Pancreatic Cancer and Alcohol: An Overview

Introduction

Pancreas is an organ located behind the stomach (abdomen). It helps in digestion of food by secreting juices, called pancreatic enzymes, which aids in digestion. Food that we consume is broken down into fats, starch, and sugars by these pancreatic juices. It also helps to regulate blood glucose levels by secreting insulin and glucagon hormones.

What Is Pancreatic Cancer?

Cancer (abnormal growth of cells) can develop in the pancreas. Among all other cancers of the pancreas, pancreatic adenocarcinoma is the most common (95 %), and the other types include ampullary cancer (carcinoma of the ampulla of Vater) and neuroendocrine tumors.

What Is a Risk Factor?

Risk factor is defined as anything that increases the chance of getting the disease. Different risk factors are associated with different types of cancers, for example, smoking, alcohol intake, family history, and age. Having a risk factor does not indicate that the person will get cancer, and people with cancers may not also have risk factors.

What Are the Types of Pancreatic Cancer Risk Factors?

There are three types of risk factors:

1. Risk factors that can be changed.

2. Risk factors that cannot be changed.

3. Risk factors whose effect needs to be clarified.

Risk Factors That Can Be Changed:

• Overweight: Being overweight is always a risk factor for any type of cancer, and pancreatic cancer is not an exemption. People with excess weight whose BMI (body mass index) exceeds 30 are more prone to developing pancreatic cancer. About 20 % of the adults who are gaining weight are more likely to develop cancer.

• Chronic Pancreatitis: Chronic pancreatitis patients are often associated with heavy intake of alcohol along with smoking, and long-term inflammation and infection of the pancreas which can lead to cancer.

• Diabetes: People with diabetes are more prone to pancreatic cancer, especially people with type 2 diabetes. This type of diabetes is seen in all age groups, and being overweight or obese is one of the reasons for developing type 2 diabetes.

• Smoking: It is considered a risk factor for any cancer. Cigar, cigarette smoking, and tobacco usage (smokeless) can increase the chances of pancreatic cancer by 25 %. However, once the person stops smoking and using tobacco, the risk factor decreases.

• Exposure to Chemicals at the Workplace: People exposed to certain metals, dyes, and chemicals continuously at their workplace are more likely to have cancer.

Risk Factors That Cannot Be Changed:

• Genes: Pancreatic cancers seem to run in the family due to genetic inheritance. Therefore, persons with a family history of pancreatic cancer are at risk of developing cancer. However, all the patients with pancreatic cancer do not have a family history of cancer. For example: If chronic pancreatitis (swelling of the pancreas) runs in the families, people in the family are at risk of pancreatic cancer throughout their lifetime.

• Age: Risk of developing pancreatic cancer increases with an increase in age. People above 45 years of age are at an increased risk.

• Gender: When compared to women, men are prone to cancer. It can be interlinked as consumption of alcohol and smoking is seen more in males when compared to females.

• Genetic Syndromes: Genetic changes or mutations in DNA (deoxyribose nucleic acid) of the genes passed from parents to their children. These genetic changes can increase the risk of pancreatic cancer by ten percent. These genetic changes can cause certain syndromes in people with an increased risk of cancer. Some of these syndromes include:

  1. Familial Pancreatitis: caused by PRSS1 gene.

  2. Hereditary Breast Cancer: caused by the PALB2 gene.

  3. Lynch Syndrome: caused by a defect in MLH OR MSH2 GENES. This syndrome is also known as non-polyposis colorectal cancer (HNPCC).

  4. Hereditary Breast and Ovarian Cancer: caused by BRCA1 or BRCA 2 gene mutations.

  5. Peutz-Jeghers Syndrome: caused by defects in STK11 genes.

Risk Factors Whose Effect Is Not Clear:

• Physical Activity: Lack of physical activity will cause several health hazards, including pancreatic cancer. Regular physical activity will keep the person healthy and reduce the number of diseases like cardiovascular diseases.

• Diet: Intake of red meat, processed meats, and saturated fatty foods show an increased risk of pancreatic cancer. High sugar intake is considered a risk factor for cancer. Intake of coffee also shows an increased pancreatic risk.

• Alcohol Intake: There is a strong association between alcohol intake and cancer. People with heavy alcohol intake are more prone to pancreatic cancer.

• Infections: Stomach infections caused by H pylori (helicobacter pylori) and infections with Hepatitis B, show cancer risk.

How Does Alcohol Harm Pancreas?

Alcohol is mainly made up of ethanol and water. After the intake of alcohol, it gets partially metabolized in the pancreas. During the metabolization process, some metabolites like acetaldehydes (one of the main metabolites of ethanol) are generated in the pancreas, which is toxic to pancreatic cells. These changes cause inflammation of the pancreas (pancreatitis), which in turn, causes pancreatic cancer.

Alcohol can also damage the pancreas by other processes like oxidative stress (difference between production and accumulation of oxygen in the cells), cellular damage (by inflammation), unregulated NADH/cytochrome p450 enzymes, and free radical formation.

What Is the Relation Between Smoking and Alcohol Intake in Pancreatic Cancer?

Smoking causes changes in DNA (deoxyribose nucleic acid), and smoking and alcohol consumption have overlapping effects on pancreatic cancer. For example, long-term alcohol consumption increases p450 cytochrome activity, increasing the cigarette smoke metabolites that cause pancreatic cancer.

Pancreatic Cancer and Alcohol Intake: Is There a Connection?

Research shows a strong association between alcohol intake and pancreatic cancer. In addition, smoking modifies the association between cancer and alcohol intake. People smoking and consuming alcohol in light, moderate or severe doses show a more than two-fold increased risk of pancreatic cancer, and there is increased risk in people with heavy alcohol intake and heavy smoking.

Conclusion:

Intake of alcohol harms the pancreas and there is a significant relation between alcohol intake and pancreatic cancer. Alcohol consumption decreases the survival rates post treatment, it also aggravates the side effects of treatment. Alcohol intake and smoking when combined together, doubles the risk of pancreatic cancer.