Pancreatic Cancer, Open Source, 15 year old's perseverance and brilliance

Steve Jobs, Patrick Swayze (Dirty dancing), Randy Pausch (The Last Lecture), Luciano Pavarotti (Italian Opera Singer) have all had a battle with Pancreatic cancer.

Pancreatic cancer is one of the toughest cancer to diagnose and treat. The survival rates are dismal, 5% at 5 years and there are no easy ways to diagnose or screen early. There can be variations  in survival based on the histology like neuroendocrine tumors doing well. CA 19.9 is a biomarker available for pancreatic cancer but with not that great sensitivity or specificity. It can raised in benign conditions like biliary tract obstruction, cholangitis, inflammatory bowel disease, acute and chronic pancreatitis, liver cirrhosis, cystic fibrosis, thyroid disease!!

There is light at the end of the tunnel. A 15 year old took up this challenege, went through open source articles and has created a cheaper and more effective way to diagnose pancreatic cancer early!

Watch this video

http://www.youtube.com/watch?v=Nq4x8C6Dcf8

This finding is yet to be peer reviewed. It is not indexed in pubmed but he does get a mention...http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392557/

We have a long way to go but progress is being made.......

Epigenetics

Among the many topics which i like to debate about, Nature versus Nurture holds a special place. It can also be called as debate of free will verus determinism. Will ponder more about that in some other post.
Today would like to bring attention to "Epigenetics". A very interesting field which kind of favors nurture theory or on second thoughts does it!!.
Let me get this by posing few questions.

1. Does our diet have an influence on our children?

2. Can I blame my health condition on my mother for what she ate or did not eat during pregnancy?

3. How do our genes learn from our experiences? How is the information incorporated into the DNA?

4. How does from a single cell embryo we become complex human beings? How does the stem cell know to become eye or ear or cardiac cell?

5. How does my nutrition and my environment influence the expression of my genes?

6. Why are identical twins different in terms of characteristics, behavior preferences?

7. Can anxiety or calmness be related to the amount of cuddling and care you received during infancy?

The answer to above question partly lies in epigenetics.

Excellent site to learn is http://learn.genetics.utah.edu/content/epigenetics/

But answers with my bias and understanding are:

1. Yes, our diet has an influence. If your paternal grandfather had food abundance you may have a shortened lifespan!!

2. During early embryonic period it is very crucial for mothers to have balanced nutritious diet (vitmin B complex, folic acid etc.). Lack of key nutrients can increase risk of obesity, cancer and diabetes.

:) Boys, men eat less and feed the women properly!

3. Our experiences can be tagged to DNA by processed called as methylation and acetylation. They are prone to change. Toxins have detrimental effect by acting on these processes.

4. By epigenetics cells become destined organs! (Language)

5. Even for adults having methyl ric food is beneficial. Food guide.

6. The genes may be same but the expression is different because of epigenetics. Also the genes are not same!!

7. Yup, if we extrapolate data from rats. Pup which is licked for first week is more calm. But we do not want the whole world to be full of Buddhas (Monks).

In another post will try to focus on role of epigentics in cancer and how this is being targeted to fight cancer.

International Childhood Cancer Day-February 15

Cancer is predominantly a disease of old age. But there are a few unfortunate children who have to deal with the ordeal of fighting cancer. The common pediatric cancers are Acute Lymphocytic Leukemia (ALL), brain tumors (medulloblastoma and gliomas), retinoblastoma, neuroblastoma, Wilms tumor, osteosarcoma and ewings sarcoma.
Why children suffer from cancer is not completely known. There are no definitive etiolgical factors associated. Cancer is a genetic disease and few genetic conditions are associated with increased risk of pediatric cancer, they are Li Fraumeni syndrome, Fanconi's anemia, Blooms syndrome, Downs' syndrome, neurofibromatosis etc.
In last 50 years significant advacements have been made in the treatment of childhood cancer bringing the mortality down by half.  Today around 80% of children with cancer can be expected to be cured but for the aim is to find cure for 100% without short term or long term toxicity.
There have been advancements in surgery, radiotherapy and chemotherapy but long term survivors of childhood cancer are at increased risk of second malignancy because of treatment ith radiation and certain types of chemotherapeutic agents. The sword of Damocles is always hanging for them!  Also they can have stunted growth both mental and physical becuase of disease and treatment. The newer targeted therapies considered less toxic need to be used with caution in children and preferably in a clinical trial, according to a paper in Lancet.Lancet.
Better understanding of childhood cancers, better therapeutic agents, better trial design, long term data, mandates greater scientific rigor and research. All fields of science from technology, genetics, clinical trials, data management, growth and development research need special focus and thrust to eliminate cancer.
As i recollect the few pediatric patients i have treated, i recollect two happy stories, one with Nasopharyngeal cancer and other with Craniopharyngioma, but numerous kids in front of whom i was helpless and was defeated. Metastatic retinoblastoma (cute 6 year old girl), metastatic Ewing's sarcoma (young 15 year old boy), a kid with Medulloblastoma. They all remind me to become a better and scientific person.

