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 84. Lymphoma with Professor Stephen Opat (Part 2)
Lymphoma is a clonal neoplastic proliferation of lymphoid cells (B cells, T cells and NK cells) and is the sixth most common malignancy reported in this country which makes it the most common hematologic malignancy with over 5000 cases diagnosed each year in Australia putting lifetime risk at 1 in 50.
Lymphoma is a clonal neoplastic proliferation of lymphoid cells (B cells, T cells and NK cells) and is the sixth most common malignancy reported in this country which makes it the most common hematologic malignancy with over 5000 cases diagnosed each year in Australia putting lifetime risk at 1 in 50.
There are over 70 different types of lymphoma which are divided into 2 main groups: Hodgkin's lymphoma accounts for 10% of cases and non-Hodgkin's lymphoma accounts for 90% of cases.
Hodgkin's lymphoma named after Thomas Hodgkin (1832) is more common in men, and tends to occur at a younger age than non-Hodgkin's lymphoma with a bimodal age distribution but the average age at diagnosis of 39 years and involves lymph nodes frequently on just one side of the body usually above the diaphragm. The tumour cell is referred to as the Reed Sternberg cell which is a bi or multi-nucleated B cell comprising characteristically just 1% of the lymphoma mass. Just to make this nomenclature interesting there is classic Hodgkins which make up about 95 % of cases and of which nodular sclerosing comprises about 70 % and mixed cellularity 20-25 % and non-classic Hodgkins is characterised by nodular lymphocytic predominant pathology.
Non-Hodgkin's lymphoma can occur at any age and although the median age at diagnosis is 67 years it is one of the more common cancers among children, teens and young adults, none the less the risk of developing NHL increases throughout life and more than half the patients with NHL are 65 years or older at diagnosis. It is also more common amongst men and those with autoimmune diseases or a family history of hematologic malignancies. Presentations often involve the finding of involved lymph nodes on either side of the diaphragm. 85% of non-Hodgkin lymphomas are B cells in origin, and 15% are T cells. The most common the B cell non-Hodgkin lymphomas are diffuse large B cells -accounting for 37% of NHL cases, followed by follicular 29%, Malt 9% and Mantle cells 7%.
This is a complex and vast subject with a number of environmental factors and associated diseases influencing the fascinating pathogenesis of lymphoma which goes to the heart of B cell biology and our immune systems’ task of fighting for our lives against antigen invaders. There are a host of treatment options available with new emerging therapies at the cutting edge of medicine and it was a privilege to have a conversation with Professor Stephen OPAT -and to journey for a short time into his world of haematology. Stephen is the professor and director of clinical haematology at MMC and has a special interest in lymphoma, chronic leukaemia, cancer genomics and disorders of metabolism. I found Stevens’ conversation incredibly insightful and welcome you to this podcast:
References:
www.melbournehaematology.com.au
www.uptodate.com
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 82. Advances in Anti-ageing Medicine with Dr John Levin
Dr John Levin practices antiaging medicine and joins this podcast to discuss his practical approach to treatment. As John laments antiaging medicine is not taught in medical school yet he believes the science of anti-ageing holds the key to significantly reducing human suffering and improving health span. Whilst the average human life span continues to increase and modern medicine more efficiently tackles diseases, the science of anti-ageing looks at mechanisms leading to cell degeneration and decay and seeks ways to regenerate cell health and thereby delay the many diseases associated with ageing.
Dr John Levin practices antiaging medicine and joins this podcast to discuss his practical approach to treatment. As John laments antiaging medicine is not taught in medical school yet he believes the science of anti-ageing holds the key to significantly reducing human suffering and improving health span. Whilst the average human life span continues to increase and modern medicine more efficiently tackles diseases, the science of anti-ageing looks at mechanisms leading to cell degeneration and decay and seeks ways to regenerate cell health and thereby delay the many diseases associated with ageing.
Many believe that regeneration clinics where therapies include removing senescent cells repairing damaged DNA and perhaps topping up a reservoir of stem cells will become a reality sooner than one might think. Until such time, however, the simple caveats of avoiding smoking and excess alcohol, adopting a healthy body mass index, controlling blood pressure and blood sugar levels, exercising, and paying attention to good nutrition, sleep and dental hygiene as well as receiving vaccination should be considered as best proven advice. John's approach dives deeper into the science and includes measurement of serum growth hormone with a physiological replacement only if required and he also uses a number of supplements included in the list below:
ANTI-AGING SUPPLEMENTS New York Academy of Science journal: work done by Cardiac Surgical Research Unit, Alfred Hospital, the Baker Heart Research Institute Melbourne and Department of Biochemistry and Molecular Biology Monash University showed that Co-Enzyme 010, Alpha Lipoic Acid and Magnesium Orotate helped protect the ageing heart against stress. In addition, work performed by the Karolinska Institute in Sweden showed that adding Selenium to Co-Q10 improved heart function and slashed mortality risks by almost 5O%. POO (Pyrroloquinoline Quinone) not only protects mitochondria from oxidative stress -it promotes the spontaneous generation of new mitochondria within aging cells, a process known as 'mitochondrial biogenesis'.
