Biliary cancer often causes no symptoms – and is therefore usually recognized too late

June 1, 2020| Eugene Craft| 0 Comment | 9:18 am

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Health

Gallbladder cancer in particular only leads to symptoms in an advanced stage. Why this is so, what role gallstones play – and why the prognosis so far has often been unfavorable.

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.

“Cancer cells are fed” – underestimated health risks lurk in meat and sausage“Cancer cells are fed” – underestimated health risks lurk in meat and sausage

Iron deficiency is often discussed. There is hardly any talk about the opposite, the frequent overloading with heme iron, the iron form made from red meat and sausage. It promotes the common diseases of diabetes, cancer and arteriosclerosis. FOCUS Online shows how you can meet your iron needs in a healthy way.

The trace element iron is indispensable for a number of vital metabolic functions in the body. As a component of hemoglobin in the red blood cells, it supplies every body cell with oxygen. Iron deficiency, which manifests itself in anemia, exhaustion, susceptibility to infection, affects around 20 percent of women and ten percent of men in Germany. The higher risk for women is explained by menstruation and decreases accordingly when the childbearing phase of life is over.

Many people have an excess of iron – and know nothing about it

Iron deficiency is known and many nutrition-conscious people pay attention to adequate iron intake. However, significantly more people could have anything but an iron deficiency, namely too much of this trace element. Probably very few people know about it, although it carries a high risk of disease.

Heme iron and non-heme iron: these are the differences

First and foremost, it is important for these relationships – there are the two known, different forms of iron, only one of which can be hazardous to health:

1. Heme iron , i.e. bivalent iron (Fe), mainly found in red meat and sausage. Heme iron has a high bioavailability, the body can use at least 20 percent from food.

2. Non-heme iron , trivalent iron (Fe3), from plant-based nutrient suppliers such as legumes, whole grains, nuts, oil seeds and various types of vegetables. Non-heme iron must first be oxidized to some form of Fe in the small intestine in order for the body to use it. In this way, only around five percent of the iron from food comes into play.

The iron requirement per day is 15 milligrams for women and 10 milligrams for men.

Underestimated health risk heme iron

What is certain is that most people in industrialized nations have at least a sufficient supply of the trace element. Due to our meat and sausage-heavy diet, a large part is even oversupplied with heme iron, and thus risks diseases. Various studies indicate these relationships .

“We assume that too much heme iron can have negative health consequences through eating meat,” explains Matthias Riedl, board member of the Association of German Nutritionists (BDEM) and diabetologist, nutritionist, internist, managing director and medical director at Medicum Hamburg.

The human organism is not prepared for high meat consumption

Normally, a complex mechanism of substances in the liver and intestines controls the iron level. If too much iron storage protein ferritin is measured, the body slows down absorption. “This does not work adequately with large amounts of heme iron, the body continues to absorb it, simply because this form of iron is extremely easy to use,” says the expert.

The nutritionist explains that the cause lies in our evolutionary history. Up until two million years ago, humans were purely plant-eaters, only then did they add animal consumption. That was sometimes more, mostly less meat – definitely a lot less than is regularly eaten today. The human organism is not prepared for this.

High consumption of heme iron feeds cancer cells

The excess iron is then deposited in the pancreas, liver and spleen, which can put stress on the organs. But that’s not all. “Heme iron can promote mutations via certain chemical compounds – for example in intestinal cells, but also in other cells,” warns the internist.

In addition, these compounds have a cytotoxic effect, so they can not only change cells, but also damage them. “And cancer cells, on the other hand, are properly fed by heme iron, so to speak,” says the expert. Malignant cells have a high demand for this trace element. A high consumption of heme iron means that existing cancer cells grow better and are stronger against the immune system.

Meat lovers are more likely to develop diabetes and arteriosclerosis

In addition to the connection between heme iron and cancer, many nutritional studies have shown two other negative effects of the “meat iron”:

1. Numerous studies show that people who consume a lot of sausage and meat are particularly likely to have type 2 diabetes .

2. In addition, this dietary preference often leads to arteriosclerosis , with the well-known secondary diseases of high blood pressure, heart attack and stroke.