References:
1. http://www.cancer.gov/cancertopics/factsheet/Sites-Types/childhood
2. http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2812%2970530-2/fulltext
3. http://www.hopau.org/uploads/flash/lessons/lsn38/2010_Boot_Camp_Koontz_Pediatrics_Appendix_2.PDF 

Diabetes and Cancer

Chronic diseases are the scourge of the new age. All over the world people living with diabetes are expected to increase, especially in India.
Epidemiological studies indicate an increased risk of cancer for diabetic people. There is increased risk of hepatocellular cancer, pancreatic cancer, breast cancer, endometrial cancer, colorectal cancer, stomach cancer and bladder cancer. Prostate is the odd guy out as the risk for it is decreased if you have diabetes (possibly because of low testosterone levels).
The causal relationship between diabetes and cancer is not well established. There may be confounding bias, observational bias as the evidence is epidemiological. There are few biological hypothesis. Hyperinsulinemia drives growth and diabetics have hyperinsulinemia. Also cancer cells express IGF-1 (Insulin like growth factor receptors) receptors. Inflammation is more common in diabetics and chronic inflammation is a risk for cancer.
Summary and Actions To Be Taken:

1. Epidemiological evidence is there to say that diabetics are at increased risk for cancer.

2. Causal relationship and biological mechanism still needs further elucidation.

3. Diabetes and cancer share several risk factors, like obesity and physical inactivity. An effort to prevent and control diabetes will have a positive effect on cancer incidence. One need not have to wait for conclusive evidence to implement healthy habits and preventive measures.

4. Researchers and clinicians need to be more aware and collect prospective data. Also design studies to benefit patients.

5. The cancer risk conferred by diabetes may be moderate but considering that 366 million people have diabetes worldwide and it is expected to reach 552 million by 2030 calls for awareness and action.

Reference: Diabetes mellitus and cancer risk: Review of the epidemiological evidence

World Cancer Awareness Day-February 4

Cancer is a dreaded disease. There is lot of stigma, prejudice, lack of information, misinformation, lack of awareness which makes this even more dreaded disease. The media also unknowingly plays role in perpetuating certain biases. Whenever a person dies of cancer it is always mentioned that she/he dies of cancer. Celebrities and laymen both have it mentioned in their obituary that they died of cancer. This creates a perception, observational bias that cancer always results in death. This is aggravated by the fact that those living with cancer are loathe to come out and claim that they are cancer survivors. There are few exceptions but they are exceptions.
On Cancer Day multiple agencies worldwide are trying to dispel myths surrounding cancer. The theme this year is Cancer-Did You Know?

Myth 1: Cancer is just a health issue

Myth 2: Cancer is a disease of the elderly, wealthy and developed countries.

Myth 3: Cancer is death sentence

Myth 4: Cancer is my fate

Tremendous effort is required to dispel these and other myths surrounding cancer.

Around 33 to 35 percent of people who smoke believe smoking's detrimental effects are exaggerated. Developing countries are at an increased risk for burden and death from cancer. Cancer treatment in past few decades has improved survival in many cancers. Early diagnosis and better therapies with multimodality collaboration has made difference to many patients. There is lot of progress still to be made. Foremost is in prevention  awareness, and educating each and everyone.
Let us all work towards a healthy present and future.

1. http://download.thelancet.com/pdfs/journals/lanonc/PIIS1470204513700275.pdf?id=4d037fefcb72946c:-1bac8636:13ca10773a7:-15d91359914026138

2.http://www.thelancet.com/journals/lancet/article/PIIS1470204511702984/table?tableid=tbl1&tableidtype=table_id&sectionType=darkBlue

3. http://www.worldcancerday.org/