Category Archives: Pancreatic Cancer

Strike Deadly Pancreatic Cancer: Healing Pillars from Bottleneck to Potentials

By Hui Xie-Zukauskas

Pillars for P. Cancer Therapy_Cancer Prevention DailyCancer. The word itself can send shivers down your spine. How about pancreatic cancer? Consider these three facts:

  • A grim reality: Pancreatic cancer is a rare and deadly cancer. Estimated 66,440 people in the US will be diagnosed with and approximately 51,750 Americans will die of pancreatic cancer in 2024 (per American Cancer Society). Data also predicts the disease to become the second leading cause of cancer deaths by 2030.
  • A growing concern: Pancreatic cancer diagnoses in young adults (under 45) are on the rise. As the incidence increases, it’s becoming a public health problem too.
  • A glimmer of hope: Yes, let’s explore it as evolving breakthroughs combat this terrible disease!

First, let me briefly emphasize what makes pancreatic cancer extremely fatal. It is because of its key characteristics such as:

  • Asymptomatic nature in early stages (if any signs, vague or nonspecific)
  • No routine screening test available
  • Invasive early and rapid spread
  • Limited effective treatments
  • Therapy-resistant, with high rate of recurrence
  • Poor prognosis, with a 5-year survival rate about 10% or low long-term survival.

For the focus here, the most common type of pancreatic cancer (85% overwhelmingly) is pancreatic ductal adenocarcinoma (PDAC); its nature remains aggressive and multifaceted.

However, the mainstays for pancreatic cancer treatment are surgery, chemotherapy, and radiation therapy, which appear to reach a “bottleneck” status with unsatisfactory clinical results. Also sadly, most cancers have already metastasized at the time of diagnosis.

Despite its complexity, genetic research and scientists’ unwavering effort have propelled discoveries!

A hallmark of pancreatic cancer is KRAS mutation. KRAS is a tumor-promoting gene, and mutated in ~95% of pancreatic cancer patients. Studies indicate that KRAS mutation likely initiates human pancreatic cancer, and drives tumor growth and progression. Even so, targeting KRAS through pharmacological interventions—especially with single agent inhibitors in the past—has confronted an “undruggable” challenge.

Yet, researchers are unlocking new opportunities in various paths, with transformed treatments encompassing but not limited to:

  • Targeted therapy: Innovative therapies—such as the use of siRNAs (small interfering RNA) through nano-delivery, anticancer vaccine, and immune T-cell therapy—are driven against KRAS mutation. Additionally, a subgroup of pancreatic patients harboring BRCA1/2 mutation can benefit from platinum-based chemotherapy and Olaparib (a PARP inhibitor). Next-generation sequencing technology will facilitate genomic mapping of cancer cells to identify more treatment targets.
  • Immunotherapy: In the past, most pancreatic cancer didn’t respond to immunotherapy, likely attributed to its immuno-suppressive tumor microenvironment that facilitates tumor escape from immunosurveillance. Now, studies and clinical trials are ongoing to alter tumor microenvironment, and make tumors active immunologically or cytotoxic T-cells respond.  
  • Liquid biopsy: This is an emerging, non-invasive, and less costly clinical tool to detect cancer biomarkers or “signatures” from blood circulating tumor DNA (ctDNA) or circulating tumor cells, etc. It shows promises for early detection, treatment precision and monitoring, and offers prognostic value in pancreatic cancer.
  • Combined therapies: In addition to a targeting approach, combined drugs to simultaneously block multiple abnormal pathways in PDAC, or a combination of immuno- and chemotherapy, can also improve survival and/or quality of life in cancer patients.  

Still today, early detection is crucial, because pancreatic cancer is curable at an earlier, localized, and surgically resectable stage.

If you experience persistent abdominal pain, unexplained loss of appetite or weight, or any concerning symptoms, don’t hesitate to see your doctor. For those with a hereditary risk, consult with oncologists to keep updated on helpful or applicable genetic development.

Finally, with a glimmer of light, a glimmer of joy for the positive impact on cancer patients, it also creates an urgent need for our awareness and actions. Spread words and modify lifestyle!

