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In the Pancreas, Common Fungi May Drive Cancer (nytimes.com)
268 points by pseudolus 13 days ago | hide | past | web | favorite | 136 comments

Actual paper:


Looks pretty strong: getting rid of the fungi stopped tumor growth and repopulating it with that type of fungi (and not with other types) restarted it again (in mice). And they've even found a drug target!

Pancreatic cancer is not the most common but one of the most deadly (<10% survival) with very short times between diagnosis (it's mostly asymptomatic) and death.

> Pancreatic cancer is not the most common but one of the most deadly (<10% survival) with very short times between diagnosis (it's mostly asymptomatic) and death.

All but one of the people I've known in my life that died from cancer died of this form. It's like 7 people.

A useful treatment can't come soon enough.

A useful early warning bio-marker needs to come first.

or whenever it does, because once we have the bio-marker, we can then throw what would be the already-invented treatment at it ...

It it maybe a cancer that hits younger people than the more common ones?

That would explain why it's the first cancer deaths someone saw in their life.

Young as in late 50s early 60s?

Also worth noting that its only deadly because its found after its metastasized. There is the similar probability that people live with a form of cancer more of their lives than without, before it grows faster and uncontrollably for unknown reasons.

Only person I know that died of it was 80-ish, happened fairly suddenly.

Nope, all the people I've known were 50s and beyond.

So why isn't Ruth Bader Ginsburg dead yet, then? She's had it 2x.

My father-in-law succumbed to it a mere six months after his diagnosis, albeit a late one because his doctors sucked.

A note about the asymptomatic nature of pancreatic cancer: my uncle and a former colleague both were eventually diagnosed with it after treatment for back pain.

In my former colleague's case, his chiropractor actually referred him for testing.

What a feeling it must be for the researchers involved in this, if it turns into a method of improving pancreatic cancer survival. I am glad their are so many medical researchers driven in this way.

My mother passed away from pancreatic cancer last year; she had no symptoms until two months before she passed, when she got a diagnosis from a scan. There are a lot of trials ongoing looking at how the area around the pancreas impacts how well different therapies work in treating it.

This is really interesting as it suggests a new avenue to improve treatment, as well as a potential tool for easier diagnosis.

This reminds me a lot of the cancers attributed to HPV, a common virus. The researchers who discovered that link have likely saved millions of lives.

Almost every instance of cervical cancer is attributed to HPV. 70% of throat cancers, 90% of anal cancers, 60% of penile cancers, 75% vaginal, and 70% vulvar cancers. [1]

It always stunned me that one little virus that used to be seen just as an embarrassment was re-categorized as being a huge risk factor for deadly cancers.

If the person who identified a common bacteria being responsible for almost all ulcers got a Nobel price, the HPV <--> cancer researchers should also have been considered, IMHO.

[1] https://www.cancer.gov/about-cancer/causes-prevention/risk/i...

"...person who identified a common bacteria..." (Barry Marshall)

Helicobacter pylori is also a suspect carcinogen, specifically in some stomach cancers. I am now wondering if it assists this evil fungus in any indirect way. Over half the world population carries h pylori, apparently mostly asymptomatically.

Is there a non invasive way of getting tested for it?

There's the poo test and a breath test.. beyond that I'm unsure. The breath test seems less available, maybe. Consider the following before alarming yourself though. H pylori, if asymptomatic, may be at a level of what some in the medical field deem best left alone. The goal in some treatments seems to beat it down rather than eradicate it. Rationale seems to weigh cost\benefit of slaughtering all the good stuff to get the bad when the bad might not do much beneath a threshold. I'm no authority. The subject, I do think is worth reading about and it doesn't appear there's a clearly advised plan for the infected asymptomatic majority.

For H Pylori, there are 2 tests that are both pretty easy: one is a blood test and the other is a breathing test (they collect the exhalation in some bag.) The results are returned fairly quickly

I lost my mom this year to the same cancer and I get really excited with any advancements that are made in this area. I feel like we're still playing with sticks and stones in terms of pancreatic cancer treatment. The whole surgery plus chemotherapy is just barbaric.

