Diabetes is the main cause of cancer-unrelated mortality among cancer survivors. Numerous studies have suggested that diabetes increases risk for developing cancer. A recent South Korean study found that having cancer itself also increases risk for developing diabetes. Researchers followed 494,189 patients between ages 20 and 70 without diabetes and cancer for a median of seven years. A follow-up revealed that 15,130 people developed cancer and 26,610 developed diabetes over time. Based on the results, it can be said that at any given time, 1.35X as many stomach cancer patients will develop diabetes compared to people without cancer. In general, cancer patients develop other clinical problems more frequently than non-cancer patients. Thus, routine diabetes screening should be conducted among stomach cancer patients.
Risk Factors
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Two studies have suggested that successful gene editing with CRISPR Cas9 (to cure genetic diseases) may be associated with an increased risk of developing cancer. This is because the edit may indicate that the modified cell lacks the cancer-suppressing protein, p53. P53 acts as the body’s cellular “first aid” kit and also causes some CRISPR edits to fail. When CRISPR makes a cut in the DNA of a cell (to remove deleterious mutations), p53 can be triggered to repair the broken cell or make it self-destruct. When these incidences do not occur and genes are successfully edited, this suggests that p53 is not functioning properly in those edited cells. Since dysfunctional P53 causes significant stomach cancer risk, there are concerns that transplanting CRISPR edited cells into the body could lead to cancer. Other scientists argue that there’s no clear connection between CRISPR editing and potential cancer. For that to be true, CRISPR-edited cells intended for transplantation have to be permanently lacking in p53, which has not been established. Also, these study results are based on cultured cells, which may act differently when transplanted back into the human body.
Genomics
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This article consists of two letters to the editor regarding a clinical trial in which the relationship between Helicobacter Pylori eradication and rate of new tumor occurrences unrelated to gastric cancer (metachronous gastric cancer) and grade of corpus atrophy was examined. In a potential trial conducted in South Korea, early gastric cancer patients who received treatment to eradicate H. pylori showed a lower rate of metachronous gastric cancer than patients in the placebo group; the patients in the treatment group also showed more improvement from baseline in the grade of corpus atrophy. Corpus atrophy was found to be more common among patients with persistent H. pylori infection than patients who had received H. pylori treatment. With regards to the recurrence of gastric cancer after eradication of H. pylori and the relationship between atrophic gastritis and metachronous gastric cancer, the authors responded that their results are not conclusive due to small sample size and number of events. The authors established that H. pylori treatment antibiotics may impact patients’ risk for other cancers and conditions but overall, H. pylori treatment should be given to early gastric cancer patients to reduce the occurrence of metachronous gastric cancer and the need for surgery.
Diagnosis and Screening
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June 3, 2018 – Increase in lifestyle-related cancers over past decade spotlights need for prevention
A recently published study found that cases of lifestyle-related cancers increased universally, while cases of cancers from infectious causes—including stomach cancers – decreased between 2006 and 2016. The 2016 rankings for the best and worst countries for stomach cancer according to number of new cases showed South Korea as the worst country with 44.5 new cases per 100,000 people and Namibia as the best country with 2.7 new cases per 100,000 people. Globally, there are 17.3 new cases for every 100,000 people. In terms of deaths, Mongolia is the worst country with 44.0 deaths per 100,000 people and Maldives is the best country with 3.2 deaths per 100,000 people. Globally, 12.6 people die in every 100,000 people.
Risk Factors
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A new modeling study suggests that gastric-cancer screening could be cost-effective in high-risk racial and ethnic groups in the U.S. When diagnosed at an early stage, patients with gastric adenocarcinoma (GA) have a five-year survival rate of 95% to 99%. But, if detected later, the survival rate drops to less than 30%.
Thus, it is recommended for people to get screened early on. However, since the prevalence of noncardia intestinal-type gastric adenocarcinoma (NCGA) in the US is low, it is not recommended for everyone.
Results of the study showed that screening with upper endoscopy (EGD) and additional surveillance only if the test detected intestinal metaplasia (IM) or more severe pathology was cost effective for Asians Hispanics, and non-Hispanic blacks. For non-Hispanic whites, it was not cost effective.
