Diabetes – A Dangerous Predecessor of Advanced Liver Cancer?
Spend a day or two in one of the medicine wards of Civil hospital, Karachi, Pakistan and you will easily realize that chronic liver disease (CLD) is rampant in Pakistani society and diabetes faithfully follows the trend. Hepatitis, chronic alcohol abuse and liver cirrhosis are a few factors leading to primary liver cancer but the National Cancer Institute reported in 2010 that diabetes is now associated with a greater percentage of liver cancer cases than any other factor. In Pakistan, the incidence of diabetes mellitus has roughly doubled in the past 20 years. Hepatocellular carcinoma – the most common form of liver cancer, has also followed up the ladder steadily.
Recent researches carried out at the University of Rochester (USA) suggest that people having high blood sugar levels are at a greater risk of having developed advanced liver cancer at the time of diagnosis. This implies that diabetes may promote more invasive tumors.
Various studies conducted in the past have depicted a number of associations between diabetes and cancer in general. The connection seems sensible because the liver regulates sugars and longtime observations have shown that people prone to liver failure are also prone to diabetes. A number of prior studies have also reflected that diabetic patients often have outcomes worse that the general population with cancer. The reasons for that however, remain unclear.
A fresh study published in Cancer Investigation, links diabetes with distant metastasis in patients having hepatocellular cancer. This is a form of liver cancer usually found in people having liver cirrhosis. The study suggests that patients who also have diabetes are more prone to have cancer that has metastasized to other organs when it’s diagnosed. Furthermore, those who take insulin to regulate their blood sugar levels have the highest rate of advanced cancer, compared to diabetics who manage their blood sugar through diet restriction or oral medications.
The research team looked at disease trends among 256 patients diagnosed with primary liver cancer between 1998 and 2008. They found that 34% of the total had diabetes at the time of cancer diagnosis. Moreover, among the diabetic group, 33% had liver cancer that had already metastasized while only 9.7% of patients having advanced liver cancer were not diabetics.
Gregory C. Connolly, senior instructor of medicine at the University of Rochester Medical Center says, “Although our research is preliminary and based on a retrospective dataset, the findings are very interesting and hypothesis-generating.” Connolly also said that the associations his team detected suggest that patients with diabetes and liver cancer may have alterations in cancer cell signaling that promote tumor invasiveness and metastasis. Hence the more we understand the mechanisms at play, the more will be our chances of success at treating patients having both diseases.
“Since the incidence of glucose intolerance and liver cirrhosis or cancer is so strong in the general population, it’s imperative to better understand the relationship so that these patients can be treated and managed in the best way possible” , says senior author of the study, Aram F. Hezel, assistant professor of medicine in hematology/oncology.
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