Biliary cancer, with around 5500 new cases per year, is one of the rare forms of cancer, but it is particularly risky. According to popular opinion, the tumor causes almost no early symptoms and is therefore usually only recognized late when an operation is no longer possible and the tumor has already metastasized.

Biliary cancer – important: inside or outside the liver

The fact is, however, that the colloquial term biliary cancer, medically cholangiocarcinoma (CCA), covers different forms. First of all, there is gallbladder cancer, which forms in the gallbladder, which in turn is embedded in the liver.

Secondly, a carcinoma can form in the bile ducts, which are not only located within the liver and direct the bile to storage in the gallbladder, but also away from the gallbladder, which lead the bile to the small intestine.

“Depending on the localization, we differentiate between intra- and extrahepatic carcinoma, i.e. those that develop inside or outside the liver,” explains Arndt Vogel, spokesman for the “Hepatobiliary Tumors” working group of the Internal Oncology Working Group (AIO) and head of the Visceral Oncological Center Hannover Medical School (MHH).

The risk of developing cholangiocarcinoma increases with age. Overall, the incidence of intrahepatic carcinomas is increasing, while that of extrahepatic carcinomas falls somewhat.

Risk factors for biliary cancer

An exception in connection with cholangiocarcinoma is Southeast Asia, especially countries like Thailand. This cancer often occurs there because certain parasites can inflame the biliary tract. Chronic inflammation plays an important role in the development of biliary cancer.

The following risk factors come into play in the western industrialized nations, but they are also closely related to inflammation:

• Primary sclerosing cholangitis, an inflammation of the bile ducts that mostly affects men.
• Cysts in the bile and bile ducts, including Caroli’s syndrome; they increase the risk of biliary cancer.
• Smoking, because the substances in smoke are known to be carcinogenic, are not only excreted via the kidneys and urine, but are also collected, processed and passed on in the bile.
• Gallstones; However, only when they cause problems, i.e. inflame the bile, do they promote the development of cancer.

Gallstones and biliary cancer

Around ten percent of Germans are said to have gallstones, and the risk increases with age. “But very few of those affected develop cholangiocarcinoma. This cancer is very rare, ”says the medicine professor reassuringly.

The gallbladder should only be removed if the stones cause problems, i.e. colic and inflammation.

Symptoms appear differently late, but are similar

The signs of gallbladder inflammation caused by stones are somewhat similar to those of cholangiocarcinoma (CCA).

So biliary cancer can cause the following signs:

• Jaundice (jaundice)
• nausea
• Vomit
• Pain in the left upper abdomen.

The location of the carcinoma is crucial for the stage at which symptoms appear:

• Intrahepatic carcinoma triggers these clear signs quite late, “because the liver doesn’t hurt when a tumor grows there,” explains the expert.
• Extrahepatic carcinoma, on the other hand, usually quickly means that the bile can no longer flow into the intestine. Bile congestion and jaundice are relatively early signs of this type of cancer.

That is why bile duct cancer that grows outside the liver is usually diagnosed earlier – but it is difficult to operate because of its often complicated location next to blood vessels and does not make the generally difficult situation with cholangiocarcinoma any easier, the oncologist limits the associated high expectations.

Diagnosis of cancer of the gallbladder and bile ducts

Doctors use cross-sectional image diagnostics such as MRI and CT. “This allows the suspicion to be clarified and the staging, i.e. stage and spread, to be identified,” explains Vogel.

The histological examination provides additional details about the tumor, whereby the samples in gallbladder cancer are relatively easy to obtain. However, this is more difficult with extrahepatic tumors because the biliary tract is often narrow and winding. The examination is carried out through an endoscope, the method here is called endoscopic retrograde cholangiopancreatography (ERCP examination).

Are there any less invasive methods? Ultrasound, carried out endoscopically through the stomach from the inside or from the outside, can also be informative, says the cancer specialist. However, the methods of first choice are MRI and CT.

Treatment of biliary cancer – surgery not always possible

If the suspicion has been confirmed and the results of the examination enable the tumor to be classified, the goal is to remove the carcinoma surgically. “However, as already described, this is sometimes difficult due to the location of the tumors,” reports Vogel. However, the surgical techniques have improved significantly in recent years.

