Pancreatic cancer from a different perspective • Hacker News Board

Re: Pancreatic cancer from a different perspective

#21

Post by creepydata » Thu, Jun 15, 2017, 8:36 PM UTC

melling wrote: post #15

creepydata wrote: post #8

Earlier quoted context omitted.

The most important thing you can do today to prevent pancreatic cancer is.... believe it or not, don't smoke. Smoking causes somewhere around 30% or so cases of pancreatic cancers.

What about the other 70% chance? We really need early detection. The list of famous people that I've heard of who died from pancrer cancer keeps growing: Randy Pausch - Last Lecture Steve Jobs Patrick Swayze Sally Ride - astronaut Piers Sellers - astronaut Hans Rosling Richard Hatch

And?

Where did I say anything about not needing early detection(1) or anything negative at all?

I'm giving actionable advice that you can follow right now at this very moment until we have other methods of prevention. That's what we got and it's easy to implement(2) and mildly effective.

(1) Though that's another can of worms considering there's cases where routine screening of asymptomatic individuals at low-to-average risk of a disease can actually do more harm than good, but that's another topic. Screening certainly can also be beneficial too, I'm not hating on it as a concept.

(2) Provided you aren't already a smoker. If you are, it can be difficult to quit, obviously.

Re: Pancreatic cancer from a different perspective

#22

Post by gms7777 » Thu, Jun 15, 2017, 8:42 PM UTC

lazerpants wrote: post #14

rosser wrote: post #4

Earlier quoted context omitted.

What ever happened to the point-of-care test developed by a teenager (Jack Andraka) using CNTs to isolate and test for mesothelin, a potential biomarker for pancreatic cancer? EDIT: Looks like it's tied up in various patent and testing limbos, the former of which seem somewhat self-imposed. There's also some doubt about the specificity of mesothelin to pancreatic cancer.

The most promising early warning tests I've seen in the past few years look at degraded DNA fragments floating in the blood that have been shed by cancers. This will probably be the winning technology for all cancer early diagnoses, though genetic biomarkers will probably fail to catch all cancers.

Circulating tumor DNA has several challenges towards being an effective test. The first is just the relatively low proportion of it in the blood (especially before growth is significant) makes reliable detection fairly difficult.

The bigger issue though will likely be managing the false discovery rate. Nearly everyone will have precancerous growths and benign lesions which may share many genetic biomarkers with potentially malignant growths. Many genetic variants associated with cancers occur years or decades before the development of a tumor. It may be difficult to develop a test that doesn't have a difficult tradeoff between sensitivity and specificity, prior to significant tumor growth. I do think its a promising approach, however, and look forward to see the progress researchers make in the coming years.

Relatedly, circulating tumor DNA is not only useful in diagnosis, but its already proving to be useful in the treatment of cancer. Its much less invasive than surgical biopsy, and as a result, clinicians can track the evolution of the tumor, response to specific treatments, and development of resistance in way that was just never possible before.

Re: Pancreatic cancer from a different perspective

#23

Post by epmaybe » Thu, Jun 15, 2017, 8:55 PM UTC

gthtjtkt wrote: post #3

jessriedel wrote: post #2

A reliable early warning system for pancreatic cancer is highly sought after because the disease progresses so quickly once detected. If caught while still confined to the pancreas it can often be cured by surgery, but the large majority of patients are already metastatic before symptoms appear. The one-year relative survival rate after diagnosis is 20%, and the five-year rate is 7%. In the US it is the 4th most comm…

Every time I read about something like this, I wonder how people can make it through medical school without dying of anxiety. So many terminal illnesses that could already be killing you with no early warning signs... how can they sleep!?

Lots of medical students have illness anxiety while in medical school. So far it hasn't bothered me too much, but I have friends that are on medication because of how stressed they would get thinking they had symptoms pertaining to diseases.

I can relate my only illness anxiety experience though: I had some lab tests done for autoimmune diseases, and came back negative for everything except a liver antibody test. The disease that the test is specific for has initial symptoms of fatigue and itching. You can imagine how most students have some amount of fatigue, and I must have had some contact dermatitis from something else giving me an itching sensation. There was a week long period where I thought my life was going to revolve around when I'd get a liver transplant.

Re: Pancreatic cancer from a different perspective

#24

Post by melling » Thu, Jun 15, 2017, 9:04 PM UTC

jessriedel wrote: post #19

melling wrote: post #18

Earlier quoted context omitted.

