CC kills more people than cervical cancer.....“cholangiocarcinoma”

There is a disease, a cancer, that kills more people than cervical cancer and whose incidence is rising in the UK and most of the industrialised world. However, most people have never heard of this cancer, and even amongst most doctors, the rising death toll from this disease is unknown. This disease is called “cholangiocarcinoma”, or CC, and unless you or someone you care about has been affected by this cancer, it is unlikely you’ll have come across this term before. I believe this is a disease whose profile needs to be raised and I would like to take this opportunity to tell you about CC.

As a liver specialist, I am continually amazed at the liver’s incredible diversity. It has, literally, hundreds of different functions in the body. One of these is to make bile, a green to yellowish fluid, which aids the digestion of fats and also carries away potentially harmful toxins into the gut for excretion from the body. The bile ducts are a system of tube like structures which carry this bile from the liver to the gut. Cholangiocarcinoma is a fatal cancer arising in these bile ducts. This particular form of cancer kills almost 2000 people per year in this country, and affects both men and women. Most people who get CC will die from the disease. Moreover, studies from around the world suggest that CC is increasing. The reasons for this are unknown.

So what causes CC and why might it be increasing? CC is believed to occur due to a combination of factors, including other illnesses that damage the liver and/or bile ducts over a prolonged period of time. Some chemical toxins have also been linked to CC and there may be a small genetic predisposition, although CC is not a directly inherited disease. In Thailand and other parts of Southeast Asia, CC is relatively common and this is thought to be due to liver flukes which are endemic in that part of the world. However, in the Western world, the majority of cases of CC have no known risk factor. Studying the cause(s) of CC is an important area of on-going research in this field, as only by understanding the underlying mechanisms can effective treatments be developed.

CC is a difficult cancer to treat as the only cure currently available is to surgically remove the whole cancer. It is also difficult to diagnose this disease in the early stages and by the time most patients present with symptoms, the cancer has spread too far for surgery to be effective.

So how does CC present itself and how do we go about diagnosing it? CC, as with several other diseases in and around the liver, typically causes blockage to the flow of bile, leading to the symptoms of jaundice (yellowing of the skin and eyes), pale stools and dark urine. Patients may also complain of malaise, fatigue and weight loss. Severe pain is not a typical feature. As many other diseases can present in a similar way, it can be difficult to confirm the diagnosis of CC. There is no single test that proves a diagnosis of CC. Specialists rely on a combination of the patient’s history, a clinical examination, blood tests for cancer “markers”, imaging scans (ultrasound, CT and MRI), and endoscopy techniques (to get bile and tumour samples from within the bile ducts) to investigate a case of possible CC. An important area of CC research is the development of new techniques to get an accurate and early diagnosis of CC.

Aside from surgery, there are other treatments which, although not curative, can help control symptoms such as jaundice and may delay progression of the cancer and/or its fatal effects. These treatments include placing “stents” into the bile duct to allow bile to flow again, and combinations of chemotherapy drugs. Several new treatments are being researched and developed to tackle CC. These include new cancer drugs; better stents and ways to directly visualise and kill cancer cells inside the bile ducts.

CC is a devastating cancer. It presents late in its course, is difficult to diagnose accurately and early, and in most cases cannot be cured. Furthermore, CC seems to be increasing and we don’t know why. Most of us haven’t even heard of it. This is a disease about which we need to raise awareness, and it’s essential we find out the causes of CC so we can develop better diagnostic tests and more effective treatments for the future.

Dr Shahid A Khan is a Consultant Physician & Senior Lecturer at Imperial College London; &advisor to AMMF, the UK’s only Cholangiocarcinoma Charity

Cured meats not responsible for pancreatic cancer

There are no clear signs that eating cured meats like ham, bacon or hot dogs could increase the odds of getting pancreatic cancer.
Pancreatic cancer is highly lethal and nearly 95 percent of patients die within five years. Research is focused on possible triggers and risk factors to prevent the development of the cancer. Previous research has suggested that the consumption of cured meat may have a possible link to pancreatic cancer risk because the preservatives used for curing, nitrate and nitrite, cause tumours in lab animals. Prevention is really the best way to save a life. Lighting up, eating lots of sugar, and being obese have all been tied to a higher risk of pancreatic cancer.