The standard treatment for patients with advanced tumors is chemotherapy, with a combination of gemcitabine and cisplatin.

In a palliative situation, i.e. to lengthen survival time and / or improve quality of life, local therapies such as selective internal radiotherapy (SIRT, radioembolization) are currently used in clinical studies . Radioactive microspheres are guided to the tumor via an inguinal catheter, its cells are destroyed and healthy tissue is spared. The first results show that for some patients many months can be gained with this.

The prognosis for biliary cancer is poor …

Despite all these possibilities, few patients can be cured. Even if the tumor could be completely removed in the healthy, the recurrence rate is still relatively high. “60 to 80 percent of the tumors come back,” reports Vogel. Because the tumors spread very early.

… but with the therapy “a small revolution is emerging”

This is the bad news. In fact, these prospects could improve in the future. The oncologist says: “Because a small revolution is taking place here at the moment.” The interest of pharmaceutical companies in this rare cancer has increased significantly, and intensive work is being carried out on the development of new drugs.

The reason for this change is the fact that it has been discovered that numerous genetic changes occur in these tumors and thus allow a molecular, i.e. targeted therapy. There have been many studies on this topic for a few years now.

Two developments are particularly promising:

1. Inhibitors against IDH1 mutations , from which patients with a corresponding cholangiocarcinoma can clearly benefit.

2. Inhibitors against FGFR2 , fusions, MSI, NTRK and others.

“There are currently a number of very promising active ingredients in the test that have the various genetic changes as a starting point,” reports the oncologist. How much these new therapies could improve the treatment of biliary cancer becomes clear when one realizes that 40 to 50 percent of all these tumors, especially intrahepatic ones, show such genetic changes and are therefore suitable for targeted, molecular therapy.

Prevention Of Bile Cancer – Quit Smoking!

However, it will be some time before the new therapies are available to all patients. Until then, it is still true that biliary cancer is difficult to treat and the prognosis is unfavorable.

This makes prevention all the more important. To what extent can everyone prevent this tumor – apart from the advice not to smoke, which is so important with regard to many other diseases? The expert also has one recommendation in particular:

Get gallstones cleared up if they’re causing problems. However, this does not mean that everyone who has gallstones should be afraid: Gallstones are considered to be risk factors for gallbladder cancer, but only one percent of all gallstone carriers develop this tumor.

The hunger for meat in Germany is great. Every inhabitant eats around 60 kilograms per year. Around 750 million animals are therefore slaughtered every year. Meat consumption has been falling for years, but only in the single-digit range. However, statistically speaking, every citizen still consumes around 1,100 animals in his life, including mainly chickens, but also just under 50 pigs and four cattle, as the BUND’s last meat atlas in 2018 calculated.

Meat causes a lot of CO ₂ , but provides the best protein

Meat is thus undoubtedly one of the staple foods. However, it is left out of the picture that meat consumption is devastating for the climate balance: Through animal production, a meat eater pollutes the atmosphere with a good 1,800 kilograms of CO ₂ per year and thus heats the climate catastrophe, vegetarians only make up about half of this.

Aside from that: nutritionally, meat offers a lot of positives. “Meat is definitely a high-quality food because it provides us with protein in particularly good bioavailability,” says Antje Gahl, press spokeswoman for the German Nutrition Society ( DGE ).

Animal protein, i.e. from meat and dairy products, can be used so well by our body because the composition of the amino acids is very similar to that of human protein. Animal protein usually contains all of the essential amino acids that we need in sufficient quantities, while plant-based foods often do not have the full spectrum of these amino acids. The body can therefore produce protein particularly quickly and appropriately from animal protein – for the muscles, for example.

In addition, meat is also characterized by other valuable ingredients:

• readily available iron,

• Selenium and

• zinc

– all minerals and trace elements that are indispensable for blood formation, immune system, cell health, fertility and much more. Another unique feature is the high proportion of B vitamins, including vitamin B12 , which is only found in sufficient quantities in animal foods such as meat, eggs, milk and dairy products.

Preserving nutrients through proper cooking

To ensure that these nutrients are preserved as well as possible during preparation, the expert recommends steaming and slow frying, preferably with little fat. Some B vitamins are sensitive to heat, such as vitamins B1, B2 and B6 – vitamin B12 a little less.

