PANCREATIC cancer is one of the deadliest and fastest killers in our society today. Because of the deeper anatomical location of the pancreas, cancer of this organ is most often diagnosed after it has already spread, rendering the condition beyond cure and practically hopeless.
In view of this “stealth” nature of this cancer, it is essential and fundamental that we find a way to prevent or diagnose this malignancy early on. The interesting link between oral bacteria and pancreatic cancer risk could be of great preventive value.
What is pancreatic cancer?
The cancer of the pancreas (usually the adenocarcinoma type) involves a malignant tumor on the gland, which produces insulin and regulates blood sugar level and also aids in digestion. It is located behind the stomach, making it hard to examine and often undetected early, the reason why most of the patients are with stage 4 advanced cancer (with distant spread) by the time they are seen by the physician. It is a treacherous form of cancer, and there is no specific screening test for the majority and the symptoms could be very subtle, non-specific (loss of appetite, weight loss, pain in the abdomen and back, etc.) and mimic other lesser serious conditions.
How common is this cancer?
Around 50,000 persons in the United States will be diagnosed with pancreatic cancer this year alone, and about 49,000 others who already have this malignancy would die. That’s how fatal this cancer, the 4th highest cause of cancer-related deaths, is. While annual death rate from pancreatic cancer among those in the Philippines is listed as about 1,400, I could not find any reliable statistics on this. The number of cases could also be underestimated because of undiagnosed and untreated cases. Most patients with pancreatic cancer are dead within six months or sooner after the diagnosis is made because of the aggressive nature of this malignancy.
What are the risk factors?
Anything that increases the chance to get the disease is a risk factor, like genetic, behavior, habits, diet, environmental conditions, etc. For pancreatic cancers, the following are the risk factors: smoking (twice higher than non-smokers), either cigar, pipe, or cigarettes, or even e-cigarettes; overweight/obesity, with 20 percent increase in risk; exposure to chemicals, like pesticides, dyes, and metal-refining chemicals. Heavy alcohol intake and diabetes type 2 likewise raise the risk. These factors above are modifiable. The following risk factors can’t be changed: age – the older, the higher the risk, almost all victims are above 45, 2/3 are at least 65, with average age at diagnosis is 71; gender – males are 30% more prone than females; race - African Americans have higher risk than whites; family – pancreatic cancer appears to be common in some families with genetic syndrome (inherited gene mutation) PRSS1. In these cases, genetic testing could help in the vigilance and prevention.
What link does it have to oral germs?
Recent studies presented at the annual meeting of the American Association for Cancer Research revealed that certain oral bacteria may be linked to a higher risk for pancreatic cancer. Knowing this is obviously very important in zeroing on individuals with the specific oral bacteria. The clinical studies conducted by the National Cancer Institute and the American Cancer Society analyzed oral-washing samples collected over several years as part of two large cancer prevention and screening research. The results showed that “two oral bacteria were elevated among patients with pancreatic cancer: Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans.” Those with the first oral bacterium (Pg) had at least 59 percent greater risk to develop pancreatic cancer, and those carrying the second bacterium (Aa) in their mouth were at least 50 percent more prone to have pancreatic cancer. This is a very significant finding, especially when confirmed by larger future studies. The discovery could help as an early predictor and therefore help in preventing pancreatic cancer. This also highlights the importance of good dental hygiene, oral care, and regular dental check-up at least twice a year.
How about diet?
Numerous studies have reported the association of diet high in meat, pork, processed meats (sausage, bacon, etc.) with increased risk of pancreatic cancer. The charred portion of barbecued meats has also been mentioned, pointing to the burning saturated fat drippings on the charcoal emitting vapors of toxic (carcinogenic) chemical upwards back to the meat. It is best not to burn grilled foods and to remove the black burnt portion of the meat, fish, seafood, etc. Others have stated that diet high in vegetables, spices, fruits may reduce the risk for pancreatic cancer and other cancers. Inactivity, lack of physical exercise, might also increase the risk for cancer formation and not only cardiovascular diseases and diabetes. Studies are ongoing on these issues.
What is the treatment for cancer of the pancreas?
Depending on the stage, which is usually advanced by the time it is detected, the treatment is individualized, according to the patient’s age, overall health, other attendant health issues, and the patient’s decision. It may include surgery, chemotherapy, radiation treatment, mental health care and palliative care for end-stage cancer.
Is pancreatic cancer preventable?
In view of the aggressive nature of adenocarcinoma of the pancreas, the absence of a screening test for pancreatic cancer, and the deep-seated location of the pancreas, there is no effective way of totally preventing cancer of the pancreas. However, we can lower our risk for this deadly cancer by living a healthy lifestyle, behavioral modification as recommended above, and a regular medical tune-up.
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Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: firstname.lastname@example.org