To probe the role of curing chemicals, researchers from the National Cancer Institute used a 124-item food questionnaire to test how much nitrate and nitrite people got from their diet. Of the more than 300,000 people who filled out the questionnaire, just over 1,000 - about a third of one percent - developed pancreatic cancer over the next 10 years. Men who ate the most of the preservatives did appear to have a slightly higher chance of getting the disease, but that increase was so small it might as well have been due to chance. There was no hint of a higher risk among women.

The above findings add to a growing body of evidence that has failed to link pancreatic cancer to certain foods or nutrients, such as dietary fibre and vitamin D.

Regardless of whether cured meats are linked to pancreatic cancer, experts say the study doesn't mean people shouldn't strive to eat a healthy diet rich in fruits and vegetables, and low in fatty foods such as cured meats. There are a number of good reasons to practice improved dietary habits - not just for cancer prevention.

By and large, the best we can do to prevent pancreatic and other cancers, is to encourage people to avoid smoking, to avoid obesity, and to practice improved dietary habits, the researchers concluded.

MEDICAL TREATMENT FOR CANCERS

What are the side effects of chemotherapy?

The common side effects include nausea and vomiting, loss of hair, stomach upset, kidney dysfunction, bone marrow suppression, tinnitus (abnormal noises in the ears) and high frequency hearing loss. Also lung disease and infertility may occur.

What is radiotherapy?

Radiotherapy involves the use of high-energy ionising radiation to cause DNA damage and ultimately cell death. Dose of radiotherapy is measured in Grays (Gy) – this represents the amount of energy deposited in the tissue. Radiotherapy is given in units called fractions over several day or weeks. To give the dose in one go is too toxic and would cause severe tissue damage and even death.  The area to be irradiated is referred to as the radiation field. This is always marked out on the skin before treatment and such markings often perisist after the treatment. Each tissue in the body has a particular tolerance to radiation. This limits the total dose that can be administered to that area.

How is radiotherapy delivered?

There are three major ways in which ionising radiation is delivered. External beam radiotherapy: This involves the use of a variety of machines to deliver external beam therapy. The source is at a distance from the body. Brachytherapy: In this the radioactive source is in or close to the area to be treated, or directly into the tumour. Radioactive isotope: This involves giving a radioactive isotope that is taken up by the target organ. Radioactive isotopes can be injected or given into a vein by an injection.

What are the side effects of radiotherapy?

The common side effects are skin diseases, nausea, lethargy, bone marrow suppression, dairrhoea, hair loss, lung fibrosis, kidney impairment and paralysis.

What is hormonal therapy?

Endocrine therapy (or hormonal therapy) is an important part of managing cancers whose growth is dependent on hormones, namely breast and prostate cancer. The aim of such treatment is to reduce the amount or effect of circulating sex hormones. Breast cancer Hormonal manipulation is used when the breast tumour is sensitive to circulating oestradiol i.e when it is positive for oestrogen receptor. Prostate cancer The growth of prostatic carcinoma is under the control of male sex hormones. Hence, the aim of hormonal therapy is to reduce testosterone levels or prevent it from binding to the androgen receptor.

What is immunotherapy?

Immunotherapy stimulates the immune system to build a response to the tumour. Interferons are naturally occurring proteins produced in response to viral infections. Three interferons are known to exist alpha, beta, and gamma. Only interferon alpha is used in treatment of cancers. The adverse effects are fluid retention, multi organ dysfunction, bone marrow and liver toxicity and fatigue.

What are the different mode of treatments for cancer?

Non-surgical or medical treatments for different cancers include chemotherapy, radiotherapy, endocrine therapy and immunotherapy

What is chemotherapy?

Chemotherapy or cytotoxic agents are drugs, which interfere with cell division. They prevent cells from multiplying. They are non-selective and will affect any cell which is rapidly dividing, whether it is cancerous or non- cancerous. Cytotoxics are usually given in combination or with drugs which interfere with replication at different phases of the cell cycle. This improves their effectiveness and reduces the likelihood of the development drug resistance. Chemotherapy is given every 21 to 28 days to allow recovery of the bone marrow. Each treatment is called a cycle and usually a course of chemotherapy involves a number of cycles. The toxicities of each agent given in combination should not overlap.