Carnosine can provide benefits to cells and tissues throughout the body that would otherwise succumb to the pathological effects of aging. Over 2000 studies have shown the beneficial effects in preventing age-related diseases such as type 2 diabetes, cardiovascular disease, dementia and cancer. Pterostilbene has multiple benefits in the treatment and prevention of human disease due to its antioxidant, anti-inflammatory and anticarcinogenic properties. Dr Bruce Ames, a world-renowned biochemist at the University of California showed that Acetyl L-Carnitine and Alpha Lipoic Acid could provide protection against the pathological hallmarks of aging. L-Citrulline increases your L-arginine which is converted into nitric oxide which causes blood vessels to dilate and helps lower blood pressure. It helps the brain function by promoting greater circulation to the brain. It also helps the body get rid of ammonia in the form of urea.
Fisetin research by the Mayo Clinic shows it helps get rid of senescent cells (Cells that no longer divide). These cells accumulate with age and at sites of multiple chronic conditions such as diabetes, lungs in chronic pulmonary diseases, vascular diseases and joints in osteoarthritis. NMN (Nicotinamide Mononucleotide) Professor David Sinclair, professor of Genetics at Harvard University says that this molecule is the missing key to regenerating healthy cells through 'old' age allowing your youthful existence to be sustained for much longer. Metformin New research is suggesting that metformin may hold promise in treating or preventing a whole host of conditions. It may be cardioprotective, it may prevent cancer, be neuroprotective and reduce dementia and stroke risk. D-Ribose Is involved in the energy production in all cells of the body.
References:
Ageless, Andrew Steele, Bloomsbury Publishing
End of Ageing, Aubrey De Grey with Michael Rae, Griffin Charles &Co Ltd
Lifespan, David Sinclair, Harper Collins
johnlevin@bigpond.net.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 81. Polycystic ovary syndrome (PCOS) with Dr Mei Cheah
PCOS is the most common endocrinopathy of reproductive age women affecting about 1 in 10. Characteristically the condition presents with menstrual irregularity, excess androgens, and polycystic ovarian morphology. More common in women with a family history and type 2 diabetes the condition is associated with obesity, infertility, pregnancy complications and metabolic derangements as well as a number of psychological consequences.
In this podcast we have a conversation with obstetrician and gynaecologist Dr Mei Cheah founder of Create Health a leading group of specialists in women's health creating visions for a healthy future, better well-being, and more informed patients. Create Health aims to deliver exceptional care across obstetrics, gynaecology, reproductive endocrinology, minimally invasive surgery, fertility and IVF plus allied and complimentary health services. We look forward to exploring the practical aspects of this diagnosis further with you.
PCOS is the most common endocrinopathy of reproductive age women affecting about 1 in 10. Characteristically the condition presents with menstrual irregularity, excess androgens, and polycystic ovarian morphology. More common in women with a family history and type 2 diabetes the condition is associated with obesity, infertility, pregnancy complications and metabolic derangements as well as a number of psychological consequences.
In this podcast we have a conversation with obstetrician and gynaecologist Dr Mei Cheah founder of Create Health a leading group of specialists in women's health creating visions for a healthy future, better well-being, and more informed patients. Create Health aims to deliver exceptional care across obstetrics, gynaecology, reproductive endocrinology, minimally invasive surgery, fertility and IVF plus allied and complimentary health services. We look forward to exploring the practical aspects of this diagnosis further with you.
References:
Dr Mei Cheah -create-health.com.au
www.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.
Episode 79. Investigations in Rheumatology with Dr Andrew Teichtahl
In this episode we explore investigations in rheumatology - What is helpful and what is not?A clinician faced with a patient complaining of myalgias and generalised rheumatic aches may be tempted to order a host of immunological and inflammatory tests whilst also assessing multiple other differential diagnoses that need considering. There are a host of serological tests available each with different degrees of sensitivity and specificity for rheumatological conditions, furthermore it is important to understand the sensitivity (ability to rule out condition) and specificity (ability to rule condition in) is applied to such tests. Fortunately, we had the opportunity to have a conversation with Dr Andrew Teichtahl who provides excellent clarification on the subject.
In this episode we explore investigations in rheumatology - What is helpful and what is not?
A clinician faced with a patient complaining of myalgias and generalised rheumatic aches may be tempted to order a host of immunological and inflammatory tests whilst also assessing multiple other differential diagnoses that need considering. There are a host of serological tests available each with different degrees of sensitivity and specificity for rheumatological conditions, furthermore it is important to understand the sensitivity (ability to rule out condition) and specificity (ability to rule condition in) is applied to such tests. Fortunately, we had the opportunity to have a conversation with Dr Andrew Teichtahl who provides excellent clarification on the subject.
Andrew is a senior staff specialist at the Alfred Hospital and the National Health and Medical Research Council Fellow at the Baker International Diabetes Institute. He is a chief investigator on two clinical trials funded by the National Health and Medical Research Council (NHMRC) and has authored over 75 publications in internationally peer reviewed journals. In his former life he was also a physiotherapist (a degree he attained with honours) and is passionate in his practice of rheumatology with expertise across rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.
References:
Dr Andrew Teichtahl: www.arthritiscentre.com.au
www.racp.edu.au Investigations: In Medicine-Rheumatology-RACP
www.ncbi.nlm.nih.gov : Common Laboratory Tests for Rheumatological Disorders, ED Gupta 2009
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.