Diabetes And Pancreatic Cancer Connection
Research shows people with diabetes tend to have some known risk factors for cancer, such as older age, obesity, poor diet and physical inactivity. And problems common in diabetes, such as too-high insulin levels and inflammation, can increase cancer risk.
If you have diabetes, this may be concerning to you, but Michael Choti, MD, division chief of surgery with Banner MD Anderson Cancer Center in Arizona, said not to be too concerned.
Its important to recognize that most patients with diabetes do not have and will not develop pancreatic cancer, Dr. Choti said. Bottom line: If you have diabetes, your risk of pancreatic cancer is very small.
What Can I Do To Control My Blood Sugar Levels
- Take medication as prescribed. Be sure to talk with your healthcare providers and/or your pharmacist if you have any questions about your medication.
- Monitor your intake of carbohydrates. Carbohydrates are foods that break down to sugar in the body. Examples include bread, pasta, rice, fruit, milk, yogurt, potatoes and corn.
- Speak with a registered dietitian or a certified diabetes educator about your specific carbohydrate intake recommendations.
- Stay as active as possible. Exercise is very helpful when it comes to controlling blood sugar levels. Even a ten minute walk every day can help.
- Check your blood sugar levels regularly throughout the day.
Chasing Diabetes’ Connection To Pancreatic Cancer
Diabetes and pancreatic cancer affect the same organ, but they have more in common than just their location. People who have one of these conditions are also more likely to have the other one.
About 30 million Americans have diabetes. Pancreatic cancer is diagnosed in nearly 54,000 people each year, and it’s the third-leading cause of cancer-related death. Most people aren’t diagnosed until their cancer has already spread and is harder to treat.
Researchers have been looking at the link between diabetes and pancreatic cancer for many years. Now they’re trying to use this connection to diagnose pancreatic cancer earlier, when treatment is more likely to improve survival.
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The Prevalence Of Diabetes Is Increased In Pc Patients
Many cohort and casecontrol studies indicate that 2550% of patients with a diagnosis of PC will have developed DM within 13 years before their diagnosis of malignancy . This implies that recent-onset DM associated with PC is caused by pancreatic malignancy and suggests that DM is a biomarker of early-stage PC. The problem is that new-onset DM, per se, is not a powerful-enough predictor of PC to stand alone as an indication for radiological or endoscopic screening, as 98% of patients with adult-onset DM will never develop PC . Imaging protocols applied to patients with new-onset DM older than the age of 50 have not been shown to be either practical or reliable as an early detection method based on the studies in Japan , France , and the USA .
In addition to the frequent development of DM just proximate to the diagnosis of PC, the concept that PC is a cause of new-onset DM is supported by several observations. Patients with premalignant pancreatic lesions from kindreds in which PC is highly prevalent typically have concurrent DM . Furthermore, new-onset DM associated with PC has been seen to resolve after the successful resection of the tumor . In laboratory studies, PC-derived cell lines induce hyperglycemia in SCID mice , and a PC-derived S-100A8 N-terminal peptide has been identified as a diabetogenic agent .
Citation: Endocrine-Related Cancer 19, 5 10.1530/ERC-12-0105
A Trial For People At Highest Risk
Since Bob Aronsons diagnosis more than 15 years ago, researchers have come to recognize that several clinical factors can also be used to identify a subset of people with new-onset diabetes who have an especially high risk of pancreatic cancer.
Three key differences that tend to be found together distinguish these people from others with new-onset diabetes, said Dr. Maitra. One is their age, he explained. People who develop diabetes as a consequence of pancreatic cancer tend to be older, he explained.
The second is that blood sugar levels tend to rise more rapidly in people whose diabetes is driven by a tumor. And the third is weight loss, Dr. Maitra explained. Normally with type 2 diabetes, people gain weight when they become diabetic. People whose diabetes is caused by pancreatic cancer can instead experience unexpected weight loss around the time of a diabetes diagnosis.
In 2018, Dr. Chari and his colleagues proposed that these three clinical risk factors, which they called the Enriching New-Onset Diabetes for Pancreatic Cancer score, may be useful for identifying people who need additional testing now, before a blood test has been developed.
As part of the EDI, CT scans will be stored in a repository. This resource could potentially be used for future studies using artificial intelligence-based approaches to improving pancreatic cancer imaging, explained Eva Shrader, PanCANs director of scientific initiatives.
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How Do I Check My Blood Sugar
- If you do not have a blood glucose meter, ask your doctor, pharmacist, or registered dietitian for information on how to get one.
- Follow your doctors recommendations for checking blood sugar. For example, if the doctor says to get a fasting blood sugar every day, check your sugar before you eat breakfast in the morning. If the doctor says to check your blood sugar twice a day, then make sure you follow that suggestion.
- The most important times to check your blood sugar are first thing in the morning, after meals and right before bed. If you are having problems controlling your blood sugars, consider checking your blood sugars more often throughout the day.
- Your healthcare team can tell you how often and when you should check your blood sugars during the day.
- When checking blood sugars, it is a good idea to keep a log. In the log record the time, blood sugar and medications taken to help determine trends.