What you are saying doesn't make sense: "the disease spreads quickly once detected ". From the article, it appears that the disease is active in your body a long time before it's detected. It's just at a very late stage before it's detected. "Because it can take 20 years or more for precancerous cells to develop into full-blown pancreatic cancer"

"The disease is spreading quickly by the time it's detected" would be more clear, but my statement is technically correct as written.

This rate of change thing you are implying doesn't really exist, right? Can you provide a reference?

Once the cancer has spread outside the pancreas to other organs then it becomes more easily detectable, and symptoms show. By then it's throughout your body and you can't easily remove it.

Here's some better information on the topic: https://www.cancer.org/cancer/pancreatic-cancer/detection-di...

Re: Pancreatic cancer from a different perspective

#25

Post by posterboy » Thu, Jun 15, 2017, 9:06 PM UTC

creepydata wrote: post #21

melling wrote: post #15

Earlier quoted context omitted.

What about the other 70% chance? We really need early detection. The list of famous people that I've heard of who died from pancrer cancer keeps growing: Randy Pausch - Last Lecture Steve Jobs Patrick Swayze Sally Ride - astronaut Piers Sellers - astronaut Hans Rosling Richard Hatch

And? Where did I say anything about not needing early detection(1) or anything negative at all? I'm giving actionable advice that you can follow right now at this very moment until we have other methods of prevention. That's what we got and it's easy to implement(2) and mildly effective. (1) Though that's another can of worms considering there's cases where routine screening of asymptomatic individuals at low-to-aver…

> If you are [a smoker], it can be difficult to quit, obviously

Stop telling people that.

Re: Pancreatic cancer from a different perspective

#26

Post by mikeyouse » Thu, Jun 15, 2017, 9:07 PM UTC

rosser wrote: post #4

jessriedel wrote: post #2

A reliable early warning system for pancreatic cancer is highly sought after because the disease progresses so quickly once detected. If caught while still confined to the pancreas it can often be cured by surgery, but the large majority of patients are already metastatic before symptoms appear. The one-year relative survival rate after diagnosis is 20%, and the five-year rate is 7%. In the US it is the 4th most comm…

What ever happened to the point-of-care test developed by a teenager (Jack Andraka) using CNTs to isolate and test for mesothelin, a potential biomarker for pancreatic cancer? EDIT: Looks like it's tied up in various patent and testing limbos, the former of which seem somewhat self-imposed. There's also some doubt about the specificity of mesothelin to pancreatic cancer.

It's almost always safe to ignore any 'Wonder Teenager makes Breakthrough' articles if the field of the breakthrough is hard science. The likelihood of a novice inventing something novel in a field with tens of thousands of PhDs is so incredibly low that the breakthrough is almost guaranteed to be overstated.

George Church (and others) looked at Andraka's preprinted paper and wasn't exactly blown away. The cost and speed comparisons were wrong, the sensitivity and specificity were both too low to be clinically useful, and like you pointed out, mesothelin has some intractable problems when trying to diagnose tumors.

https://www.forbes.com/sites/matthewherper/2014/01/08/why-bi...

Kids with the aptitude and interest to devote themselves to biotech or engineering should absolutely be encouraged but putting them on the cover of magazines never works out.

Re: Pancreatic cancer from a different perspective

#27

Post by melling » Thu, Jun 15, 2017, 9:10 PM UTC

creepydata wrote: post #21

melling wrote: post #15

Earlier quoted context omitted.

What about the other 70% chance? We really need early detection. The list of famous people that I've heard of who died from pancrer cancer keeps growing: Randy Pausch - Last Lecture Steve Jobs Patrick Swayze Sally Ride - astronaut Piers Sellers - astronaut Hans Rosling Richard Hatch

And? Where did I say anything about not needing early detection(1) or anything negative at all? I'm giving actionable advice that you can follow right now at this very moment until we have other methods of prevention. That's what we got and it's easy to implement(2) and mildly effective. (1) Though that's another can of worms considering there's cases where routine screening of asymptomatic individuals at low-to-aver…

Yes, not smoking helps with all sorts of cancers, heart disease, strokes, etc. We don't all know that by now? An awful lot of healthy people get cancer.

The current belief is that a lot of cancers are just "bad luck": https://www.scientificamerican.com/article/most-cancer-cases...