The way in which meat and meat products are prepared determines how many vitamins are destroyed and how undesirable pollutants are formed. Therefore, everyone should consciously pay attention to high temperatures such as when grilling or the duration of heating. The longer and hotter it is cooked, the more pollutants are created or parts of the valuable B vitamins are destroyed.

Nevertheless, barbecuing is particularly popular . An important tip from the expert for grilling: “Dab the marinade before you put the meat on the grill.” Otherwise it will drip into the embers, burn and, among other things, produce polycyclic aromatic hydrocarbons. PAHs are strongly suspected of increasing the risk of cancer.

Meat is healthy when prepared correctly. But is it also an indispensable food? “No”, says the qualified ecotrophologist. Apart from vitamin B12, which is also contained in milk and dairy products, each of these nutrients can be obtained from plant-based foods – even if not in the ideal composition and high quality that is given with meat.

The “dark side” of meat: cholesterol, purine and arachidonic acid

However, meat is also the main source of cholesterol. In high amounts, cholesterol is a risk factor for arteriosclerosis and thus heart attack and stroke. It is not only present in the visible fat in the meat, but also in low-fat pieces. 100 grams of lean meat provide around 50 milligrams of cholesterol per 100 grams. 300 milligrams per day is the maximum limit for the intake of cholesterol per day for healthy people, i.e. without a lipid metabolism disorder.

In addition, meat, especially offal, contains purine, i.e. uric acid, which supports gout. Arachidonic acid plays a role as the third negative, natural ingredient in meat. The body creates inflammatory substances from this fatty acid. Diet suggestions for diseases with an inflammatory character such as rheumatism are therefore always meat-free or strictly reduced in meat.

“The majority of the amount of cholesterol and purine ingested with food actually comes from meat and meat products such as sausage and ham, a particularly large proportion of which have offal,” confirms the scientist. Nevertheless, cholesterol is an indispensable substance in the body because it takes on important tasks in building cells and nerves. “But our body also produces cholesterol itself and is therefore not dependent on the intake with food,” she explains. Anyone who then eats a lot of meat and sausage quickly absorbs high amounts of cholesterol.

Red meat vs. White meat

However, not all meat is created equal . When it comes to health, a distinction is made between red and white meat. Red meat, i.e. beef, pork, lamb, sheep and goat, is considered particularly unhealthy because it is said to favor diseases.

“Anyone who eats a lot of red meat and especially processed red meat has a higher risk of colon cancer, as many studies indicate, according to the current state of knowledge, consumption of white meat (poultry) is not related to cancer,” says the qualified ecotrophologist. Overall, however, the quality, quantity and method of preparation of the meat are decisive in contributing to a healthy diet.

Pork is leaner, chicken is fatter than expected

But the animal from which the meat comes also plays an important role. How about pork, the most popular meat in Germany and the other types of meat consumed in this country?

pig

Depending on the fat content, pork provides between 100 and 250 kilocalories per 100 grams, 70 milligrams of cholesterol. It also has a high content of vitamins B1 and B6.

So pork is surprisingly low in calories, but provides more cholesterol than, for example, beef. “Reach less for high-fat parts,” advises Antje Gahl, “but because of its vitamin B1 and B6, zinc and iron content, pork can make a contribution to a wholesome diet.”

Pork is popular because of its fine taste and can be used in many ways, quickly prepared and is particularly suitable as pan-fried meat (schnitzel) or roast with a crispy rind.

Beef

In terms of calorie content, beef is comparable to pork, depending on the fat, has around 150 to 200 kilocalories per 100 grams and 50 milligrams of cholesterol. It scores with high levels of vitamin B12, zinc and iron.

The strong taste of beef is particularly appreciated by many meat eaters. Because of its long fibers, beef lean meat must be specially prepared; apart from the fillet pieces, it requires a longer cooking time.

poultry

White, tender meat and a nutty taste are the characteristics of chicken, duck, turkey and goose. Because of the layer of fat under the skin, poultry meat provides a relatively large number of calories, around 270 kilocalories per 100 grams. If you choose a skin-free steak, you only get around 160 kilocalories. The fat content is around 25 grams per 100 grams of poultry meat.