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How Is Pancreatic Cancer Treated
Depending on the type and stage of the cancer and other factors, treatment options for people with pancreatic cancer can include:
The doctors on your cancer treatment team might include:
- A surgical oncologist: a doctor who specializes in treating cancer with surgery
- A radiation oncologist: a doctor who specializes in treating cancer with radiation therapy
- A medical oncologist: a doctor who specializes in treating cancer with chemotherapy, immunotherapy, and targeted therapy
- A gastroenterologist: a doctor who specializes in diagnosing and treating diseases of the digestive system.
Many other specialists may be involved in your care as well, including nurse practitioners, nurses, psychologists, social workers, rehabilitation specialists, and other health professionals.
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What Should We Make Of All This
The conclusion is that its still not clear yet whether diabetes is a cause, or consequence, of pancreatic cancer. It seems likely that it can actually be either, depending on each individual case.
Whats important is that people affected by diabetes dont panic. Someone who has diabetes wont necessarily also develop pancreatic cancer.
In fact, less than 2 in 100 people with diabetes are diagnosed with pancreatic cancer in the 3 years after being told about their diabetes. And the more time that elapses after the diabetes diagnosis, the less likely it is that someone will develop pancreatic cancer although their risk is still a little higher than that of someone who doesnt have diabetes.
The number of pancreatic cancer cases is small, which means although a higher risk than the general population, a relatively small risk for people with diabetes, confirms Howarth.
Distinguishing Type 3c Diabetes From Other Types
It is not always easy to diagnose and classify a patient with type 3c diabetes mellitus correctly. Long-standing type 1 and type 2 diabetes mellitus patients are associated with exocrine pancreatic failure and patients with diabetes mellitus are at a higher risk for developing acute and/or chronic pancreatitis anyway. Patients with previous episodes of pancreatitis may also develop type 1 or type 2 diabetes independently of their exocrine pancreatic disease. In order to classify patients with type 3c diabetes mellitus correctly, commonly accepted diagnosis criteria should be established.
In distinguishing between the different diabetes types the presence of islet cell antibodies is consistent with type 1 diabetes mellitus, and the presence of clinical or biochemical evidence of insulin resistance is associated with type 2 diabetes mellitus. Due to the lack of commonly accepted diagnostic criteria up to date, we propose the following criteria for diagnosing type 3c diabetes mellitus .
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Diabetes Pancreatic Cancer And Metformin Therapy
- 1Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- 2Department of Medicine, Veterans Affairs, Los Angeles, CA, USA
- 3Cancer Prevention and Genetics, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- 4Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
Pancreatic Cancer And Diabetes A Cellular Case Of Chicken And Egg
Credit: Flickr/CC BY-NC 2.0
Weve all heard the age-old question about the chicken and the egg.
Well scientists studying the link between diabetes and pancreatic cancer are facing a similar conundrum. It seems theres a link between the two conditions, but its not clear which one comes first.
While the majority of people with diabetes will never develop pancreatic cancer, the question of whether diabetes could be a cause or a consequence of pancreatic cancer is an important one.
Answering this could help scientists better understand the biology of these two conditions, and might help spot people at higher risk of pancreatic cancer.
So, as its pancreatic cancer awareness month, weve dug into the evidence to see what is known about these links, and which questions remain unanswered.
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Warning Signs For People With Diabetes
People with diabetes don’t need to panic about getting cancer, but they should be more aware. “The chance is that less than 1% will have pancreatic cancer,” Frank says. “And the greatest risk of pancreatic cancer is in the first 1 to 2 years after the diagnosis.”
During that time, he suggests staying alert for any symptoms that could be pancreatic cancer, like unexplained weight loss, changes in bowel habits, or bloating. “If they have those mild symptoms and they have new-onset diabetes, they should talk to their doctor. They should also know their family history. If there’s cancer in the family, they should talk to a genetic counselor,” he says.
“In essence, being your own advocate is what we can recommend right now, while we do the research and see if we can get a test that can help diagnose pancreatic cancer earlier,” Matrisian says.
American Cancer Society: “Key Statistics for Pancreatic Cancer,” “Signs and Symptoms of Pancreatic Cancer,” “Tests for Pancreatic Cancer.”
American Diabetes Association: “Statistics About Diabetes.”
Cancer.Net: “Pancreatic Cancer: Statistics.”
Should Diabetics With Pancreatic Cancer Avoid Eating All Sugar
No, unless this is the advice of a physician or dietitian. Cutting all forms of sugar out of the diet will not result in the death of cancer cells because cancer cells cannot be starved. Glucose is the basic food source for all cells, including cancer cells. In a person with cancer, metabolic changes can cause the body to break down body fat and lean body mass to make energy for both cancer cells and healthy cells. This is the case regardless of sugar intake. It may be necessary to avoid foods high in simple sugars if the individual experiences problems with watery diarrhea after eating such foods. Foods high in simple sugars include rich desserts, ice cream, candy, sweetened drinks and fruits packed in syrup.
