Difficult to diagnose and cure, pancreatic cancer is becoming more common. It is a hidden cancer, often discovered too late for surgical removal or chemotherapy. As scientists explore the complex, evasive tactics of pancreatic cancer cells, they are learning a new method of successfully treating cancer.
What is the Pancreas?
The pancreas is a critical organ that is located behind the stomach. It is small – only about six inches long – but it is absolutely necessary for survival.
Like a miniature factory, the pancreas digests fats, carbohydrates and protein. It secretes insulin, and diabetes occurs when the pancreas is no longer able to produce sufficient insulin to digest sugar.
Steadily Increasing Cases of Pancreatic Cancer are Highly Fatal
In a 2011 article by Nancy Marie Brown of Dartmouth College, she states that pancreatic cancer is on the rise. She cites American Cancer Society data from 2007, which showed that approximately ninety percent of persons diagnosed with pancreatic were predicted to die.
According to Brown, the high mortality rate is due to the fact that pancreatic cancer is very difficult to diagnose and even more challenging to treat.
Why Is Pancreatic Cancer Difficult to Diagnose?
- The pancreas is hidden behind the stomach and cancer cells are hard to detect.
- Pancreatic cancer is a cancer of epithelial cells, which are both external skin cells and cells that cover internal organs. Cancers of epithelial cells are called “carcinomas” and more difficult to detect than other forms of cancer.
- To diagnose pancreatic cancer, a tube must be inserted into the stomach to take a picture of the pancreas. With no symptoms, such an invasive procedure cannot be justified in routine preventive health care. By the time symptoms appear, it is usually too late for surgery or successful chemotherapy.
Pancreatic Cancer Cells are Resistant to Chemotherapy
Even when diagnosed in time for chemotherapy, Brown explains that pancreatic cancer cells are extremely complex and frustrate attempts at therapy.
Their activity can be compared to “morphing” or to a three dimensional puzzle: as chemotherapy drugs try to destroy pancreatic cancer cells, the cancer cells actually signal each other to react with multiple simultaneous mutations, evading the effects of therapeutic chemicals.
Epigenetics Responds to the “Multi-dimensional Cancer Cell”
Although pancreatic cancer cells mutate very rapidly, the mutations can be tracked and studied. This has been made possible by the science of epigenetics, defined as follows by the Genetic Science Learning Center at the University of Utah:
“The development and maintenance of an organism is orchestrated by a set of chemical reactions that switch parts of the genome off and on at strategic times and locations. Epigenetics is the study of these reactions and the factors that influence them.”
Epigenetics Makes Progress in Pancreatic Cancer Research
Researchers at the Johns Hopkins Kimmel Cancer Center combined epigentics and DNA sequencing technology to study mutations in pancreatic cancer cells and have already discovered the following.
- Some chemotherapy patients with endocrine pancreatic cancer show the same three gene mutations (MEN-1, DAXX and ATRX). Because of the similarity in mutations, scientists were able to identify this subtype of pancreatic cancer, which has a better prognosis than other forms of the disease.
- Other patients undergoing chemotherapy for endocrine pancreatic cancer showed mutations of entirely different genes ("mTOR pathway genes," TSC2, PTEN, and PIK3CA). Patients with this subtype of cancer responded well to an anti-cancer drug called everolimus.
- By far the most common and deadly form of pancreatic cancer occurs in the duct, or entrance to the pancreas. These cancers showed much greater numbers of mutations than patients with endocrine pancreatic cancer. It is hoped that the same methods can be used to identify and destroy ductal cancer cells.
Improved Survival of Pancreatic Cancer through Epigenetics
The ability to recognize patterns of genetic mutation, through the science of epigenetics, will enable researchers to categorize different types of pancreatic cancer.
When doctors are able to differentiate between subtypes of pancreatic cancer, they can determine which chemicals will be most effective in treating pancreatic cancer.
Epigenetics: Hope for Successful Treatment of Pancreatic Cancer
Because pancreatic cancer is so complex, it has caused researchers to turn to epigenetics to identify subtypes of pancreatic cancers and personalize treatment. In the future, epigenetics may enable doctors to target other deadly forms of cancer with the most effective chemicals for successful therapy.
References
Brown, Nancy Marie, “Pancreatic cancer: Deadly and on the rise,” © 2011 Trustees of Dartmouth College.
“Genetic Study Reveals Clues to Pancreatic Cancer.” NCI CANCER BULLETIN, January 25, 2011, Volume 8 / Number 2.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