“If people don’t eat ‘appropriately’, they get sick”

The higher the meat consumption, the higher the risks for cancer, diabetes and arteriosclerosis. What actually stands behind it: “If people do not eat ‘species-appropriate’, i.e. eat too much red meat and sausage and thus too much heme iron, they will get sick,” warns Matthias Riedl. It is well known that primitive peoples who still eat originally – eat very little meat and no sausage – do not have arteriosclerosis at all, for example.

Trivalent iron from plants is converted into bivalent iron

So heme iron has a rather negative effect on the body. Non-heme iron, on the other hand, does not pose these health risks – but is converted into bivalent iron in the body in order to make it available. Doesn’t it then become as unfavorable as bivalent heme iron? “No, because the trivalent iron from plants is converted into a bivalent iron, but not into heme iron,” explains the expert.

Providing the body with healthy iron – vegetables and fruits with non-heme iron

In order to provide the body with sufficient iron without meat, there are a number of plant-based foods that have a high content of non-heme iron, such as:

Lentils around 2.7mg / 100gr
Chickpeas around 2.7mg / 100gr
Peas 1,5mg / 100gr
Spinach 3,6mg / 100gr
Chanterelles 6.5mg / 100gr
Elderberry 1.6mg / 100gr
Pine nuts 9.2mg / 100gr
Millet 6.9mg / 100gr
Flaxseed, ground 8,4mg / 100gr
Amaranth 8.9mg / 100gr

Spinach contains a comparatively high amount of iron for a plant-based food, but at the same time the substances it contains can prevent it from being absorbed by the body. Beans or lentils are therefore better suited as a vegetarian source of iron.

Intelligently upgrade the bioavailability of iron from vegetables and fruits

Sure, none of these foods provide as much iron as meat. “The availability of iron from plant-based foods can be increased by cleverly combining the ingredients in a meal,” says Matthias Riedl. Vitamin C, for example, improves absorption. Suggestion for a corresponding daily plan:

In the morning: oatmeal / muesli with fruit, a glass of orange or lemon juice for breakfast,
Lunch: millet salad with paprika (the pods are extremely rich in vitamin C),
In the evening: whole wheat pasta with broccoli or parsley pesto

Coffee and tea inhibit iron availability

However, there are also plant substances that have an inhibiting effect on iron absorption. These are phytates and polyphenols, for example, these plant substances are contained in coffee and tea. So avoid these drinks during, immediately before and after a meal containing iron. In wholemeal products, on the other hand, the phytate content plays a lesser role, as they convince with their high iron content.

Cover your iron requirement healthily, certain meats are also allowed

“Those who follow a purely vegetarian / vegan diet can still get too little iron, especially women are at risk here,” says the expert.

Pregnant and breastfeeding women in particular should take preparations if they have a proven iron deficiency. Otherwise there is a ‘species-appropriate’ solution for everyone: That means a small, moderate meat meal per week, preferably poultry meat, because white meat is not statistically associated with the disease risks mentioned.

At 20, 40, 60 and 70 years: how to eat healthily at any ageAt 20, 40, 60 and 70 years: how to eat healthily at any age

Sometimes the body needs more protein, sometimes more carbohydrates and after a certain age it should be less overall. If you want to eat healthily for a lifetime, you should always keep an eye on your age when shopping and cooking.

According to today’s recommendations, a healthy diet consists of plenty of fresh vegetables and fruit, good oils, as little industrially processed food as possible, economical consumption of animal products, white flour and sugar – from children to old people.

So there is only healthy and unhealthy diet, but no age-related diet. But: Over the years and depending on the situation in life, the need and utilization of nutrients change. And here age definitely plays a role. For example, the nutritionists at the University of California in San Diego have put together an overview of what to look out for .

This is what matters from 20 to 40:

The basal metabolic rate is highest in young adults, which means that the body consumes the most calories even without physical activity. At this age, many people can “eat what they want” without getting fat. At least at this age, the body forgives a few fast-food orgies and other antics.

In general, it is important to build up muscles, bones and connective tissue between the ages of 20 and 30 , also with the help of a sensible diet. Everyone can benefit from this basis in later years, when it is no longer so easy to maintain fitness.

In these years, special attention to nutrition requires more of a life circumstance for women: pregnancy.

Special dietary instructions for young pregnant women only

In addition to a diet full of high-quality nutrients and the natural avoidance of tobacco and alcohol , it is important to ensure an optimal supply of vitamins, minerals and trace elements so that the child develops well. Eating for two, on the other hand, is completely unnecessary and wrong.

