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Cancer of the pancreas is notoriously hard to detect at a curable stage.
It’s hidden behind other organs, and symptoms of trouble rarely reveal themselves early. Advancements in treating pancreatic cancer have been incremental. “We’ve barely maneuvered from 5% survival to 6% survival, [and] now we are at about 9% survival,” says Dr. Jose Trevino, surgeon-in-chief for VCU Massey Cancer Center.
Jose Trevino (Photo courtesy VCU)
A study that Trevino co-authored with researchers from the University of Florida and released in the June issue of Microbiome may point the way to better outcomes for people with pancreatic cancer and other forms of the disease. The study, “The Oral Microbiome, Pancreatic Cancer and Human Diversity in the Age of Precision Medicine,” looks at the interplay between the oral and pancreatic microbiome, part of the gaggle of microbes in each of us, and how it’s shaped by factors including our genetics, behaviors, environment, race and ethnicity.
The research reviews previous studies and notes how advancements in next-generation DNA sequencing has led to a better understanding of the oral microbiome.
“All this limited but yet incredibly interesting data was coming out where, first and foremost, obviously people who have bad oral health don’t have overall good health, like periodontal disease is very much associated with cardiac disease,” Trevino says. “And as you start to read more and more into this, you realize that there are differences ... not only on the genome level, but the oral microbiome level when it comes to differences in race and ethnicities.
“We know there are differences in outcomes in cancer, in particular prostate, lung, as well as pancreatic, and then the oral microbiome in general, it seems to drive health in some cases. What an incredible idea to try to bring it all together.”
The review is a foundation for further research. Trevino, a member of Massey’s developmental therapeutics research program and the VCU School of Medicine’s chair of surgical oncology, is collecting saliva samples from pancreatic cancer patients at different stages of their lives and treatments to monitor changes in their microbiomes.
Currently, pancreatic cancer is often diagnosed at an advanced stage, with 80% to 90% of patients diagnosed at a late, incurable stage, according to the study. The American Cancer Society notes that few symptoms occur early on, and that because the organ is deep in the body, tumors are hard to detect in a physical exam.
The oral microbiome changes in people with cancer of the pancreas years before diagnosis. That insight may lead to earlier diagnosis. “The question is, is there something in our oral microbiome bacteria per se, certain bacteria, that change throughout time … that might be early detectors of cancer,” Trevino says.
Unresolved questions remain. Is a particular microbe moving directly to the tumor, or is it getting there systemically? Is it protective, or is it enhancing tumor growth?
For Trevino, the hope is that doctors may someday be able to use a simple sputum sample to screen for a disease while it’s in an early stage, or even when it’s premalignant.
“Maybe one day ... we can be thinking of something as simple as an antibiotic to somehow reverse the opportunity the cancer has to grow, and help us be more susceptible to current therapies, just a simple antibiotic which we have,” he says.
Doctors and researchers have long focused on seeking a magic bullet when it comes to healing cancers, but Trevino says there is a need to take a more holistic approach. “Cancer is so systemic, such a whole-body thing,” he says.
Trevino expects this line of research will continue throughout his career.
“As a surgeon, it’s one patient at a time right now, where I’m cutting out a cancer one patient at a time, but my hope is that one day, the work that we’re doing could help another person continue the work, and subsequently help thousands, if not millions, of people with this disease.”
Pancreatic Cancer
In 2020, pancreatic cancer was the third leading cause of death from cancer in the United States, claiming 46,774 lives, according to the Centers for Disease Control and Prevention. The five-year survival rate for pancreatic cancer patients is 11%, according to the study.
Disparities exist in the prevalence of pancreatic cancer, and also in its treatment and outcomes, according to the study. The study notes that Black Americans with pancreatic cancer are often diagnosed later and have poorer outcomes than other ethnicities. The CDC reports 13.4 deaths per 100,000 for African Americans from pancreatic cancer, compared with a rate of 11.3 in white, non-Hispanic Americans and a rate of 7.6 per 100,000 in Americans of Asian or Pacific Island descent.
