Pancreatic cancer

Pancreatic cancer

Pancreas

Definition

Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form amass. These cancerous cells have the ability to invade other parts of the body. There are a number of types of pancreatic cancer. The most common, pancreatic adenocarcinoma, accounts for about 85% of cases, and the term “pancreatic cancer” is sometimes used to refer only to that type.

Epidemiology and burden of Pancreatic Cancer

  •  Pancreatic cancer is the twelfth most common cancer in the world (joint position with kidney cancer), with 338,000 new cases diagnosed in 2012. Czech Republic had the highest rate of pancreatic cancer in 2012, followed by the Slovenia and Slovakia.
  •   About 58 per cent of pancreatic cancer cases occurred in more developed countries.
  •   Pancreatic cancer is the 3rd leading cause of cancer-related death in the United States.
  •   The average life expectancy after diagnosis with metastatic disease is just three to six months.
  •    Pancreatic cancer has the lowest survival rate of all cancers – just 3-6% of those diagnosed survive for five years.

Prevention of Pancreatic Cancer

  • Statin use of more than 6 months is associated with a risk reduction of pancreatic cancer of 67% (adjusted odds ratio, 0.33; 95% confidence interval, 0.26-0.41; P < 0.01). (Pancreas. 2007 Mar;34(2):260-5)
  • Diet rich in tomatoes and tomato-based products with high lycopene content helps reduce pancreatic cancer risk (OR = 0.58; 95% CI: 0.34-1.00). (J Nutr. 2005 Mar;135(3):592-7)
  • Metformin is associated with a reduced risk of pancreatic cancer in patients with T2DM (RR 0.63, 95% CI: 0.46-0.86, p=0.003). (Diabetes Res Clin Pract. 2014 Oct;106(1):19-26)
  • Dietary folate intake is associated with a decreased risk of esophageal and pancreatic cancer, but not gastric cancer (OR, 0.59; 95% CI: 0.51-0.69). (J Gastroenterol Hepatol. 2014 Feb;29(2):250-8)
  • Studies have suggested an inverse association in risk of pancreatic cancer with intake of citrus fruits (OR, 0.83; 95% CI, 0.70-0.98). (Pancreas. 2009 Mar;38(2):168-74)
  • A Western dietary pattern, characterized by higher intake of red and processed meats, potato chips, sugary beverages, sweets, high fat dairy, eggs, and refined grains, is associated with a 2.4-fold increased risk of pancreatic cancer among men. (Nutr Cancer. 2013;65(1):157-64)

Treatment for Pancreatic Cancer

  • Long-circulating and pH-sensitive liposomes containing cisplatin (SpHL-CDDP) has shown significant antitumor activity in pancreatic cancer-bearing mice, with lower toxicity in comparison with free-CDDP. (Nucl Med Commun. 2016 Jul;37(7):727-34)
  • Curcumin combined with omega-3 fatty acids provides synergistic pancreatic tumor inhibitory properties. (Nutr Cancer. 2008;60 Suppl 1:81-9)
  • Gemcitabine Adjuvant Therapy (GEM) prolongs overall survival compared with other treatments after the resection of pancreatic cancer. (Am J Clin Oncol. 2015 Jun;38(3):322-5)
  • Despite a higher incidence of three-fourths toxicity, Gemcitabine plus cisplatin (GemCis) offers better outcomes of ORR, PFS/TTP, and 6-month survival, which indicates GemCis may be a promising therapy for pancreatic cancer compared to gemcitabine alone. (World J Surg Oncol. 2016 Feb 29;14:59)

Risk factors for Pancreatic Cancer

  • Cigarette smoking is associated with an increased risk of pancreatic cancer. The rapid reduction in risk associated with quitting suggests that smoking cessation could eliminate 25% of the 27,000 deaths from pancreatic cancer occurring annually in the United States. (Arch Intern Med. 1996 Oct 28;156(19):2255-60)
  •  The study has indicated that high-dose aspirin, rather than low-dose aspirin, might be associated with decreased risk for pancreatic cancer, especially for Americans. (Pancreas. 2014 Jan;43(1):135-40)
  •   Intake of red meat and pork meat is associated with the increase in risk of pancreatic cancer (68% high risk). There were no associations of pancreatic cancer risk with intake of poultry, fish, dairy products, eggs, total fat, saturated fat, or cholesterol. (J Natl Cancer Inst. 2005 Oct 5;97(19):1458-65)
  •  Meta-analysis of cohort studies provides evidence that greater adult attained height is associated with increased pancreatic cancer risk, RR = 1.03 (95 % CI: 1.00-1.07). (Cancer Causes Control. 2012 Aug;23(8):1213-22)
  • High fructose and sucrose intakes play a role in pancreatic cancer etiology. (RR: 1.35; 95% CI: 1.02, 1.80; P for trend = 0.046). (Am J Clin Nutr. 2007 Nov;86(5):1495-501)
  • Requiring diabetes duration of at least 5 years results in an RR of 2.0 (95% CI, 1.2 to 3.2). (JAMA. 1995 May 24-31;273(20):1605-9)
  • Gallstones and cholecystectomy are associated with an elevated risk of pancreatic cancer, respectively (for gallstones: RR, 1.70; 95% CI, 1.30-2.21; P < 0.001; for cholecystectomy: RR, 1.31; 95% CI, 1.19-1.43; P < 0.001). (Pancreas. 2016 Apr;45(4):503-9)

Systematic reviews

  1. Chemotherapy regimens for advanced pancreatic cancer: a systematic review and network meta-analysismore
  2. Gemcitabine plus erlotinib represent a new option for the treatment of advanced pancreatic cancer, with mild but clinically meaningful additive efficacy compared with gemcitabine alonemore
  3. Adjuvant and neoadjuvant therapies in resectable pancreatic cancermore
  4. Factors that affect risk for pancreatic disease in the general populationmore
  5. Critical appraisal of clinical practice guidelines for treating pancreatic cancer based on the global disease burdenmore
  6. Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomasmore

Treatment with Medicinal Herbs

  • Green or Black tea (Camellia sinensis) – Dose 1-2 tsp dry leaf/cup water 1-3 x/day; 50-100 mg green tea ployphenols; 100-200 mg StX (50% polyphenols); three 333-mg tea capsules, each containing 50 mg polyphenols/day

Reference: Handbook of Medicinal Herbs (2006)

Herbals

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