 

Image Credits: slidemodel.com; CancerPreventionDaily

From Dilemma to Deadly Disease: How Do You Deal with It

By Hui Xie-Zukauskas

Balance Covid and CancerDo you have a loved one or friend suffering from cancer? How are they doing, particularly regarding wellbeing and cancer treatment aspect during the COVID-19 pandemic?

Also, are you one of the folks whose cancer screening is due or who may experience something uncomfortable, concerned yet reluctant to schedule a hospital visit?

I’m asking these questions because if the answer is yes, you are not alone. This is the reality and challenge we face now.

A dilemma is confronting us. Staying away from the hospitals may delay a critical treatment or a timely diagnosis, which could worsen cancer progression and prognosis; yet visiting the hospital may increase a risk for the coronavirus infection, which can lead to a potentially dangerous or destructive outcome.

So, I’m going to address this struggle and solutions to help you make a better decision about your health.

Balance current situation with long-term gain

Let’s face it. Oncologists have warned that delayed cancer screening and diagnosis during COVID-19 will result in thousands and more avoidable deaths in the coming decade.

The experts’ insight is clear. Although fearing of COVID-19 risk is understandable, there is also unintended consequence in cancer. I cannot emphasize enough that cancer develops through a multistep process over years. Regardless of what’s going on around the world and how many things we put on hold, malignant growth does not stop.

That is why detecting and treating early lesion(s) are critical. Cancelled or delayed cancer screenings suggest some undetected cancers because screening benefits are undeniable. Then undetected cancer that actually exist translate to the delay or loss of interventions, consequently allowing the cancer to grow or metastasize.

So, weigh in benefits and risks, or pros and cons, make cancer care or screening a priority and take COVID-19 precautions at the same time. Fortunately, it can be done safely.

The best example that early detection and treatment save lives is late Justice Ruth Bader Ginsburg’s cancer journey, during which she went through successful treatments with colon, lung and pancreatic cancer since 1999. We can take a brief note on what she taught us.

Learn from Justice Ginsburg’s cancer battle

First, we see hope and inspiration from advanced medical therapies, from her personal battles and survivorship. It’s truly extraordinary that Ginsburg fought five bouts of cancer last two decades and lived well to 87 years old.

Second, we learn her resilience and commitment to life, health and work. Ginsburg’s rigorous exercise routine, her dedication to the job she loved, exceptionally she rarely missed work while undergoing cancer treatments, her time with family and friends, all helped her combat cancers.

Finally, we can ascertain that early diagnosis and treatment matter, as they can steer cancer course towards cancer-free direction. In Ginsburg’s case, every time doctors found a new cancer by accident came as a result of her routine checkups or treatments for other conditions. Then immediate surgeries and therapies restored her health. You can view it as luck or timely discovery or both.

Because she recently died from complications of pancreatic cancer, let’s extend to the next point.

Zero in preventing pancreatic cancer
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Pancreatic cancer is one of the most malignant and lethal diseases. It is highly invasive and can widely metastasize to various organs of the body. It’s also resistant to most treatments, with a poor prognosis (up to now a five-year survival rate is lower than 9%).

But when it comes to pancreatic cancer, it’s easy to permit a blind spot. This is because the disease rarely displays specific early signs and there is no acceptable screening test available at this time.

Even though one may experience some symptoms such as abdominal pain, stomach ache or lower back pain, jaundice, or bloating and weight loss, these indications can easily be brushed off in the hustle and bustle of everyday life. And worse, when these sufferings or concerns are presented, individuals already have an advanced pancreatic cancer that’s untreatable or unresectable.

More alarming is that incidence of pancreatic cancer has been increasing in recent years. Based on scientific projection, by 2030 it will end up second deadliest cancer in the U.S. next to lung cancer.

All the above-mentioned aspects, therefore, make the urgent need to understand causes and risk factors of pancreatic cancer. More important, the key is prevention and early detection.