I'm not surprised that fungi as a causative agent for cancers (and that by extension anti-fungals might be cancer protective).

It was once believed stomach ulcers were due to acid imbalance and we now know many types of stomach ulcers are due to infection and treatment with antibiotics is the proper course of treatment.

I think that more research in this line will be very productive. I believe that he balance/imbalance of the body's fauna will eventually be shown to be the root trigger of many other issues. Knowledge like this is invaluable because it can quickly turn major health concerns into preventable diseases.

It's not just about our genetics, it's about our interplay between our genetics and our environment.

> I'm not surprised that fungi as a causative agent for cancers

It bloody amazes me. What reason or prior experience do you have that makes it seem reasonable?

This may be a little harsh but I think you could rephrase OP's point as "The body seems really complicated so I'm not surprised that there are complex interactions going on".

I see what you're saying and it's a good point, but those complex interactions seem to throw up impossibly amazing stuff, for example the utterly mindblowing idea of mitochondria being captured organisms. To say "it's complex so surprises should be surprising" to me just doesn't make work. I still get staggered by this stuff. If I ever lose the ability to be mindblown, it'll be a sorry day.

Fungi in the pancreas isn't in the same league but it's still pretty good!

I have (idiopathic) Chronic Pancreatitis and I wonder if the same holds for me. I'm already on enzymes but not diabetic (yet, knock on wood). There is a link in the article pointing to Crohns so I have hope that there is some correlation. If anyone has any more info, I'd gladly hear you out as it could be life changing for me. For instance, if I'd want to try this myself, what could be a good off the counter medication (in EU)? And what would be a good interval of taking these? I notice that doctors are slow on the uptake with these kind of discoveries so I've become more prone to trying remedies (diet changes mostly) myself. (Note: I don't shun away from bad news, would like to hear that too)

I have a condition that can lead to pancreatitis, diabetes and usually involves digestive enzymes. I've successfully gotten off the digestive enzymes.

If you aren't already: I will suggest you keep a food and symptom journal, stay away from table salt (sea salt or kosher salt are both better) and figure out if you have trouble with specific oils. Symptoms can sometimes lag behind triggering events substantially. A journal can help you find patterns and make inferences.

I personally avoid peanut oil. It's very inflammatory and inflammation is has been linked to diabetes.

I've long put off having a food and symptom journal, because I'm pretty disorganized, but I will take your advice serious. Can I ask how you exactly correlate the symptoms with your food intake? From what I've read the digestive system takes max 48 hours from in to out.

I do a lot of reading. I discuss stuff a lot with my adult sons who still live with me. I look for patterns.

A lot of stuff happens about 48 hours after the triggering event. My son did some research and this seems to be a significant blood and lymph timing thing.

Other significant time frames seem to be one week, two weeks, one month and six weeks. These aren't peculiar to "things I ate." These are health events triggering physiological changes that don't show up until later.

It's harder to connect those longer time frames to the triggering event, but I am sometimes reasonably confident of the connection because of the specifics involved and I just read a lot and discuss this stuff a lot and write about it a lot. Patterns eventually become clear if you pay enough attention.

As your diet changes, your body changes and your needs change. It's a moving target.

I don't have anything to address your questions but I am curious what dietary changes you've made.

Smaller meals; eating too much will lead to acute attacks. Multiple smaller meals is recommended with chronic pancreatitis. It's still a difficult thing to achieve, since eating 24/7 is kind of against human nature and going out you will have to forego it a lot. Also when the pancreatitis becomes acute I tend to pause large meals altogether, relying on yoghurt instead.

Limit sugar intake; limited sugar intake has health benefits and seems to help diabetics, so I've cut my sugar intake as well. Sometimes I cheat, but only once in a while.

I don't drink any alcohol whatsoever. Alcohol is an antagonist.

When pancreatitis is acute (or upcoming), I limit my caffeine intake and instead use coffee without caffeine. Caffeine is a trigger for pancreatitis. I still like my caffeine boost, but I rather forego it when my pancreas is acting up.