Therefore, all expectant mothers should take folic acid in the first 3 months of pregnancy . Iodine tablets can also be useful. And vegans also have to pay attention to a number of micronutrients that they lack by avoiding animal foods: iron, zinc , calcium, vitamins B12, B2 and D as well as an appropriate intake of omega-3 fatty acids.

This is important from 40:

From the age of 40, the metabolism begins to slow down. While the body can usually break down too much sugar and carbohydrates by the age of 30, it loses this ability by the age of 40 at the latest. Suddenly, an unchanged diet is reflected in the stomach and hips.

Anyone who is only now finding an adequate diet can still set the course for a healthy future.

Anyone who has already eaten reasonably healthy should now pay more attention to the following elements:

Fruits and vegetables in bright colors – the antioxidants they contain act as cell protection with an antiaging effect in the body.
more whole grains on the menu
a (small) portion of red meat twice a week – good for building muscle , also important for women because of the prevention of iron deficiency
Vegetarians should pay particular attention to green leafy vegetables such as spinach, kale or Swiss chard.

Here are some things to watch out for in your 50s and 60s:

Now begins a dangerous age for cardiovascular problems such as high cholesterol and high blood pressure. Anyone who has neglected their diet and has not taken much exercise must expect type 2 diabetes .

It is now important to have a diet that keeps the blood sugar level stable and prevents deposits in the blood vessels. It should be low in cholesterol, high in fiber and slowly digestible carbohydrates, so:

lots of vegetables
little animal fat
no sugared soft drinks
little white flour products

In addition:

nuts
Good oils (olive, flaxseed)
Fish (omega-3 fatty acids and vitamin D)
Low-fat dairy products (calcium)

Changes in hormones accelerate the loss of calcium from the bones. The substitution of calcium plus vitamin D can now counteract the threat of osteoporosis . Because of the breakdown of estrogen during menopause , it occurs earlier and more frequently in women. But bone loss threatens men too.

An omega-3 supplement can benefit heart health if someone doesn’t eat sea fish. Omega-3 fatty acids stabilize the blood vessels.

Proper nutrition with 70 plus:

With age, various physiological and psychological changes occur that directly affect nutritional needs. The taste buds and appetite decrease, as does the desire to cook freshly and by yourself.

The body is less able to absorb and use many vitamins and minerals. With age, the digestive juices in the stomach change, reducing the absorption of iron, calcium, and vitamins B6, B12, and folic acid.

Long-term use of prescription drugs can decrease the absorption of certain nutrients.

Less calories, but not less nutrients

Seniors need fewer calories than younger people, but no fewer nutrients. Protein becomes important again in old age: it can delay muscle loss in old age, especially when combined with strength training.

As a rule of thumb, one gram of protein per kilogram of body weight per day . However, it should not be exclusively protein from meat, as it promotes inflammation, especially in the joints.

Because digestion becomes sluggish with age, fiber is important for the 70+ generation. A teaspoon of psyllium husks are a recommended alternative to the vegetables or whole grains that would be necessary for an optimal supply. To do this, seniors have to drink plenty, even if that is difficult for many.

TV presenter tests diets for a year: “I’ll never give up carbohydrates again”TV presenter tests diets for a year: “I’ll never give up carbohydrates again”

For a year, the presenter and author Anna Funck pored through various nutrition trends to find out: What really makes you more beautiful, fitter and healthier? Their conclusion: It can be a little chocolate – and carbohydrates in any case.

I don’t know about you, but do you always feel so drained and overfed, especially in the first few months of the new year? Yes? My condolences. I do not anymore. I’m out of the number. But I’ll also be happy to tell you how I did it. Or as my friend Inke said the other day: “You are always so slim – despite feasting. How does that work?”

“Diets are not about the ‘what’, but the ‘how'”

My answer to that, when her eyes got bigger and bigger: “Very simple: In principle you can eat anything, it’s not about the ‘what’, it’s just about the ‘how’. Carbohydrates are okay, even chocolate is perfectly fine. ”And the best thing is: I actually only found that out on the side while I was trying to eat my family and myself as healthy as possible.

For a year I cooked my way through all the usual diet trends: from paleo and superfoods to apple cider vinegar and algae sweets to bog water, I tried a wide variety of methods.

