Pancreatic Cancer (Exocrine Cancers)

Pancreas is an oblong flattened gland in the digestive and endocrine system located in the abdomen. By secreting pancreatic juice to the small intestine, pancreas helps to break down carbohydrates, proteins, and lipids. Traditional Chinese medicine view pancreas as a vital organ in responsible for the absorption of foods' qi and nutrients before passing them to other organs to nourish our body.

Cancer of pancreas or pancreatic cancer is defined as condition of a malignant neoplasm of the pancreas, as the cells have become cancerous and divided uncontrollably. Most pancreatic cancers start in the ducts (exocrine component of the pancreas) that carry pancreatic juices with cancer of an epithelium that originates in glandular tissue accounts for over 75 - 90% of all cases of exocrine cancers.

Causes and risk factors
1. Age
The risk of the disease increases with age. It may be caused by wear and tear or due to diet which have stressed out of the organ.
2. Gender
Men is at higher risk than women to develop pancreatic cancer due to more men are smokers and heavy drinkers
3. Foods contamination with chemical agent
As a result of contamination of food qi absorbed by the pancreas during digestion (TCM)
No one known how cigarette carcinogens trigger pancreatic cancer but the link is there.
4. Alcohol
Researchers suggested that pancreatic cancer may be is a predisposed of chronic pancreatitis due to excessive alcohol drinking.
5. Family history
Studies showed that 5–10% of pancreatic cancer patients have a family history of pancreatic cancer.
6. Western diet
Diet high in fat, sugar, artificial sweeteners, low veggies and fruits are at risk to develop pancreatic cancer.
7. Diabetes
Onset of diabetes is the early sign of the disease
8. Obesity
Obesity is one of the major cause of diabetes.
9. Smoking
According to the American Cancer Society, smoking increases the risks associated with pancreatic cancer
10. Etc.

Symptoms

1. Back pain
Due to tumor grows in the back of the pancreas
2. Unxeplained weight loss
Any unintentional weight loss over 10% may be a symptoms of cancer
3. Loss of appetite
This is another common symptoms of cancer
4. Pain and discomfort in the stomach area
Due to location of pancreas
5. Jaundice
Due the blockage of bile duct as the growth of the cancer, causing bile back up to the liver
6. Fat in stool increase
As a result of less bile flow in aiding digestion.
7. Etc.
Diagnosis and tests
1. Endoscopic retrograde cannulation of the pancreas (ERCP)
ERCP is a test to look for any normality of pancreas by taking the X ray with dye injected by a endoscopy (which is thin tube inserted through the mouth into the stomach then into the duodenum) into the pancreas duct.

2. CT scan
A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details.The pictures are viewed by your doctor to see the extent of the tumors abnormalities, such as spreading of cancer to the nearby structure and lymph nodes. This test is helped to determine whether liver abnormality is a cyst or a tumor. Unfortunately, CT scan can only review the existence of cancer, but can not tell it is a primary or secondary cancer.

3. MRI (magnetic resonance imaging)
MRI (magnetic resonance imaging is one of many advanced technology used to visualize internal structures cross sectional imaging of your body used effectively in providing the better details of the metastasis of cancer in the ovaries and surrounding areas.

4. Etc.

Grades

The Grades of ovarian cancer are depending to the tendency of spreading. Low grade cancers usually grow more slowly and are less likely to spread while high grade cancer indicates otherwise.

Stages
Pancreatic cancer is classified as 5 stages
1. Stage 0,
If the cancerous cell have not penetrated in deeper tissue but in the surface of the pancreas lining.

2. Stage I

In stage I, The cancerous cells are no longer in the surface but have invaded into deep pancreas lining, but still completely inside the pancreas.

a. Stage IA1
The cancer is not ≤ 3 mm (1/8 inch) deep and ≤ 7 mm (1/4 inch) wide.
a.1. Stage IA1:
The spreading is < 3mm(1/8 inch) deep and & less than 7mm (1/4 inch) wide.
a.2. Stage IA2: The invasion area is ≥ 3 mm but ≤ 5 mm (about 1/5 inch) deep and & less than 7 mm (about 1/4 inch) wide.
b. Stage IB:
The cancer in this stage have invaded the connective tissue, & less than 5mm (1/5 inch).
b.1. Stage IB1:
Cancer is 4 cm large (1 3/4 inches).
b.2. Stage IB2:
Cancer is ≥ 4 cm (1 3/4 inches) but & less than 5cm (1/5 inch)