Smoking is very bad. I used to smoke and quit many times. It noticeably affects the pancreas. I've since exchanged it with vaping and don't notice it affecting my pancreas. There is research out there that nicotine by itself is an anti inflammatory agent; still I want to quit vaping too but have other issues that interplay too.

There are other small things too (like I take my yoghurt every morning religiously and sleep on my right side mostly). The above is a summary of the most important things that are evidence based and known to work with pancreatitis.

I haven't had a full blown acute attack in a year or two (I lost track a bit), but sometimes I have smaller attacks that don't require me to go to the hospital. I then limit my intake of food (and drink only the necessary to stay hydrated). The thing with Chronic Pancreatitis is also that it may stabilize after a while due it 'failing to attack itself' because it cannot produce its own enzymes anymore. That may be the case for me too as my pancreas is severely calcified.

Interesting, thanks for sharing. I haven't had any acute illnesses that drove my own dietary changes but I too have completely cut alcohol and refined sugar from my diet and I generally feel great in my body. I did strict Keto for about 8 months (less than 10 net grams of carbs per-day) and it made me feel really good but I couldn't keep it up with weightlifting. Nowadays I follow a low-ish carb paleo diet which makes me feel pretty good and seems to strike the right balance between healthy fats and okay carbs.

Thanks for your input too. I've looked into lowering carbs but I'm raised on pasta. I find it kind of hard to replace. Do you have any suggestions? I generally don't have a lot of patience or energy for cooking anyway, so changing the type of food I eat is a challenge for me.

Sorry for the late reply.

First of all, I don't think pasta is too terrible if it's fitting in your macros. Wheat will have a larger glycemic impact on you though than many other carbohydrate sources (e.g. sweet potatoes, which I consider a super food for humans, alongside eggs).

The most important thing about diet change is to resist making big, dramatic changes. Think in terms of weak signals: figure out what foods would be easy to meal prep for, that you like eating, and would be good combined together in simple ways. By simple I mean very simple, pick two major macros (carbs and protein, or fat and protein). Once you've got that figured out and you've decided how to combine them, then you can add easy low-effort accessories at meal time.

I ended up landing on what I call a "power bowl" dinner meal that I eat every single night (I haven't tired of it yet) consisting of:


- Main 1: 150 grams of sweet potato (cubed and baked with some olive oil and salt)

- Main 2: 10oz of a main protein (I rotate between chicken, cod, pork, and burger patties)


- 2 cups of spinach

- optional fried egg

- tomato / onion

- zero carb rosemary dressing (high fat though)

It's extremely easy to meal prep, very easy to weigh and measure, it tastes really good, great mix of macros, the carbohydrates from sweet potatoes have a low glycemic impact (unlike anything made from wheat), and I get a lot of protein. If it gets boring I can add a fried egg, or goat cheese, or change the protein, or add some green chiles, etc. so creating novel flavors is easy and doesn't require significant prep time.

At some point I'm going to start growing my own sweet potatoes and spinach at which point I only need to buy my protein and other add-ons.

I also don't have patience or energy to cook, one of my early-20s favorite meals was white rice with canned meat sauce. I don't eat that anymore but the trick to changing what you eat is to:

- Keep it simple

- Keep it whole (as in "whole food")

- Meal prep the bulk items (you can bake sweet potatoes and chicken/cod/pork in less than an hour on Sunday, then assemble the bowls easily at night)

Making it easy and simple to assemble will help keep you from convincing yourself you're too tired and should just run to Chipotle :-p This is why I like the power bowls because they don't require any special timing, or prep, or techniques, or specialized ingredients (unless you want them).

That's all for dinner. I stay fasted through breakfast and I usually eat 5 eggs with 4 slices of high-quality bacon for lunch. I have lots of nuts, fruits, and paleo granola for snacks.

I’m curious if an extended (1-2 weeks) fast could help. If eating is what bothers it maybe an extended break could help? Fasting seems to help a variety of other medical conditions.

Yes, there is recent evidence regarding this with pancreatitis too. I fast whenever I sense my pancreas is inflamed (as is also customary in hospital visits - practically the only treatment). However I'm bordering (sometimes crossing) underweight so I don't do it regularly.