Carbohydrates make us happy and relaxed

Since then, I’ve always shook my head a little when I hear again that Jennifer Lopez and others are calling out “No Carbs Week” on Instagram again. Carbohydrates only bark, but they don’t bite. They are not angry – on the contrary: They make us happy, let us relax and increase our ability to perceive. The brain needs carbohydrates, otherwise it will cook on the back burner.

“But they should make you fat?” My friend Inke explains to me again. Whereupon I have to laugh: “Yes, we all think so. Because we combine them incorrectly. If we only ate one type of carbohydrate per meal and took enough breaks, we would not gain weight at all. ”

Incidentally, a theory that I stumbled across during my research from Hamburg to Hollywood. Even Hollywood stars are taught that – only not the fat average German.

The body needs carbohydrates – but not too much at once

Need an example? Let’s take our breakfast. Hands up, who eats a jam roll in the morning? Mistake number one! Because there are three types of carbohydrates in jam rolls per se. The first is the cereal in the bun, the second is the fructose from the jam and the third is perhaps a refined sugar for preservation.

Our body then thinks: “Great, I know the grain, I’ll use it, but I’ll put the other two carbohydrates on my hip right away. And then I get tired and lie down first. “Hello afternoon low!

So my trick – if it has to be a roll – would be to top it with a neutral hard cheese. This meal doesn’t make you fat or tired. But please don’t use a soft camembert, because it contains lactose.

Now you also know why I never offer my children a few cornflakes with milk and sugar before school. In terms of metabolism, the dwarfs would prefer to go straight back to bed – with such a combination of milk and industrial sugar and cereals, no wonder.

Select carbohydrates specifically

“But that’s terribly complicated – I have to know all the carbohydrates!” Interjects Inke.

Actually, it’s not difficult. Meat and fish as well as vegetables, hard cheese and eggs are neutral. And you wouldn’t actually eat rice, potatoes and pasta together with that. Actually, I just make sure that I only eat one sugar or only one type of cereal or only one starch together. When I fry something, I don’t mix the fats, I stick with one. In the restaurant, I don’t eat the bread basket empty if I’ve ordered potatoes with the fish anyway. And if it should be a glass of wine (also contains carbohydrates), then I enjoy it best after dinner.

Give your digestion breaks

We come to factor two: The ‘how’ does not only refer to the composition of our meals, but also to the ‘when’. In general, I noticed that we are actually digesting continuously.

In the morning we eat our fattening breakfast, which nobody really needs because it takes away all energy, then we drink a carbohydrate bomb in the form of a café latte with lots of milk and sugar afterwards, push ourselves into the canteen, then need it caffeine again because we’re so tired from eating before we go back in the evening.

Our body actually just wants a break. And maybe a green tea, a smoothie, or just nothing so he can send the cleaning crew through. We eat and eat and don’t even know why.

What can you still eat? It is confusing

I admit, everything has gotten very confusing too: gluten is bad, milk full of hormones, meat the devil, everyone is confused. I often hear that you can continue to eat as normal. It is worthwhile to feed in more precisely. If we buy it cheaply in the bakery for twenty cents, the dough can contain additives such as corn, potatoes, glucose syrup, i.e. sugar, and there are also flavor enhancers.

Do you notice what? Again several carbohydrates and chemistry. And immediately we get fat and tired, have a stomachache like we did in the ninth month and in the end even stomach ache, migraines and sleep disorders. With organic you are on the safe side. And with breaks and some kind of carbohydrate too, I think.

Sinning is allowed – but then there is a long pause

And whoever has sinned, simply waits five instead of two hours. Who is perfect and always obeys all the rules? If I am invited to a friend’s house, I sometimes skip five, but I always return to the one-carbohydrate principle. This also applies to snacking: at the moment I like to treat myself to a bar of chocolate in the evening – from Monday to Friday.

Yes you’ve read correctly. Chocolate is my insider tip, because the cocoa practically covers the sugar, which is why chocolate is just one type of carbohydrate. Or as my nutritionist Dörten Wolff once put it: “If you know how to eat chocolate correctly, it doesn’t necessarily work!”

In my case, eating right means: If I notice that I have to put in another chocolate unit in the evening, then I eat meat and vegetables instead of high-carbohydrates for dinner. My dessert, the chocolate, is my carbohydrate component. Without question, it should be high quality chocolate and not cheap, adulterated one.