Spoiler Alert (2022) and Neuroendocrine Cancer

Adapted from TV journalist Michael Ausiello's memoir, the film narrates his own life as if it were a sitcom he is recapping. Michael, awkward and guarded, meets photographer Kit Cowan in a Manhattan bar in 2001. Kit is out; Michael is not, and has never had a boyfriend. Over thirteen years they build a life, weather Kit's coming out to his parents Marilyn and Bob, and eventually separate for a period after infidelity and Michael's emotional withdrawal. They are in couples therapy and reconciling when Kit becomes unwell and, in 2014, is diagnosed with a rare stage 4 neuroendocrine cancer. The final act follows treatment, hospital rooms and hospice: Michael becomes the recapper of a story whose ending he already knows and cannot rewrite. Kit's parents move in close, and the couple marry. Kit dies in 2015. The film ends on a deliberately artificial fantasy scene, staged in the sitcom register it has used throughout, before Michael begins again alone.

Spoilers throughout. Discussing the cancer storyline means discussing how this ends.

The film is honest about the specific texture of caregiving: the ward routines, the indignities, the way a partner becomes a clinical secretary tracking scans and drugs. It is unusually good on how a serious diagnosis reorganises a family — Kit's parents and Michael, previously wary of one another, are forced into a single unit. It depicts anticipatory grief accurately, showing that mourning starts long before death. Hospice is presented as care rather than surrender, which is a rare and useful framing. It also refuses to sanctify Kit: he is irritable, frightened and sometimes cruel, and the relationship's earlier damage does not dissolve because he is ill. The decision to marry late, with the illness already advanced, mirrors what many couples actually do. Being adapted from a first-person memoir, its emotional record stays close to the source.

The medical route is compressed and simplified. Kit's symptoms lead to diagnosis quickly on screen, whereas neuroendocrine cancers are notorious for long delays and repeated misdiagnosis. Stage 4 disease and its treatment are conveyed mainly through hair loss and tiredness; the fuller reality of more than a year of chemotherapy and radiotherapy — including the stretches when a person is simply too unwell to be witty — is smoothed over. Several relationship details are also rearranged from the memoir. And the fantasy final scene, while a deliberate device, risks leaving the impression that dying is a scene change rather than a physical process.

Neuroendocrine cancers arise from hormone-producing cells scattered through the body, most often in the gut, pancreas or lungs. They range from slow-growing neuroendocrine tumours to fast, aggressive neuroendocrine carcinomas, which is why the phrase 'rare neuroendocrine cancer' can mean very different things. NCI notes there are often no early signs at all: tumours of the stomach and appendix are frequently found by accident during tests or treatment for something else. When symptoms do occur they depend on site — abdominal pain, unexplained weight loss, tiredness, bloating, diarrhoea, nausea and vomiting for small-intestine tumours; blood in the stool, rectal pain or constipation for rectal ones. If disease spreads to the liver, carcinoid syndrome can develop: flushing, diarrhoea, abdominal discomfort, breathing difficulty and a fast heartbeat. There is no screening test for neuroendocrine cancer for people at average risk, and none is recommended. CDC's list of cancers with recommended screening covers only breast, cervical, colorectal and lung cancer. Most neuroendocrine cancers are therefore found because someone investigated a persistent symptom, or incidentally. Persistent unexplained gut symptoms, weight loss or flushing that do not settle deserve investigation rather than repeated reassurance — that is the practical message this film's story supports.

A film is not a diagnosis, and a dramatised illness is not a guide to your own. What a story like this is genuinely good for is lowering the barrier to a conversation you might otherwise put off.

If something in your body has changed and stayed changed for a few weeks, that is worth raising with a doctor — not because it is likely to be cancer, but because most of the time it will not be, and finding that out is the point. Where screening exists for a cancer, it is the one thing you can do before anything is wrong at all. See screening and possible warning signs.

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Spoiler Alert is worth watching as a film. It is not a guide to the disease it portrays. The gap between the two is what this page is for — and the thing worth carrying away is that a change which persists is worth a conversation, whatever a story led you to expect.

This page describes a work of film or television for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].