Recent thread on HN that I recommend reading

[0]: https://news.ycombinator.com/item?id=18202118

Ever looked at Sjogren? Pancreatitis is a precursor

Thanks for the suggestion. I will look into it.

I'll suggest trying iodine. Some claim it helps diabetics, and I found it to help blood sugar as well. Then try glycine - i know someone with crohn's who said it helped.

I've actually long eliminated salt (iodine) from my diet, because of various reports that it wasn't beneficial, but am now coming back on that. Thanks for telling me that. From what I read glycine is in nuts and meat, I'll have to read more on its properties.

Iodine is required for thyroid function, so _no_ Iodine is very bad. Trace amounts form diet may be enough (disclaimer IANADietician), but pretty much all the table salt we buy and use is Iodised.

I've noticed that all the sea salts I see, especially anything that comes in a grinder is increasingly not iodized these days. It's like I have to try and buy regular morton salt in a huge cylinder and not fancy hip salt if I want iodized salt anymore.

Salt is an important component of the mucus lining your gut.

Somewhat interesting that folksy/homeopathic "cancer cures" often suggest things like garlic, which is a fairly good antifungal.

Is there any downside to periodically taking strong antifungals? We don't have beneficial fungi do we? I have been considering a dose of ivermectin twice a year. Studies hav correlates it with a strong anti cancer effect.

This article [1] by Carl Zimmer discusses the topic.

It doesn't offer a conclusive answer to your questions, but makes the point that there could well be a beneficial role for fungi in the body that we currently know little about as it hasn't been researched in much depth.

I've personally had cause to research the human microbiome very deeply (i.e., as deeply as a layperson reasonably can) in the past 10+ years, and whilst the idea of eradicating all fungi has seemed compelling at times, I'm now much more on the side of taking moderate steps to keep things in balance.

Evolution and complex systems being what they are, it's unlikely that you could completely remove one component of the system without causing unintended negative consequences.

[1] https://www.nationalgeographic.com/science/phenomena/2013/05...

One thing fungi are generally good at is regulating bacteria. So that might end up being the beneficial role. However, it would have to be very specific fungi to survive within the body at all yet not damage the body, and likely also respond to and be suppressed by specific regulators that the body itself is producing.

Saccharomyces boulardii (“Brewer’s/baker’s yeast”) seems to be one such strain.

It is commonly taken therapeutically to keep other fungi and bacteria under control.


Most, perhaps all antifungal, and in particular the most common, he azols, clear through the CY P450 pathway in your liver, unfortunately a very important pathway. Fungal diseases are hard to treat in part because doses high enough to be efficacious can lead to liver failure.

I would be wary of gratuitous use of antifungals (and I am a developer of an antifungal treatment that entered clinical trials). I would use an anti-dandruff shampoo if I had that problem but that’s about my limit.

Does this apply only to oral pharmaceutical antifungals? Or does it also apply to topical ones like clotrimazole for yeast, or food based oral antifungals like garlic?

Your dermis is designed to keep stuff out so though some of the topical will enter your system the amount is likely to be negligible (note: I am not a physician!!). Anyway topicals are used to treat fungi that attack dermal and nail tissue (e.g. tinia mentagrophytes or tinea pedis) so the whole point of using them is that you're applying the drug to the invader. This is why dandruff shampoo supposedly works.

I wouldn't worry about eating garlic although I haven't seen any studies suggesting it might actually be efficacious. But it is delicious!

Thanks! That's what I figured about topicals. As for foods, I guess the question would have been better framed as IF a food has any antifungal effect, would it thus necessarily also stress the liver? Or is that merely a common property of anti-fungal meds so far, but not a property of things that kill fungus per se.

At least in the context of toenail fungus, the topical treatments avoid risk to your liver (but generally don't work because it's hard to penetrate the nail and nail bed). However, even assuming a carcinogenic role for fungus, topical treatments are very unlikely to be useful for preventing internal cancers like pancreatic cancer.

Just curious, not trying to argue with you at all, but does that mean you’d discourage the occasional consumption of raw garlic (3-4 cloves)? I eat probably a few cloves of garlic whenever I eat Korean BBQ which is probably at least once or twice a month.

