Cancer is known as the king of all diseases. Who is the king of cancer? Pancreatic cancer deserves it. Ralph Steinman, the winner of the 2011 Nobel Prize in physiology and medicine, Pavarotti, the world singer, and Alan Rickman, the "Professor Snape" in Harry Potter, died of pancreatic cancer. By all means, there is no way to take back more lives from pancreatic cancer. Once pancreatic cancer is found out, it is basically equivalent to the death penalty, and less than 10% of the people can live for more than 5 years. This was the case 40 years ago, and it is also the case today with the rapid development of medical technology. In 2018, the Lancet published a research survey to analyze the changes in the five-year survival rate of cancer patients in China over the past decade. Pancreatic cancer is still at the bottom, even falling instead of rising. Source: references [7] Why is pancreatic cancer so terrible? 1. Late discovery The early diagnosis rate of pancreatic cancer is only 5%. Although most cancers are found in late stage, pancreatic cancer is often more difficult to be found in early stage. This has to mention the geographical location of the pancreas. The pancreas, an organ, is deeply hidden in the center of the abdominal cavity. In front of it is the stomach, above it is the liver, and below it is the intestine, which is wrapped by a number of organs. Located in the "deep Palace", no matter how it turns over clouds and rains, it looks calm outside. Pancreatic cancer is not without early symptoms, such as epigastric discomfort, back pain, indigestion or diarrhea. However, these symptoms are too similar to general digestive system symptoms. They have no specificity. It is difficult for people to think about cancer, let alone pancreatic cancer. Even if they are examined, it is difficult to make early diagnosis. While the patients didn't take it seriously, cancer cells were rapidly expanding their power and "conquering cities and territories" in the body. This is another terrible thing about pancreatic cancer - it is progressing rapidly. 2. Fast progress In this regard, pancreatic cancer has several unique additions. First, more than 90% of cancerous pancreatic cells have KRAS gene mutations. This gene mutation will lead to the inactivation of "tumor suppressor" more and more frequently, which is equivalent to releasing the seal, and the tumor growth will naturally be greatly accelerated. Source: Cuihua On the other hand, pancreatic cancer also has a unique growth environment. One side of the water and soil nourishes another side of the people. The tumor also has its own side of the water and soil, which is called "tumor microenvironment". The microenvironment of pancreatic cancer is like a powerful protective cover, which can not only produce many growth factors to support the survival of tumor cells, but also resist the attack of the immune system and block the delivery of drugs. In a pancreatic tumor, cancer cells account for less than 20%, and the microenvironment supplying it is wrapped around like an iron wall. What's more, pancreatic cancer cells not only proliferate rapidly, but also metastasize easily. 3. Easy to transfer The pancreas is rich in lymphatic vessels and blood vessels, which is the fast way for cancer cells to transport to distant organs such as liver, lung, bone, brain and kidney. In addition, the pancreas is close to the stomach, intestine, bile duct and other organs. The acinus of the pancreas is not hindered by the formation of capsule, and the tumor is easy to spread directly. The stack of buffs makes pancreatic cancer metastasize in the early stage. According to statistics, about 70% of the patients who died of pancreatic cancer died of extensive metastatic diseases. 