After all, genetic factor is about 10%. Be watchful and eliminate the blind spot. Focus more on modifiable risk factors. Here are actions you can take:

  1. Trust your instinct and science. Don’t put off cancer diagnosis or cancer-related visits. You can always consult via Telemedicine first if any need or troubling concern arises.
  2. Open to necessary hospital/clinic visits. Don’t let fear and anxiety overwhelm you. Hospitals have made stringent protocols to ensure the safety of both patients and staff. I personally witnessed it at different hospitals from recent experience with my family member’s illnesses.
  3. Go for genetic testing if you are a high-risk individual, such as having a family history of pancreatic cancer, other cancers or certain familial syndromes, and hereditary pancreatitis. It can detect a cancer-causing mutation that drives pancreatic tumor growth. Moreover, BRCA1 and BRCA2 mutations trigger not only breast and ovarian cancer but also pancreatic cancer.
  4. Beware changes in your body (including subtle ones). Don’t ignore symptoms that may indicate something is wrong.
  5. Pay attention to elderly people. The risk goes up with aging, because ~80% diagnosed are 60 years old and up.
  6. Control diabetes, chronic pancreatitis, and obesity, especially childhood obesity—all are well established risk factors.
  7. Live a healthy lifestyle. No smoking, no heavy alcohol drinking, no high fat and high sugar food, and minimize red or processed meat consumption. Be physically active.
  8. Maintain a good oral health. Emerging evidence has linked poor oral hygiene or poor periodontal health to a higher risk for pancreatic cancer. This relation between a chronic oral infection and carcinogenesis should be no surprise, given that chronic inflammation and bacterial/viral infection are underlying mechanisms for cancer development.
  9. Build a powerful immune system. Make it your strong defense and preserve from diet, exercise to mentality and sleep.
  10. Protect yourself, your family and your community whether it’s fighting against carcinogens or the coronavirus. This is a personal responsibility. Before having an effective and safe vaccine to prevent COVID-19, wear a mask when out in public, watch your space at least 6-feet apart from others, wash your hands frequently, and avoid close contact with people who are sick.

Conclusion

The fear of COVID-19 has influenced some people’s decision to cancel or act on cancer screening or treatment. However, one should make effort to prioritize cancer screening, diagnosis and care while taking precautions to minimize COVID-19 risk. And become vigilant about pancreatic cancer.

 

Image credit: Scientists & CPD

 

 

Emerging New Evidence on Pancreatic Cancer Risks

By Hui Xie-Zukauskas

Risk_assessThis is a key topic on my editorial calendar this year due to the striking statistics of the increasing incidence and lethality of pancreatic cancer. For 2017, an estimated 53,670 people will be diagnosed with pancreatic cancer, and over 43,000 deaths resulting from it are expected in the U.S. alone (source: American Cancer Society).

Pancreatic cancer still has a very poor prognosis, with an overall survival of 5% over five years. The disease is remarkably aggressive, rarely diagnosed at an early stage, and difficult to treat due to its resistance to radiotherapy and chemotherapy. Therefore, the cancer’s cruelty creates a tremendous emotional burden for both patients and their loved ones. Even for survivors, the battles and treatments are brutal.

This does not mean we can do nothing.

To treat this horrible disease early and save more lives, identifying risk factors of pancreatic cancer and targeting high-risk people for effective screening are crucial. Therefore, steps to help prevent pancreatic cancer need everybody’s attention. A better understanding of the factors associated with pancreatic cancer can pinpoint preventive strategies to reduce its incidence.

Through literature review, I’ve compiled a list of risk factors for pancreatic cancer from research findings and emerging new evidence over the last 10 years. Here I share them with you in three categories.