In addition, poultry meat is particularly rich in protein, so it provides a lot of energy. Zinc, potassium and B vitamins make poultry meat particularly healthy.

But be careful, the crispy skin of chicken and duck contains lots of purines, so it can increase the risk of gout. This is particularly relevant for those who already have elevated purine levels, warns the expert. However, poultry is safe for healthy people in this context.

But: “Poultry meat contains significantly more cholesterol than is generally assumed, namely around 90 milligrams per 100 grams,” she adds. Chicken may be low in fat, but that doesn’t mean it’s low in cholesterol, as is often assumed.

lamb

The tender, dark meat with its strong taste is not one of the Germans’ favorite varieties. However, it contains many B vitamins as well as iron and has a high proportion of valuable protein. What is surprising, however, is that on average lamb provides more calories than pork, almost 200 kilocalories per 100 grams of fresh meat, as well as 70 milligrams of cholesterol and many saturated (unfavorable) fatty acids.

Particular attention should be paid to the fatty acid composition with many saturated fatty acids in lamb. Like chicken, lamb is not fundamentally unproblematic when it comes to fat – as is often assumed.

Wild

It looks different with game meat. Saddle of venison, venison ragout, roast venison and wild boar are rarely served in Germany, although the meat is actually very low in fat, rich in protein and rich in vitamins B1 and B2, potassium, magnesium, iron, zinc and selenium – and therefore healthy. Depending on the variety, it provides only 100 to 160 kilocalories per 100 grams of fresh produce, with less than ten grams of fat, around 60 milligrams of cholesterol and hardly any purine.

However, game meat should only be enjoyed well cooked because it can contain parasites, as the Federal Institute for Risk Assessment ( BfR ) warns. The radiation exposure of venison can also be high, depending on the region. “In wild boars, values ​​are still occasionally measured today that exceed the limit value for marketing 600 Becquerel per kilogram by more than ten times,” reports the Federal Office for Radiation Protection BfS .

horse

Horse meat is also controversial, although it is very healthy with a high content of minerals, vitamins and protein, but low in fat (around two grams per 100 grams of meat) and low in cholesterol. Here there are more psychological reasons why the meat of the popular sport animals is frowned upon, in contrast to France , where it is coveted as a delicacy.

You can eat that much meat

Meat is therefore quite healthy. “Nobody has to go without meat in principle, because it is a valuable part of our diet,” says the expert. However, it depends on the amount, and the following applies: less is more.

The DGE recommends that people who eat meat do not consume more than 300 to 600 grams of meat and meat products per week. That goes for adults. So it’s practical: eat meatless for a few days, then a meat dish. A portion of meat can weigh 100 to 150 grams, a slice of cold cuts 15 to 25 grams, depending on the type.

“Meat makes perfect sense in a wholesome diet, because it covers the need for many important nutrients with a single food. Even these small amounts are sufficient for this. It is best to choose predominantly plant-based foods and supplement them with animal-based foods, ”emphasizes Antje Gahl.

Of course, that doesn’t mean everyone has to eat meat. Those who prefer a vegetarian diet can supply these nutrients through a targeted selection of different types of vegetables and fruits, whole grain products, legumes, nuts and dairy products.

Organic meat or meat from conventional farming

Meat consumption in moderation is therefore quite healthy. It is not necessary to weigh one type of meat against another. Variety as well as personal preferences, taste and last but not least religion are important, emphasizes the qualified ecotrophologist. For more and more people, the ecological balance of rearing and animal welfare also play a role, keyword antibiotics, but also manure pollution and thus nitrate in the groundwater.

In organic animal husbandry, even fewer antibiotics may be used than in conventional farming, although there has also been a reduction recently. It is different with manure, whether organic or bulk, every animal produces just as much of it.

The best advice: eat less animal foods and more plant-based ones. In this way, fewer resources are used, the environment is less polluted and CO ₂ emissions would be significantly reduced. Because meat production in particular produces a lot of the climate gas methane, which is many times more harmful to the climate than CO ₂ .

Halve meat consumption

But as mentioned at the beginning: With 60 kilograms of meat consumed per person per year, Germany is far from the moderate recommendations of the DGE, which make up at most half of this amount. Accordingly, healthy meat consumption should hardly exceed around 30 kilograms per year – for the benefit of health, animals and the environment.