Healthy Cooking Columns

Pancreatic Cancer

Pancreatic cancer forms in the tissues of the pancreas. The incidence of pancreatic cancer is much lower than that of other cancers – only 3% of all cancers are pancreatic cancers – yet diagnosis is difficult because it is located behind the liver and stomach, deep in the body. It does, however, account for about 7% of all cancer-related deaths due to the aggressive nature of the tumor, the typically advanced stage at diagnosis, the challenges of surgery, and the limitations of existing drug therapies.¹

The majority of pancreatic cancers (85%) are adenocarcinomas (cancers of mucus-secreting glands), including ductal (the most common type of pancreatic cancer overall), exocrine (the exocrine glands make pancreatic enzymes) and invasive adenocarcinomas; the remaining minority of pancreatic cancers are acinar cell carcinoma (a subtype of exocrine cancer) and neuroendocrine tumors (sometimes called islet cell tumors).² There’s a good explanation of these subtypes at cancer.org.

The average age of pancreatic cancer patients at diagnosis is 71, and a family history for pancreatic cancer increases your risk by 9%.

• About 1 in 67 American men will develop pancreatic cancer (approximately 1.5%)
• Average number of deaths per year is about the same as the estimated number of new cases (46,000).
• 25% of those with pancreatic cancer will survive beyond 1 year
• 5 to 6% of those will survive beyond 5 years

Major risk factors include:

• Chronic pancreatitis (increases risk by almost 3 times)
• Hereditary pancreatitis (lifetime risk of 40-55%)
• Family history of pancreatic cancer (9%)
• Prolonged tobacco use or smoking (increases risk by 2 to 3 times)
• BMI >35 (increases risk by about 55%)
• Heavy alcohol usage ( >3 drinks/day) (increases risk by as much as 36%)

Diet and Risk of Pancreatic Cancer

As with numerous digestive tract tumors there is correlation between pancreatic cancer and diet. There is data showing many dietary items can either increase or decrease the risk of pancreatic cancer.

Flavonoids

Flavonoids, bioactive food components from fruits and vegetables, have been associated with reduction in the risk of developing pancreatic cancer and inhibiting metastasis (spreading to other body parts, including organs or bones) and cancerous cell growth. The following are examples of flavonoids found in fruits and vegetables and some of their theorized effects on cancerous cell growth:

Apigenin and luteolin help reduce cancerous cell growth. Dietary sources of apigenin include spices, such as rosemary and basil, and leafy greens, like spinach.³

Quercetin also helps prevent cancerous growth and helps induce cellular death in cancerous cells. Quercetin can be found in a multitude of fruit and vegetable sources, including kale, apples, broccoli, cauliflower, turnips, buckwheat tea, green tea, sweet potatoes, dill, and red wine.⁴

Genistein is found predominantly in soybeans, fava beans, and legumes, also helps induce cellular death in cancer cells and interferes with cancerous cell growth. It also enhances the effectiveness of chemotherapy drugs, including gemcitabine (trade name: Gemzar©) , erlotinib (Tarceva©), and cisplatin (‎Platinol©). Genistein can also be found in prairie turnip (a root vegetable similar to potatoes) and coffee. ^5,6

Protein

Studies on the role of dietary proteins and pancreatic cancer have seen differences between the effects of animal-based protein and plant-based proteins in the diet. Diets with exclusively plant-based proteins were found to prevent pancreatic cancer – some researchers believe this is by inhibiting cancer cell growth.⁷ Plant based sources of protein include quinoa, buckwheat, hempseed, chia, soy, beans, and peanuts.

Diets high in fat and animal-based protein, however, appears to interfere with the natural repair mechanisms that can lead to pre-cancerous lesions healing spontaneously.⁸

Vitamins

Vitamins play a large role in the development of pancreatic cancers and preventing them from spreading. Important vitamins include vitamin D, vitamin E, and folate. (Download the PDF: Amounts of Folic Acid in Common Foods).

