Sunday , 19 May 2019

Fighting pancreatic cancer

Nandkumar Kamat

Having lost two uncles aged 60 and 67 to carcinoma of stomach or gastric cancer, I have always dreaded cancer. In both cases from detection, treatment and death everything was over within three years. But there is lot of hope ahead with better surgery, radiation therapy and chemotherapy. Immune therapy is advancing fast. It has many challenges in treating pancreatic cancer because the mechanisms are different.

If scientists become successful to direct killer T cells to affected region in pancreas then it would be a big breakthrough. The immunosuppression barrier around pancreatic cancer is like a firewall which makes effort to kill the cancer cells selectively very difficult. But scientists are developing many animal models and growing simulated cancerous organoids artificially to study the full metabolism. The trick lies in starving the cancer cells off their energy and supplying more energy to immune cells and making them active. Anyone worried about cancer needs to somehow survive for just five to 10 years for effective cures. Drug and vaccine developers are sure that within 20 years battle against all types of cancers would be won.

The obsession to read about cancer was so much when I was studying for M.Sc. Biochemistry at Goa Medical College that I didn’t leave out any available book on the subject. My uncle breathed his last right in front of me and the full trajectory of his disease had unfolded before me. Several factors are making people in Goa more susceptible to various types of cancers. Very few people know that inherited defect in genes such as BRCA1, BRCA2 or PALB2 makes one susceptible to pancreatic cancer. Pancreatic cancer shows first signs when eyes and skin shows yellowish tinge, suddenly without any reason one feels back or abdominal pain with weight loss and when there is late onset of diabetes.

Pancreatic cancer is difficult to detect. Only 20 percent patients can go for surgery. Only 25 percent patients survive after surgery. Who is at high risk? Almost all cigarette smokers. Besides people having some rare inherited gene defects, close relatives with pancreatic cancer are susceptible. Non obese middle aged people with new diagnosis of diabetes are also at risk. Problem with pancreatic cancer is the cells travel in bloodstream and spread everywhere and if they reach the liver they can form small tumours. A drug combination called Folfironox is used to control the cancer provided the capillary network to carry the drug hasn’t collapsed.

This collapse is known as fibrosis and proves to be a big challenge in chemotherapy. Drug developers are working very hard to crack KRAS gene, the mutations in which drive this cancer. They tried everything to find some crack in KRAS gene but so far no candidate drug ligand has been found which can bind and block its expression. In May 2018 Dhar and other researchers published some promising results on use of Bitter Melon Juice (BMJ) in targeting cancerous pancreatic cells (Dhar, Deepanshi, et al “Bitter melon juice exerts its efficacy against pancreatic cancer via targeting both bulk and cancer stem cells” Molecular carcinogenesis (2018)). They used Chinese variety of commercially available bitter melon (karela) and claimed that the juice is useful in attacking gemcitabine resistant cancer cells. BMJ is known to contain mainly cucurbitane‐type triterpenoids, triterpene glycoside, phenolic acid, flavonoids, essential oils, fatty acids, saponins and amino acids. Now their research provides certain leads to us about change in our diets which now excludes anything tasting bitter.

Cucurbitane-type triterpenoids and other phytochemicals have been very effective in fighting various types of cancers. Goans traditionally cultivated and consumed bitter gourds and muskmelons. The Goan traditional diet included various recipes of ‘karatim’, ‘karle’ or bitter gourds. To overcome the bitter cucurbitin taste cooks used to pickle it with lemon juice and make it more palatable. Slices used to be deep fried and served. It is now becoming clear that such bitter fruits were intentionally included in traditional diet because somehow people knew for the centuries that secret of prevention of cancer may be in the edible but unpopular plants around us. The claims on BMJ fighting off and killing cancerous pancreatic cells doesn’t mean that people ingesting such juice would be cured of the cancer. It only shows us the way we have changed our diets by excluding bitter tasting items.

We need to also carefully look into the ancient Divali tradition of crushing ‘the wild common muskmelon, Cucumis melo variety agrestis and then putting a little juice on the tongue. The medicinal properties of this bitter fruit are known. However the needle of suspicion for rise of pancreatic cancers mainly points to our food, water, milk intake all laced with unknown xenobiotics or unidentified carcinogens. Its difficult to see precisely which xenobiotic triggers the genes causing pancreatic cancer. Organically grown food may be the best choice to prevent cancers. Avoiding water and milk of poor quality, avoidance of tobacco and alcohol and going back to our traditional diet with focus on lesser known fruits and vegetables may be the key to prevent pancreatic cancer. At present only five to nine percent pancreatic patients survive beyond five years of treatment. So there is lot of hope ahead as new diets, drugs and remedies get discovered. Till then only cure for pancreatic cancer is to prevent it in first place.