was a message from Neal Wilkes.
“Tara would love to talk and has a story to share,” wrote Neal in an email. “Tara has a deep faith in God, many prayers, and a great team of doctors. God led us to Duke and this was and is the key to her success.”
Following the publication of that article, the couple sent this message: “Hopefully this will inspire others with this dreadful cancer.”
Dr. Mettu couldn't give a prognosis for Wilkes (Tara) at the time, except to say that she and the other patient featured in that same article (Dolly Dunnagan) "had done well, perhaps better than average.”
“I am always inspired by the optimism of my patients with pancreatic cancer; so many of my patients find the ability to make the best of this situation and are very much invested in helping to further our treatments for this disease by participating in research that will move the needle forward in pancreatic cancer,” she said.
In October 2021, Dr. Mettu reached out to share some good news: “You had previously written about Ms. Tara Wilkes in 2018. She is now five years out from completing her therapy for pancreatic cancer and is disease-free, and what we would consider cured.”
The only drug Tara had regularly taken over the past five years was Vitamin D and Calcium.
On December 6, 2021, four years since we'd last corresponded via email and phone, Tara, her husband Neal, and I (the author of the article) reunited over Zoom — to celebrate the milestone of reaching that magic number 5, and to spread the word about pancreatic cancer for a new article.
They caught me up on the last few years.
“We've been camping and we spend time with the grandchildren. And, of course, we do a lot in the yard and things like that,” said Tara, who turned 60 in October.
The couple’s four grandchildren, all of whom live in state, are of course growing fast and there’s a fifth on the way, they shared.
Tara and Neal still live on the same lake in Rockingham. They mentioned that they now have a pontoon boat that they take out often. And that they also bought a little pop-up camper — Tara handled the remodeling and interior decorating. Together they’ve traveled and camped in their favorite spots, like Travelers Rest at the foothills of the Blue Ridge Mountains in South Carolina, Bodie Island in the Outer Banks of North Carolina, and scenic overlooks in the Georgia mountains.
Duke Cancer Institute Blog
Sharlene Mitchell, pancreatic cancer survivor. (photo by Duke Health)