The active form of vitamin D binds to Vitamin D receptors produced by pancreatic cells and helps kill cancerous cells. It also reduces the risk of the cancer spreading by inhibiting the creation of new cancer cells, the creation of blood vessels that feed cancerous tumors, and metastasis. In addition to sunlight (UV rays), dietary sources of vitamin D include liver, mushrooms, eggs, and fatty fish such as salmon, tuna, eel, and mackerel.^9,10

Vitamin E, which is commonly found in nuts and greens, helps with deactivating certain proteins that stimulate cells to grow and divide, which inhibits cancer cell growth. It is also believed to enhance the effectiveness of the chemotherapeutic drug, gemcitabine (Gemzar). Dietary sources of vitamin E include wheat germ oil, almonds, sunflower seeds, spinach, peanuts, broccoli, and hazelnuts.^11,12

What this means for you

To help reduce your risk of developing pancreatic cancer, avoid tobacco products, maintain a healthy weight, and keep your alcohol consumption moderate. Making small dietary changes can have a positive lasting effect, so decrease your intake of animal fat and protein, replace them with plant-based proteins and fats, and eat plenty of vegetables and fruit.

1. Jemal, A., Siegel, R., Xu, J., Ward, E., Cancer statistics, 2010. CA Cancer J. Clin. 2010, 60, 277-300.

2. Seufferlein, T., Bachet, J.B., Van Cutsem, E., Rougier, P., Pancreatic adenocarcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Ann Oncol. 2012, vii33-40.

3. Melstrom, L., Salabat, M., Ding, X., Milam, B. et al., Apigenin inhibits the GLUT-1 glucose transporter and the phosphoinositide 3-kinase/Akt pathway in human pancreatic cells. Pancreas. 2008, 37, 426-431.

4. Gibellini, L., Pinti, M., Nasi, M., Montagna, J. et al., Quercetin and cancer chemoprevention. eCam. 2010, 1-14.

5.Banerjee, S., Zhang, Y., Ali, S., Bhuiyan, M. et al., Molecular evidence for increased antitumor activity of gemcitabine by genistein in vitro and in vivo using an orthotopic model of pancreatic cancer. Cancer Res. 2005, 65, 9064-9072.

6. Pavese, J. Farmer, R., Bergan, R. Inhibition of Cancer cell invasion and metastasis by genistein. Cancer Metastasis Review. Sep 2010; 29(3): 465-482

7. Fontana, L., Adelaiye, R., Rastelli, A., Miles, K., Ciamporcero, E., Longo, V., Nguyen, H., Vessella, R., Pili, R. Dietary protein restriction inhibits tumor growth in human xenograft models of prostate and breast cancer. Oncotarget. 2013, 4, 2451-2461.

8. Z’graggen, K., Warshaw, A., Werner, J., Graeme-Cook, F., Jimenez, R., Fernandez-del Castillo, C. Promoting Effect of a High-Fat/High-Protein Diet in DMBA-Induced Ductal Pancreatic Cancer in Rats. Ann Surg. 2001, 233(5), 688-695.

9. Bao, Y., Ng, K., Wolpin, B., Michaud, D. et al., Predicted vitamin D status and pancreatic cancer risk in two prospective cohort studies. Br. J. Cancer 2010, 102, 1422-1427.

10. Skinner, H., Michaud, D., Giovannucci, E., Willett, W. et al., Vitamin D intake and the risk for pancreatic cancer in two cohort studies. Cancer Epidemiol. Biomarkers Prev. 2006, 15, 1688-1695.

11. Huang, P., Chuang, H., Chou, C. Wang, H., Lee, S., Yang, H., Chiu, H., Kapuriya, N., Wang, D., Kulp, S., Chen, C. Vitamin E Facilitations the Inactivation of Kinase Akt by the Phosphatase PHLPP1. Science Signaling. 2013, 6(267), 1-13.

12. Nitsche, C. Edderkaoui, M., Moore, R., Eibl, G., Kasahara, N., Treger, J., Grippo, P., Mayerle, J., Lerch, M., Gukovskaya, A. Phosphatase PHLPP1 Regulations Akt2, Promotes Pancreatic Cancer Cell Death, and Inhibits Tumor Formation. Gastroenterology. 2012, 142, 377-387.