I haven't seen any study even suggesting that garlic might have any antifungal effect. And I find raw garlic too sharp, though I love it cooked various ways. But if it gives you pleasure why not?

That would gradually recruit antifungal-resistant yeasts, which can be very problematic (see Candida Auris which is thought to be the result of antifungal pressure in intensive agriculture).

re. beneficial fungi, AFAIK there are no known species that are part of our natural microbiota, but there may be unknown benefits. S. Boulardii supplements are know to help deal with gut flora disruptions like infections or antibiotic treatments.

S. Boulardii seemed to help me. I had a period of about a year with Crohn’s-like symptoms. I tried a lot of remedies, S. Boulardii did seem to help.

Here is another point to consider: If you were growing say Shiitake mushrooms on a container, a "bad" or potential unknown fungus might move in first to it and out-compete with your crop and thereby ruin your attempt.

But if your Shiitake mushrooms took hold and established a strong and healthy foothold the other mushrooms/spores/fungi will not be able to "move" in on after the fact.

So if you took this to a human perhaps the "good" fungus needs to be healthy and well colonized to prevent other random things from trying to grow in areas they shouldn't be in.

But I don't want shiitake mushrooms in my pancreas!

How do you know until you try.......???

Why not?

This is the same thing as the gut microbiome.. You need healthy bacteria and now fungi in your digestive system.

Incidentally, many mushrooms have profound anti-cancer properties. Shiitake is one of them.

That sounds quite intriguing, could you link to some of the papers on this topic as I'd be interested to read further.

I think that kind of reasoning is akin to saying we should eat pesticides because there aren’t beneficial pests in our bodies..

I did take an antifungal while sick, two actually. The first one made me break out in hives and the second one was a bit dehydrating (also couldn’t drink alcohol while on it). Would not recommend unless it’s necessary.

Having drunk alcohol on terbinafine because it was July 4 and I was an idiot I wouldn’t recommend the experience

They usually aren't perfectly well targeted.


Ivermectin apparently works directly on tumors, it isn't an antifungal...


Its an anti-helminth. Dewormer.

Is there any downside to periodically taking strong antifungals?

I type on computers for a living but I think in general everything in your body is in balance. For example, if you remove bacteria via an antibiotic you can get a fungal infection. It stands to reason that if you remove fungi via an antifungal the reduced competition for resources could cause an overgrowth of bacteria.

From the article

“But it’s probably too soon to add broad spectrum antifungals, many of which have lots of side effects, to cancer treatment regimens, even in experimental settings.”

The article says there are lots of side effects, but anti-fungals are pretty commonly prescribed for things like toe-nail fungus and yeast infections. Liver function needs to be monitored.

And yes, I'm sure there are likely beneficial fungi that live on/in humans. While beneficial bacteria have been studied for years now, we just don't know as much about beneficial fungi.

Amphotericin B is really bad news ("Amphoterrible").

Ivermectine is for killing heartworms in dogs, right? Is it also an antifungal?

Aside from usage in many other beasts beyond dogs, ivermectin has a fairly wide and possibly growing range of applications, eg used externally to treat rosacea, internally for river blindness, etc. It has anthelmintic effects on many roundworms, but not flatworms. It's an acaricide and generally effective in treating scabies; also lice and bedbugs. Definitely keep pet spiders away from ivermectin! I've seen nothing (yet) indicating antifungal properties. Anyone considering self administration (a commenter somewhere above) should note the hepatotoxicity of the drug.

Edit note: I am pretty sure ivermectin is the active ingredient in Revolution, an extremely popular medicine for dogs... and cats, combatting both heartworm and fleas and maybe more.

Homeopathic isn't the same as folksy. Folksy may or may not work, but at least there could be some potential method of action beyond the placebo effect. Homeopathic treatments are just placebos. They have been diluted repeatedly to the point where they don't actually contain any active ingredients.

For example, you put garlic into water, then take 1% of that water, mix it into another container of water, take 1% of that etc... Until the "medicine" doesn't actually contain any detectable garlic. The water supposedly retains some kind of "memory" of garlic.