If the patient is experiencing weight loss unrelated to blood sugar control, it may be caused by cancer induced weight loss, called cancer cachexia. In this situation, chemical changes in the body cause the breakdown of body fat and lean body mass to make energy for cancer and healthy cells. It may be necessary to introduce another supplement into the diet. Consult your doctor or dietitian to find out which supplement is right for you.
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Diagnosing Type 3c Diabetes
Diagnosis and management of type 3c diabetes can be challenging, partly due to lack of awareness of the condition. But remember, we know that type 3c is linked to problems with the pancreas. So, you can ask your doctor to check for type 3c if youve had pancreatic problems and can explain your reasons why.
Researchers have identified criteria for diagnosing type 3c diabetes including poor function of the pancreas, damage that is visible on imaging scans or removal of the pancreas. Diagnosis also requires the ruling out of other types of diabetes so doctors may look for autoimmune markers for type 1 diabetes using a blood test. Giving doctors a thorough medical history may help them to diagnose the condition. We know that type 3c diabetes is linked to problems with the pancreas so you can ask your doctor to check for this if you have had pancreatic problems.
People with type 3c diabetes often require insulin therapy with regular monitoring.
Symptoms of Type 3 Diabetes
If you have Type 3c diabetes, then your pancreas may not be able to give you what you need to digest your food. This is called pancreatic exocrine insufficiency and means that your pancreas isnt working properly.
The signs to look out for can include:
- Losing weight without trying to
- Stomach pain
- Feeling more tired than usual
- Frequently passing wind
- Diarrhoea or fatty or oily stools
There are also common signs and symptoms of diabetes to look out for as well:
Advice For Patients With Type 3c Diabetes
- Eat meals little and often in a regular pattern and include starchy carbohydrates such potatoes, bread, rice or pasta
- Try not to skip meals
- You may be advised to test blood glucose levels. Your healthcare team will show you how to do this and advise you when to test.
- Consider a diary to record insulin, pancreatic enzymes, exercise and food intake
- Ask for a dietitian referral.
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Considering Complementary And Alternative Methods
You may hear about alternative or complementary methods that your doctor hasnt mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.
Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctors medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be harmful.
Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known about the method, which can help you make an informed decision.
Epidemiological Evidence Of Diabetes As A Risk Factor For Pancreatic Cancer
Diabetes or impaired glucose tolerance is present in 50-80% of patients with pancreatic cancer . More than 85% of the diabetes cases in patients with pancreatic cancer are diagnosed fewer than 2 years before the cancer diagnosis or during the cancer course. Patients with new-onset diabetes, in other words, those in whom diabetes was diagnosed no more than 2 years before cancer was diagnosed, are usually considered as having âsecondary diabetesâ caused by the cancer under the assumption that pancreatic cancer is a rapidly fatal disease: a person with pancreatic cancer-caused diabetes would not live for many years without his or her cancer being diagnosed. However, most cancers have long latencies, and many diabetes and prediabetic cases are undiagnosed before the cancer is diagnosed. No current clinical or laboratory methods accurately determine the time when disease is initiated or distinguish the type II diabetes from the pancreatic cancer-caused diabetes. Therefore, misclassification bias seems to be unavoidable in studies of the association between diabetes and pancreatic cancer.
Based on these data, long-term type 2 diabetes mellitus likely is an independent risk factor for pancreatic cancer. Additional larger studies are required to further examine the potential confounding effect of smoking and obesity on the association between diabetes and pancreatic cancer.
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Genomic Associations Of Diabetes Chronic Pancreatitis And Pancreatic Cancer
Although there is strong clinical and epidemiological evidence that links the risk of PDAC to long-standing T2DM or to chronic pancreatitis , the genetic basis of susceptibility among these three diseases varies widely, with little overlap. Indeed, genetic heterogeneity of all three is the rule. Through extensive studies of case series and families and using a variety of study designs, catalogs of genes have been identified for each condition. Interestingly, what is known about the mechanism by which these genes influence susceptibility is uneven because of the different methods used to identify the genes.
All three diseases share the following characteristics: 1) all have subsets of patients who report family history or familial clustering, which are indicators of shared genetic and/or environmental etiologies, 2) variation in age at diagnosis has been linked to familial risk in some patients, and 3) Mendelian segregation analyses provide a formal demonstration that in some families there is evidence for a hereditary component . In addition, there are epidemiological risk factors that may interact with genetic factors to enhance risk.
The Relationships Between Pc And T2dm
Many recent studies have proved that the relationship between PC and T2DM is complex and bidirectional.13 Pancreatic ductal adenocarcinoma , the most common form of PC, has been thought to be more related to T2DM.14 As American Cancer Societys Cancer Facts & Figures 2013 stated, about 25% of the patients had T2DM at the time of diagnosis of PC, and roughly another 40% had pre-diabetes.15 Besides, a total of 50% increased risk was observed in PC patients with long-term T2DM, consequently, PC can result in T2DM. Moreover, it also stated that T2DM was an early sign of the tumor. Therefore, the relationships between PC and T2DM are both cause and consequence.16,17
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