First – Established risk factors

  1. Cigarette smoking: It is consistently associated with a two-fold increase in pancreatic cancer risk. Cancer-causing agents (i.e., carcinogens) existing in tobacco products cause DNA damage, which lead to abnormal cell growth.
  2. Obesity: Obesity produces an inflammatory state. Specifically, visceral obesity (i.e. belly fat) is linked to an increased risk for pancreatic and other cancers, independent of general obesity measured by body mass index (BMI).
  3. Chronic inflammatory conditions: such as chronic pancreatitis, liver cirrhosis.
  4. Diabetes: Particularly, type 2 diabetes is among a cluster of metabolic syndromes including hypertension, dyslipidemia, insulin resistance, and obesity.
  5. Age (55+): The risk of developing pancreatic cancer increases with age.
  6. Gender: Men are more likely to develop pancreatic cancer.
  7. Inherited genetic mutation: Genetic factors accounts for ~10% pancreatic cancer. 

Second – Emerging risk factors

  1. Environmental risk: Exposure to mutagenic nitrosamines, organ-chlorinated compounds, or heavy metals is involved in the initiating phase of pancreatic cancer.

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  2. Gut microbiota: The role of the microbiota in the development of pancreatic diseases is increasingly accepted. Gut bacteria translocation and small intestine bacterial overgrowth have been found in acute pancreatitis and chronic pancreatitis, respectively.
  3. Infection: Helicobacter pylori (H. pylori) infection.
  4. Ionizing radiation: Most relevant evidence comes from studies done on workers due to occupational exposure. 

Let me add a bit more on invisible microbiota. Imbalance in gut microbiota is also related to other risk factors for pancreatic cancer (such as smoking, diabetes, and obesity). Furthermore, oral microbiota change in periodontitis is associated with an increased risk of developing pancreatic cancer.

Third – Preventable or modifiable risk factors

  1. Sedentary behavior: Physical inactivity is directly and independently linked to multiple types of cancer.
  2. Smoking: Smoking is the biggest preventable cause of cancer.
  3. Excess alcohol intake
  4. Dietary factors: A diet high in red and processed meats, fat, calories, and fructose may increase cancer risk.  In contrast, a diet rich in whole wheat or whole grains, fiber, vegetables, and fruits is associated with reduced cancer risk.
  5. Obesity: Obesity is a significant risk factor for more than 10 types of cancer, severe morbidities, and premature death; it is also considered the major modifiable risk factor for multiple cancers and chronic diseases.

Each cancer is different. Sadly, pancreatic cancer has struck individuals who were healthy, non-smokers, athletes, or as young as age 30-40.

In summary

Fighting against pancreatic cancer starts with learning about its risk factors so as to save preventable deaths in the larger population.

Meanwhile, there is hope – thanks to advanced research and technology that deliver better treatments or promising therapeutic options. So, let’s also remember HOPE.

 

Image credit: http://fatfplatform.org/risk-assessment/

Why It Is Critical to Prevent Diabetes: Association with Pancreatic Cancer

By Hui Xie-Zukauskas

Stop diabetes logoHere are a couple of sobering statistics: A total of 25.8 million children and adults in the United States and 347 million worldwide have diabetes. These figures demonstrate clearly that diabetes has become a pandemic in today’s world.

Preventing diabetes in our own and our families’ lives should be of great concern to us for several reasons. One reason is that a diagnosis of diabetes can result in life-altering changes needed to manage the disease. But there is another big reason such a diagnosis is troubling, and today I’m going to focus on that reason. I’m going to talk about the urgent need for diabetes prevention because diabetes is a known risk factor of pancreatic cancer.

What is diabetes?

Diabetes is a chronic disease in which the body either cannot make enough insulin (Type 1) or cannot effectively uses its own insulin (Type 2). Insulin is a pancreatic hormone that regulates blood sugar by facilitating glucose (sugar) storage in the cells for energy. When insulin fails to do its job, blood sugar levels rise.

Type 2 diabetes affects 90% of people with diabetes around the world and results largely from being overweight and physical inactivity. High blood sugar levels can lead to long-term damage to cells and organs, as seen in complications like high blood pressure, blindness, kidney disease, and nerve disorders.

What is pancreatic cancer?

Pancreatic cancer is a deadly disease in which cancerous cells develop inside the pancreas, an organ that produces hormones such as insulin and digestive juices. (See more on “The Rule of Three for Pancreatic Cancer Prevention”).

What is the relationship between the two?