It's incredible how much mindshare ideas like this get. If you could cure pancreatic cancer by mixing garlic with water, diluting several times, and then drinking it -- nobody would possibly have pancreatic cancer.

One dubious use of homeopathic remedies in the UK was simply to take the burden away from Drs when certain patients kept presenting with phantom issues

Placebos do work for some things. Though not likely against something like Pancreatic Cancer.

Placebos probably work for problems related to neural system (the less you are nervous the more healthy you are).

Taking Steve Jobs as an example here is a bad way to get healthy. Steve Jobs was simply used to listening to (back then) always smarter engineers. Medicine, however, wasn’t revolutionised the same way.

Steve Jobs apparently tried a homepathic diet in lieu of surgery for quite a while. He did have the less aggressive type of pancreatic cancer (islet cell carcinoma vs adenocarcinoma).

I listened to Ashton Kutcher talk about how he tried to copy Steve Jobs by drinking lots carrot juice and he ended up in the hospital.

Sadly, we lost my mother to pancreatic cancer. She always had an allergy to garlic, it would leave her extremely bloated and uncomfortable.

You mean holistic and naturopathic?

Don't confuse them with water benders.

First inside brain cells in areas affected with Alzheimer's disease (https://news.ycombinator.com/item?id=10401344) and now this.

I'm increasingly thinking we have severely underestimated and misattributed the damage caused by covert fungal infections.

Shouldn't this be an easy hypothesis to test?

Or a cohort that has taken some sort of anti-fungal med and we could look at their outcomes?

I'm pretty sure 'easy' is not the word I'd choose to describe it.

To pick one common fungal infection among many: Let's have a look at fungal nails (https://www.medicinenet.com/fungal_nails/article.htm).

As they note, "Onychomycosis is a fungal infection usually caused by a special type of fungus known as a dermatophyte. Since most of these infections are relatively superficial, it would seem that topical treatments ought to work well. This is not the case because the nail unit is relatively impenetrable."

Where I live, typical treatments for an established fungal infection of this kind would apparently include medical nail varnish with Amorolfin (at least weekly) or Ciclopirox (daily), for 6-12 months in cases with small, highly localized infection, or, for larger infections, oral Terbinafine (daily, for 3 months) or Itraconazole.

In my understanding (Life scientist here, but not really medical professional) Terbinafine is the nicer one of those last two as far as the patient's own body is concerned - a modern, effective, prescription-free antimycotic - and it still has a respectable list of side effects (https://en.wikipedia.org/wiki/Terbinafine#Side_effects).

This is not like procaryotes (Bacteria, Archaea, ...) where many aspects of their biology is almost alien compared to our own cells and possible to target with minimal host damage. Save for the fungal cell wall, and some exotic aspects to DNA reproduction and cell membrane biosynthesis, fungi are much closer to animal, and the game with them tends to be "let's see if we can find something that hurts you (much) more than it hurts me".

If they are hiding inside human cells or tissues reaching them with antimycotics to a significant extent at all is tricky. Not sure about the pharmacological accessibility of the pancreas, to be honest, but many drugs don't even enter the brain without being specially designed for it, let alone get inside the nerve cells. And even if we can get in there treatments are fairly long, disagreeable and/or risky, and far from guaranteed to be successful.

Is the drug effective against the particular fungus? Does it remain effective under the course of microbial evolution? Is the body capable of eliminating the fungus entirely with aid from the drug? (Arguably maybe not, if the fungus is very good at hiding.)

So, I agree that looking at the existing outcomes after treatment with antimycotics could be a good first step, but as far as I can see, if you detect an effect you can be fairly sure there is one, but if you don't detect an effect that doesn't really tell us much because it could mean either there's no problem or, just as well, that the treatment has just been too ineffective in eliminating the deep covert infections for one reason or the other. And there's every reason to believe we may be in that latter scenario.

But, with Alzheimer's and pancreatic cancer on the list of allegations so far, is it worth testing? On a society level, yes, unequivocally.

This seems like an extremely promising development and the study looks to have done everything right regarding controls.

I'm hoping this isn't just another "works in mice!" story, but it doesn't seem like that is the case, as this is dealing with something very different (specific fungal infection) than most other studies.