Re: Pancreatic cancer from a different perspective

#28

Post by DanBC » Thu, Jun 15, 2017, 9:12 PM UTC

melling wrote: post #15

creepydata wrote: post #8

Earlier quoted context omitted.

The most important thing you can do today to prevent pancreatic cancer is.... believe it or not, don't smoke. Smoking causes somewhere around 30% or so cases of pancreatic cancers.

What about the other 70% chance? We really need early detection. The list of famous people that I've heard of who died from pancrer cancer keeps growing: Randy Pausch - Last Lecture Steve Jobs Patrick Swayze Sally Ride - astronaut Piers Sellers - astronaut Hans Rosling Richard Hatch

> What about the other 70% chance?

http://www.cancerresearchuk.org/about-cancer/pancreatic-canc...

> We don’t know what causes most pancreatic cancers. But there are some factors that may increase your risk of developing it.

[...]

> About 7 out of 10 cases (70%) of chronic pancreatitis are due to long term heavy drinking. Chronic pancreatitis is a known risk factor for cancer of the pancreas.

> Some research suggests there may be a link between heavy drinkers and risk of pancreatic cancer.

> The risk is higher in people who drink 3 or more alcoholic drinks a day compared to those who drink less than 1 alcoholic drink a day.

[...]

> The links between diet and pancreatic cancer are unclear.

> A study showed that pancreatic cancer risk was higher in men who ate 120g red meat a day compared to those who ate no red meat.

> Some studies show an increase in risk with large amounts of saturated fat in your diet.

> A diet high in folate may reduce the risk of pancreatic cancer, but different studies have shown conflicting results. Folate is found in leafy, green vegetables.

Re: Pancreatic cancer from a different perspective

#29

Post by mikeyouse » Thu, Jun 15, 2017, 9:31 PM UTC

melling wrote: post #15

creepydata wrote: post #8

Earlier quoted context omitted.

The most important thing you can do today to prevent pancreatic cancer is.... believe it or not, don't smoke. Smoking causes somewhere around 30% or so cases of pancreatic cancers.

What about the other 70% chance? We really need early detection. The list of famous people that I've heard of who died from pancrer cancer keeps growing: Randy Pausch - Last Lecture Steve Jobs Patrick Swayze Sally Ride - astronaut Piers Sellers - astronaut Hans Rosling Richard Hatch

Steve Jobs very notably had the 'good' kind of pancreatic cancer which has a very high success rate from treatment. There are two types of cells in the pancreas, exocrine cells and endocrine cells.

1. Exocrine cells - 95% of pancreatic cancer are in the exocrine cells which produce the enzymes that are responsible for food digestion, and 95% of exocrine cancers are adenocarcinomas which impact the cell lining of the pancreatic duct. This is the bad one, with a survival rate below 10% 5 years after diagnosis.

2. Endocrine cells - The other 5% of pancreatic cancers impact endocrine cells which produce enzymes to regulate your blood sugar. Jobs' cancer was reportedly a Glucagonoma which was overproducing glucagon leading to very high blood sugars. These are extremely rare cancers but broadly, with early surgery the 5-year survival rate is above 85%. The 10 year survival rate is above 65%.

That's why there was so much criticism for Jobs' delayed treatment. His tumor was first diagnosed in 2003 and he basically ignored it for a year in favor of alternative treatments and healthy eating. By the time he actually had surgery, the cancer had progressed to mets in his lymphs and his liver.

Re: Pancreatic cancer from a different perspective

#30

Post by gilbetron » Thu, Jun 15, 2017, 10:18 PM UTC

jessriedel wrote: post #2

A reliable early warning system for pancreatic cancer is highly sought after because the disease progresses so quickly once detected. If caught while still confined to the pancreas it can often be cured by surgery, but the large majority of patients are already metastatic before symptoms appear. The one-year relative survival rate after diagnosis is 20%, and the five-year rate is 7%. In the US it is the 4th most comm…

9 years ago a good friend of ours told us he had pancreatic cancer, but he hadn't yet looked into the details of the disease. The look on my face told him it was bad.

Turned out to be Islet Cell (the same type that Jobs had), and they were able to catch it in time.

He's one of the extremely rare to actually have been cured of it - and I still don't think he ever really researched the disease and doesn't really count himself one of the "real" cancer survivors.

I had Thyroid cancer at the same time and he was more worried about me ;)