Symptoms, Screening, & Early Detection
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Research has shown that certain gut bacteria appear to boost people’s response to cancer treatment. Some microbes can be adversary and activate inflammatory responses that disrupt the body’s protection mechanisms or make cells resistant to drugs, promoting cancer survival. Other gut bacteria, however, can help defend against tumors. Studies have shown that some cancer treatments depend on the gut microbiome activating our immune system. Thus, researchers are trying to manipulate the composition of beneficial microbes in the intestines of cancer patients that don’t respond to immunotherapies to see if it can help treatment. University of Pittsburgh immunologists are partnering with the pharmaceutical company Merck to conduct clinical trials in which fecal bacteria will be collected from patients who respond to treatment and transferred into the intestines of non-responding patients. Scientists from the MD Anderson Cancer Center are also partnering with the Parker Institute for Cancer Immunotherapy and Seres Therapeutics to conduct clinical trials for fecal microbiome transplant. It’s still unclear exactly how microbes might interact with immunotherapy drugs. With regards to side effects, fecal microbiome transplants have proved safe and effective in many people without cancer but unexpected effects can always occur.
Clinical Trials Information
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Medical marijuana can exist in a variety of formulations such as dried flowers, resins, extracts and oils. It’s legalization and use for medical purposes is still a developing issue and the perspectives of many health care providers is also following the same path. Medical marijuana can be used to ease chronic pain, chemotherapy-induced nausea and vomiting (CINV), sleeping disorders and certain anticancer agents. Overall, the evolution of medical marijuana is a conflict-ridden issue, but its efficacy has demonstrated as a possible method of treatment for a variety of conditions.
Cancer Treatment Side Effect Management
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Certain cancers and their treatments can lead to heart problems. Generally this occurs
in three ways: 1) cancer can metastasize to the heart or its lining 2) certain rare tumors
can release chemicals into the bloodstream that damage the heart’s valves and
muscles 3) certain white blood cell tumors secrete proteins that become sticky deposits
known as amyloids, which damage the heart. It’s important to note that many cancer
risk factors overlap with those for cardiovascular disease and cancer patients generally
experience more heart problems than the average person. For patients without risk
factors, heart problems may still be a threat as some treatments are known for
cardiotoxicity. Cancer treatments can cause structural problems, vascular conditions
that affect blood vessels, myocardial dysfunction and heart failure, and electrical
conduction issues. Some side effects can occur years after cancer treatment is ended.
Thankfully, there’s a growing number of cardio-oncology teams with medical staff
trained to deal specifically with these issues.
Article Source: Malmo, Katherine. (2018). Straight to the Heart. Cure, pp. 20-23
Side Effect Management
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The goal of this study was to test the effect of HIPEC (Hyperthermic Intraperitoneal Chemotherapy) on survival and postoperative outcomes after complete cytroreductive surgery compared with resection alone. At 3 years, HIPEC significantly improved overall survival with almost 26% of patients alive at 3 years compared with 13% of patients in the surgery alone group. The median overall survival was 18.8 months for patients treated with HIPEC compared to 12.1 months for surgery alone. Survival results at 5 years were consistent. About 20% of patients were still alive at 5 years, and 15% of patients were considered cured by HIPEC. In conclusion, cytoreductive surgery plus HIPEC improved overall survival compared with resection alone for patients with gastric cancer with peritoneal carcinomatosis.
Clinical Trials
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John Hopkins Kimmel Cancer Center researchers developed a single blood test that can detect for eight common cancer types through assessment of the circulating proteins and mutations in cell-free DNA. The test, called CancerSEEK, is a unique noninvasive, multianalyte test that simultaneously evaluates levels of eight cancer proteins and the presence of cancer gene mutations from circulating DNA in the blood. The test was evaluated on 1,005 patients with nonmetastatic, stages I to III cancers of the ovary, liver, stomach, pancreas, esophagus, colorectum, lung or breast. For the five cancers that have no screening tests—ovarian, liver, stomach, pancreatic and esophageal cancers— the median overall sensitivity, or the ability to find cancer sensitivity ranged from 69 percent to 98 percent. The test had greater than 99 percent specificity for cancer.
Symptoms, Screening & Early Detection
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