4. Difficult to treat Just mentioned, the microenvironment of pancreatic cancer blocks drugs out, so it is not sensitive to chemotherapy. The effect of "targeted therapy", which often creates miracles, on pancreatic cancer is far from ideal, and targeted drugs targeting KRAS gene are not yet on the market. Even the most popular PD-1 immunotherapy, which has made breakthroughs in many cancers, is still struggling in pancreatic cancer. At present, surgical resection is the only potential cure for pancreatic cancer, but only 15% ~ 20% of patients are suitable for surgery, and the survival rate is often not significantly improved after surgery. Surgery, chemotherapy, targeting... Every way is difficult. However, the incidence rate and mortality of pancreatic cancer have been increasing year by year even when the treatment is progressing slowly. According to the latest data released by PanCAN, pancreatic cancer will become the second largest cancer after lung cancer. This has a lot to do with the common bad habits of modern people. Do these things to keep pancreatic cancer away from yourself It is estimated that 5% ~ 10% of pancreatic cancer has a genetic component, which is beyond our control. However, the risk factors associated with pancreatic cancer have long been clear. Changing these bad habits may greatly reduce the risk of the disease. First of all, it is the old saying of weight control and balanced diet. Studies have shown that obesity (BMI ≥ 35) and a history of more than 10 years of diabetes can increase the risk of pancreatic cancer by 50%. They are also related to unhealthy eating habits. Eat less high oil and sugar foods, red meat and processed meat. You can eat a balanced diet with fresh fruits and vegetables, whole grains and lean protein. Especially eat less fried food. When the amino acids and proteins in food are fried at high temperature, they will decompose heterocyclic aromatic amines that can induce pancreatic cancer. In addition, be sure to exercise more. Exercise can not only reduce obesity and the risk of type 2 diabetes, but also inhibit cell carcinogenesis at the micro level. More importantly, quit smoking! quit smoking! quit smoking! Smoking is a clear and recognized risk factor for the incidence of pancreatic cancer. The amount of smoking is positively correlated with the incidence of pancreatic cancer. Tobacco smoke contains more than 4000 compounds, of which at least 69 are known carcinogens. Researchers found that nicotine in tobacco can induce interstitial transformation of pancreatic epithelial cells, create conditions for tumor cell invasion and metastasis, and also promote the inactivation of tumor suppressor genes, leading to the occurrence of pancreatic cancer. There are 350 million smokers in China. When they light their cigarettes, they are inviting the "cancer king" to their side. As long as you can quit smoking, the risk of pancreatic cancer will gradually decrease, or even return to normal level. In addition to smoking, drink less wine. Heavy drinking increases the risk of chronic pancreatitis, which is also a risk factor for pancreatic cancer. Pancreatic cancer is terrible, but we can choose not to be its accomplice, and help it get together at the right time, place and people. reference [1] David P. Ryan, M.D., Theodore S. Hong, M.D., and Nabeel Bardeesy, Ph.D. Pancreatic Adenocarcinoma. N Engl J Med. 2014; 371:1039-49. [2] Duell EJ, Lucenteforte E, Olson SH, et al. Pancreatitis and pancreatic cancer risk: a pooled analysis in the International Pancreatic Cancer Case-Control Consortium (PanC4). Ann Oncol 2012; 23:2964-70. [3] Aune D, Greenwood DC, Chan DS, et al. Body mass index, abdominal fatness and pancreatic cancer risk: a systematic review and non-linear dose-response meta-analysis of prospective studies. Ann Oncol 2012; 23:843-52. [4] Klein AP, Lindstr? m S, Mendelsohn JB, et al. An absolute risk model to identify individuals at elevated risk for pancreatic cancer in the general population. PLoS One 2013; 8(9): e72311. [5] Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61:69-90. [6] Bosetti C, Lucenteforte E, Silverman DT, et al. Cigarette smoking and pancreatic cancer: an analysis from the International Pancreatic Cancer Case-Control Consortium (Panc4). Ann Oncol 2012; 23:1880-8. [7]Zeng, H., Chen, W., Zheng, R., Zhang, S., Ji, J. S., Zou, X., Xia, C., Sun, K., Yang, Z., Li, H., Wang, N., Han, R., Liu, S., Li, H., Mu, H., He, Y., Xu, Y., Fu, Z., Zhou, Y., Jiang, J., … He, J. (2018). Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries. The Lancet. Global health, 6(5), e555–e567. https://doi.org/10.1016/S2214-109X (18)30127-X [8] Internal medicine 9th Edition [M] People's Health Publishing House, 2018 349-440. (Xinhua News Agency)