Episode 85. Pancreatic Cancer with Dr Michael Lee
Pancreatic cancer is the eighth most common cancer reported in Australia. In 2021, it is estimated that there will be 4261 new cases and 3391 deaths. The incidence has increased from 10 per 100,000 in 1982 -to 12 per 100,000 today with the average age of onset between 60 and 65 years. At the time of diagnosis, approximately one-third of patients already have advanced disease with a limited 3 to 4-month survival prognosis, overall, 1-year survival for pancreatic cancer is only 16% and 5-year survival of 3% despite new approaches to management.
Pancreatic cancer is the eighth most common cancer reported in Australia. In 2021, it is estimated that there will be 4261 new cases and 3391 deaths. The incidence has increased from 10 per 100,000 in 1982 -to 12 per 100,000 today with the average age of onset between 60 and 65 years. At the time of diagnosis, approximately one-third of patients already have advanced disease with a limited 3 to 4-month survival prognosis, overall, 1-year survival for pancreatic cancer is only 16% and 5-year survival of 3% despite new approaches to management.
Risk factors include obesity, smoking (fivefold increase risk) and type 2 diabetes mellitus which after cigarette smoking and obesity is likely the third most modifiable risk factor for pancreatic cancer.
Other risks include family history (7%) and autosomal dominant syndromes such as Hereditary pancreatitis, Peutz-Jeghers syndrome, Hereditary breast and ovarian cancer syndrome (BRCA 2 and 1 genes), and Lynch syndrome and the Familial atypical multiple mole melanoma syndromes.
Additionally, there is probably a risk associated with ongoing heavy alcohol consumption and subsequent chronic pancreatic inflammation.
After imaging and subsequent diagnosis, staging determines locally respectable, borderline respectable, locally advanced unresectable or metastatic disease, and guides the choice of surgery, chemotherapy, radiotherapy and or palliation.
It was a privilege to be joined in this conversation by Dr Michael Lee from the Peter McCallum Cancer Centre, an oncologist specialising in clinical translational genomic research and advanced cancers with a special focus on metastatic pancreatic cancer. Michael trained in Australia and subsequently worked in Vancouver at the BC Cancer and Michael Smith's Science Centre before returning to Melbourne where he is undertaking a PhD with the aim of developing a new novel therapy for pancreatic cancer. Michael’s motto is to provide holistic oncology care with an honest conversation, supported by the latest research from the bench side to the bedside and tailoring it to his patient’s goals and wishes.
References:
www.petermac.org
canceraustralia.gov.au
www.cancer.org.au
www1.racgp.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 76. Breast Cancer with Dr Corinne Ooi
Breast cancer affects 1 in 7 women and remains the most diagnosed cancer in Australia with 57 new cases diagnosed each day, 1000 new cases per year and tragically 2000 deaths annually. Men are not excluded, for every 100 breast cancers one is diagnosed in a male. Genetic links for breast cancer such as the BRCA 1 and 2 genes receive significant attention but account for only 5% of total cases,75% of patients have no family history and additionally 75% of breast cancers are diagnosed in patients 50 years or older. Multiple risk factors including family history, young age of menarche and older age of menopause are frequently cited but less well known is the association with obesity which is responsible for up to 8% of all breast cancers. It is estimated that 1: in 4 cases of all breast cancer may be prevented with attention to known modifiable risk factors. Breastfeeding and earlier age of pregnancy are both protective factors.
Breast cancer affects 1 in 7 women and remains the most diagnosed cancer in Australia with 57 new cases diagnosed each day, 1000 new cases per year and tragically 2000 deaths annually. Men are not excluded, for every 100 breast cancers one is diagnosed in a male. Genetic links for breast cancer such as the BRCA 1 and 2 genes receive significant attention but account for only 5% of total cases,75% of patients have no family history and additionally 75% of breast cancers are diagnosed in patients 50 years or older. Multiple risk factors including family history, young age of menarche and older age of menopause are frequently cited but less well known is the association with obesity which is responsible for up to 8% of all breast cancers. It is estimated that 1: in 4 cases of all breast cancer may be prevented with attention to known modifiable risk factors. Breastfeeding and earlier age of pregnancy are both protective factors.