3. Stage II
In stage II, the cancerous cells have spread to distant tissues, but is still within the pancreas.

4. Stage III
In this stage, cancerous cells has spread to the tissues immediately surrounding the pancreas.

5. Stage IV
In this stage, cancerous cells has spread to the tissues immediately outside of the pancreas, other distant parts of the body

Prevention
A. How to avoid
1. Reduce intake of alcohol
As excessive drinking is one of risk of pancreatic cancer.
2. Eat more vegetables and fruits
By avoiding Western diet cause of the disease.
3. Control weight and exercise
researchers found that weight control and exercise reduce the risk of pancreatic cancer by 50%.
4. Eat organic foods
Avoid fast foods which contain high amount of trans fat, salt and preservatives.
5. Stop smoking
Smoking is associated with increased risk of pancreatic cancer, it may be due the carcinogens in the smoke.
6. Etc.

B. Diet
1. Garlic
An analysis of several case-controlled studies in Europe suggests an inverse association between garlic consumption and risk of common cancers.
2. Carrot
Carrot contains high amount of beta carotene which has shown to induce appotosis of cancer cells. In study of Cell Cycle Regulation and Induction of Apoptosis by β-carotene, researchers found that in vivo study warrants further confirmation that β-carotene acts as apoptosis agent in cancer cells particularly leukemia cells but not normal cells.

3. Freeze dried strawberry
In study of 36 participants consumed 60 grams of freeze dried strawberries daily for six months and completed a dietary diary chronicling their strawberry consumption. The results showed that 29 out of 36 participants experienced a decrease in histological grade of the precancerous lesions during the study.

4. Tomato
Many studies showed that antioxidant lycopene in tomato inhibits cancer cell growth and exhibit apoptosis, causing cell death.

5. Cruciferous vegetables
Cruciferous vegetables such as cauliflower, broccoli, cabbage, etc. beside contain high amount of antioxidants, but also phytonutrients that have been shown to help prevent the onset and halt the progression of certain cancers.

6. Etc.

C. Nutritional Supplements
1. Antioxidants
Antioxidants such free radical scavengers vitamin A, C, E enhance the immune system against the forming of free radicals and prevent the alternation of cell DNA cause of abnormal cell growth.

2. Flavonoids
In a study of flavonoids intake in human, The researchers found that flavonoids’ anticancer property has been proposed to exist via prevention of the formation of cancer-causing metabolites, inhibition of tumor cell proliferation, and stimulation of programmed tumor cell self-destruction (apoptosis).

3. Lycopene and 1,25-dihydroxyvitamin D3
In a study of Lycopene and 1,25-dihydroxyvitamin D3 cooperate in the inhibition of cell cycle progression and induction of differentiation in HL-60 leukemic cells, researchers found that The combination of low concentrations of lycopene with 1,25-dihydroxyvitamin D3 exhibited a synergistic effect on cell proliferation and differentiation and an additive effect on cell cycle progression. Such synergistic antiproliferative and differentiating effects of lycopene and other compounds found in the diet and in plasma may suggest the inclusion of the carotenoid in the diet as a cancer-preventive measure.

4. Quercetin
In study of effects of quercetin on human laryngeal cancer Hep-2 cells, researchers found that Quercetin could effectively inhibit the proliferation of Hep-2 cells and its mechanism is probably related to the apoptosis.

5. Polyphenols
In some clinical studies researchers suggested that the polyphenols in green tea, may play an important role in the prevention of cancer by killing cancerous cells and stopping their progression.