Accumulated studies have revealed a positive association between diabetes and pancreatic malignancy, although the details of what is the exact causal relationship are complex and controversial. Diabetes may be either a symptom or a risk factor of pancreatic cancer. Here are some facts showing why it has been concluded that the two maladies are connected:

-          Pancreatic cancer occurs two times more in people who have diabetes than in those without diabetes.

-          Approximately 80% of patients diagnosed with pancreatic cancer, when diabetes co-exists, often have a progressive malignancy.

-          Patients with new-onset Type 2 diabetes are at a higher risk of developing pancreatic cancer. When suffering from cancer, they have a worse rate of long-term survival and a higher rate of post-surgical complications.

-          45% of pancreatic cancer patients have diabetes and more than half of diabetes cases are newly developed. Thus diabetes has been proposed to be a clue for early cancer diagnosis.

In summary, diabetes is considered to be a risk factor of pancreatic cancer and has a negative impact on the prognosis and outcome of this deadly form of cancer. That is one excellent reason why it is so important to prevent diabetes.

To help in that prevention, here are a couple of small, easy, and effective dietary practices that can be achieved on a daily basis:

  • To help keep your blood glucose under control, avoid foods high in sugar. High sugar-containing foods include rich desserts, candies, ice cream, sweetened drinks and fruits packed in syrup. Furthermore, many processed foods hold excessive sugar.

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  • Drink plenty of water, which benefits your body in many ways, especially helping remove metabolic by-products when hyperglycemia occurs.

Following these two suggestions daily can go a long way toward helping keep you free of the plague of diabetes… And oh yes, don’t forget to include an appropriate measure of exercise in your lifestyle!

Until my next cancer prevention blog, I wish you Good Health, Good Living and Happy Thanksgiving!

 

Image credit: By articaal.blogspot.com

The Rule of Three for Pancreatic Cancer Prevention

By Hui Xie-Zukauskas

Imagine this – it starts from deeper in the abdomen, inside the pancreas, an organ between the stomach and backbone, gradually hits a person at 60s with no sign or some digestive discomfort, pain in the abdomen, yellowish skin, and then unexplained weight loss. After that, it aggressively takes the person’s life. That is pancreatic cancer.

pancreas-cancer_Med.WorldPancreatic cancer is one of the deadliest forms of all cancer. With current medical technology, the five-year survival rate is only six percent. The cases are apparently increasing, as about 45,000 people are expected to be diagnosed with pancreatic cancer in 2013; among them 38,000 people will die of the disease this year.

To help raise awareness of this devastating disease among those who are unfamiliar with pancreatic cancer, let me use “The Rule of Three” to highlight pancreatic cancer prevention.

Rule #1: Never smoke, and live a healthy lifestyle.

Cigarette smoking is a well-established risk factor for pancreatic cancer. It’s also important to maintain a healthy lifestyle, eat more plant-based foods and less meat, stay physically active, and keep a healthy weight. Obesity has also been linked to pancreatic cancer.

Rule #2: Prevent and treat chronic pancreatitis.

Inflammation plays a role in developing pancreatic cancer, and chronic pancreatitis is a known risk factor. In addition, pancreatic cancer is more common among individuals with histories of cirrhosis (a chronic liver disease), diabetes, and previous surgery to the upper digestive tract. Pancreatic cancer may also be attributed to a pathogen for periodontal disease (named porphyromonas gingivalis).
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Rule #3: Keep diabetes at the bay.

Type 2 diabetes is closely associated with pancreatic cancer, as a body of research reveals. As the population ages and the obesity epidemic continues, the incidence of diabetes is predicted to rise. People with diabetes are more likely to develop pancreatic cancer than those free of diabetes.

A final point

Still, as is true for other cancers, early detection is always important for combating the pancreatic cancer. This is particularly critical for those with a family history of this disease, because the risk can be doubled or tripled by familial pancreatic cancer.

In brief, pancreatic cancer is deadly, but you can lower your risk by not smoking, preventing pancreatitis and diabetes, and raising your awareness about the importance of living a healthy lifestyle.

 

Image credit: by medicineworld.org