In this episode we are joined by breast cancer surgeon Corinne Ooi who reviews risk factors linked to breast cancer and discusses management strategies when a breast lump is detected. This is a fascinating conversation with a truly passionate surgeon.
Useful references include:
- Dr Corinne Ooi – Southern Breast Oncology - sboncology.com.au
- Breastcancerriskfactors.gov.au - www.canceraustralia.gov.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 70. Familial Cancer Screen with Dr Lucy Gately - Part 2
Genetic testing for cancer is important for a small number of families at increased risk due to the inheritance of genetic mutations. Most commonly this involves the inheritance of breast cancer genes such as the BRCA 1 and 2 or colorectal cancer genes such as the Lynch syndrome genes. Although these only represent a small percentage of total cancers reported there is significant public interest in these syndromes.
Genetic testing for cancer is important for a small number of families at increased risk due to the inheritance of genetic mutations. Most commonly this involves the inheritance of breast cancer genes such as the BRCA 1 and 2 or colorectal cancer genes such as the Lynch syndrome genes. Although these only represent a small percentage of total cancers reported there is significant public interest in these syndromes.
We have a further discussion with Dr Lucy Gately from the Cabrini Family Cancer Clinic in this episode in regard to the BRCA 1 and 2 genes on chromosome 17 inherited by 1:400 women and men, and the Lynch syndrome genes which are accounted for by five mutations inherited by about 1:280 people. The Lynch syndrome is believed to affect about 80,000 Australians of whom perhaps only 5% know they have inherited this mutation. Whilst the BRCA 1 and 2 genes are associated with both breast and ovarian cancer in women, BRCA 2 inheritance may also imply an increased incidence of prostate cancer and breast cancer in men. Lynch mutations have been associated with up to 12 different forms of cancer although colorectal cancer and endometrial cancer are most highly represented by these mutations.
It is a great pleasure to discuss this fascinating subject in more detail with Dr Lucy Gately whose expertise on this complex subject is generously shared.
Useful references include:
- www.cabrinicancerclinic - BRCA gene mutations
- Genetic Testing Fact Sheet – www.cancer.gov
- Genetics: Breast Cancer Risk Factors – breastcancer.org
- BRCA 1 and BRCA 2 associated hereditary breast and ovarian cancer – www.ncbi.nlm.nih.gov
- Lynch syndrome – www.cancer.net
- What is Lynch syndrome – Lynch syndrome Australia – lynchsyndrome.org.au
- Understanding genetic tests for Lynch syndrome – Centre for genetics – www.genetics.edu.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 69. Familial Cancer Screening with Dr Lucy Gately and Lynne McKay - Part 1
In the context of family cancer screening, genetic testing looks for specific inherited changes or variants in a person’s genes which may predispose them to an increased risk of developing a neoplasm. Harmful variants in some genes are known to be associated with an increased risk of developing specific cancers such as mutations to the BRCA 1 and 2 genes associated with breast and ovarian cancer and the Lynch genes associated with colorectal and endometrial cancer.
In the context of family cancer screening, genetic testing looks for specific inherited changes or variants in a person’s genes which may predispose them to an increased risk of developing a neoplasm. Harmful variants in some genes are known to be associated with an increased risk of developing specific cancers such as mutations to the BRCA 1 and 2 genes associated with breast and ovarian cancer and the Lynch genes associated with colorectal and endometrial cancer.
Alterations in tumour suppressor genes (loss of function) and proto-oncogenes (gains of function) are fundamental to our understanding of the science associated with family cancer syndromes and can be tested in the setting of family cancer screening clinics. The subsequent very important genetic counselling for patients and relatives who may have inherited such mutations involves discussing the risk of inherited cancer, individual risk screening and cancer risk reduction strategies.
In this episode, we are joined by Dr Lucy Gately and Lynne McKay from the Cabrini Family Cancer Clinic who have been instrumental in delivering one of Australia’s premier family cancer screening services and genetic counselling services to our community. Please welcome them to this conversation.
Useful references include:
- Family Cancer Clinic for Risk Assessment Advice and Testing – www.cabrini.com.au
- Family Cancer Centres – www.cancer.vic.org.au
- Genetic Testing for Cancer Risk – www.cancer.net
- Family Cancer Syndromes – American Cancer Society – www.cancer.org
- Cancer Genes – pubmed.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.