Treatments
A. In conventional medicine
1. Surgery
a. Depending to the location, grade and stage of the cancer and other factors
If the cancer is removable, it may be
a.1. Whipple procedure:
The procedure is to remove the head of pancreas together with parts of duodenum and bile duct and reconnect the remaining, sometime, a portion of the stomach is often removed as well.

b.1. Distal subtotal pancreatectomy:
The procedure is to remove the body and tail of the pancreas as well as the spleen.

b. Risks and side effect
Surgical and anesthesia risks

2. Chemotherapy
Chemotherapy
Chemotherapy is most use to treat with advance stage of cancer combined with radio therapy, as it has spread to a distant parts of the body by using drugs taken by mouth or injected into a vein or muscle of the patient to stop the growth of or to kill cancer cells. Pancreatic cancer is often respond well to chemotherapy, resulting of shrinking or stabilization of the tumor . Drugs used to treat ovarian caner include gemcitabine.
b. Side effects
b.1. Nausea
b.2. Vomiting
b.3. Hair loss
b.4. Fatigue
b.5. Anemia
b.6. Mouth sores taste and smell changes
b.7. Infection
b.8. Etc.

3. Radio therapy
a. Radiation may be used for stages II, III, and IV to kill any cancer cells remaining in the body. By using high-energy x-rays or other types of radiation, radiation therapy kills the cancer cells and keep them from growing or regrowing. In pancreatic cancer, radiotherapy is helpful to improve quality of life and relieve the symptoms, including pain.
c. Side effects
c.1. Fatigue
c.2. Chest pain
c.3. Heart problem
c.4. Short of breath
c.5. Skin discoloration or pinkness, irritation.
c.6. Etc.


B. Herbal medicine
1. Aloe
in some studies, researchers suggest that some chemical compounds of aloe, such as acemannan, aloeride, and di(2-ethylhexyl)phthalate (DEHP) may have immunomodulating and anticancer effects.

2. Asparagus Cochinchinensis
In vitro studies researchers found that curcumin acts as a weak phytoestrogen, exhibits neuroprotective, antiproliferative and preventative effects against cancer.

3. Devil's Claw
The extract of Harpagophytum procumbens, commonly known as devil's claw,
In vitro studies, researchers found that cat's claw demonstrated anticancer effects against several cancer cell lines and has been reported to be effective in the treatment of lymphoma cancer, according to a study conducted by K. S. Wilson, M.D., which was published in the journal "Current Oncology" in August 2009.

4. Absinthe
Absinthe is also known as Wormwood, a distilled, highly alcoholic beverage flowers extracted from leaves of the herb Artemisia absinthium. In a study, researcher at the University of Washington found that wormwood can be used as a promising potential treatment for cancer among the ancient arts of Chinese folk medicine.

5. Scutellaria
Scutellaria is also known as skullcaps, a genus of flowering plants, genus Scutellaria, belonging to family Lamiaceae. In a study of Inhibition of Cancer Cell Proliferation and Prostaglandin E₂ Synthesis by Scutellaria Baicalensis, researchers found that Scutellaria baicalensis selectively and effectively inhibits cancer cell growth in vitro and in vivo and can be an effective chemotherapeutic agent for HNSCC. Inhibition of PGE2 synthesis via suppression of COX-2 expression may be responsible for its anticancer activity.

6. Etc.


C. Traditional Chinese medicine
1. Bai Hua She She Cao
The Sanjiv Kumar YADAV, Shao Chin LEE (Yong Loo Lin School of Medicine, National University of Singapore researcher results showed that the ethanol extract from Bai Hua She She Cao effectively evokes cancer cell apoptosis, possibly through burst-mediated caspase activation.

2. Pu Kong Yin (Dandelion Root)
In a study of The efficacy of dandelion root extract in inducing apoptosis in drug-resistant human melanoma cells, researchers found that treatment with this common, yet potent extract of natural compounds has proven novel in specifically inducing apoptosis in chemoresistant melanoma, without toxicity to healthy cells.

3. Jiu Zi (Chinese leek)
In a study of A Pilot Study on Anticancer Activities of Chinese Leek researchers found that Chinese leek extract inhibited cancer cell growth and induced apoptosis in vitro. Oral administration of leek extract significantly reduced lung metastases in the present animal model.

4. Jie Geng
The Researchers found that Saponins in Jie Geng have been shown to very significantly augment the cytotoxicity of immunotoxins and other targeted toxins directed against human cancer cells.

5. Xia Ku Cao (Selfheal Fruit-Spike)
Researchers found that cyasterone in Xia Ku Cao showed anti tumor activity.

6. Etc.
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