I have one of the variants of Ehlers-Danlos Syndrome, a genetic condition that changes how collagen proteins are folded. The results of the condition vary wildly depending on how specifically the proteins fold, but in my case it's pretty minor. I'm "hyper flexible" and I'm more prone to fungal infections.

My skin is a buffet for fungal infections and I've been fighting a persistent Malassezia infection for years. It's caused me to have intense dandruff and lost a lot of my hair as the infection clogs my hair follicles.

The only thing that helped was taking oral anti-fungals, but once I stopped, the infection came back within a few weeks.

Reading that the specific fungus I'm fighting is also plausibly responsible for pancreatic cancer is a bit frightening.

I wonder if I can get routinely screened for pancreatic cancer without appearing like a crazy person to an uninformed doctor.

Pancreatic cancer is one of the worst to detect, often detected in the very last phase when nothing could be done; if I were you I would insist on regular checks given you likely suffer from seborrheic dermatitis given your symptoms.

From Internet: "(Eczematic) dermatitis can be one of the earliest indications of pancreatic cancer."

Back when I was in college, someone gifted me Randy Pausch's "The Last Lecture". It was my first introduction to this terrible disease. Little did I know then, that a decade later, I would lose my beloved father in-law to the same disease.

When he was diagnosed, I digged into Randy's old blog, and realized how little things have changed since then. There is now a new cocktail of Chemotherapy drugs, but apart from that we have hardly progressed on this front. I don't think we could have really saved him even with an early diagnosis.

Surgery seems to be the only permanent, generic cure as far as most cancers are concerned. But with Pancreas, from what I read, even that gave a very grim future (as in Randy's case). If at all you survive the Whipples, you will be entirely on expensive enzyme supplements for the rest of your life AND carry a significant risk of metastasis.

So good to see someone mention Randy Pausch. The Last Lecture was such a poignant speech. RIP, Randy and your father-in-law. Truly an evil disease.

Link for anyone that hasn't seen it, I highly recommend it: https://www.bing.com/videos/search?q=the+last+lecture+youtub...

I would say that surgery is never considered a permanent generic cure- most people would say you aren't cured, you just don't have a remission. This is true for basically all types of cancer.

Now, the closest thing to a cure for these types of cancers is immunotherapy. Nearly everybody in the cancer field has shown amazement at therapies that "seem to melt the cancer in front of your eyes".

It seems like the Chemotherapy / radiation is a lot more targeted and has less side effects. Furthermore, genetically targeted treatments and the early detection mechanisms of cancerous cells to avoid large scale re-growth seem to have improved markedly.

That said, detection in the case I'm thinking about was super early which always helps with outcomes.

not for pancreatic. only about 5% of cases have a genetic target, and there is no known test for early detection. you can look at a healthy pancreas and a few months later same person is stage iv.

Of interest to people who are willing to examine claims of treatment modalities outside of the mainstream medicine, without labeling them as quackery:

An Italian oncologist by name Tullio Simoncini believes that cancer is primarily caused by a fungus and he uses baking soda (sodium bicarbonate) as the primary treatment. He claims that he's been successfully treating patients for decades. I'm willing to give him the benefit of doubt, and I'd would welcome any information from someone who has investigated his treatment, or has direct experience either as a patient or personally know a patient.

His website: http://www.simoncinicancertherapy.com/en/index.html

To the causal skeptic who will feel the urge to respond to my post : It's ok to be skeptical(Infact it's the wise thing to do, initially), but flippant skepticism is another matter altogether. Flippant skepticism a dead end, even if it's very gratifying. I'm also aware that there are unverified rumors that Simoncini's license was suspended. Personally to me, it does not matter if his license was indeed suspended.

> “This is intriguing and exciting research,” said Dr. Ami Bhatt, who studies microbes at Stanford University. “But it’s probably too soon to add broad spectrum antifungals, many of which have lots of side effects, to cancer treatment regimens, even in experimental settings.”

I wonder if there are natural dietary changes you can make to help reduce the likelihood of these fungi.

Could've saved Iain M Banks :(

Steve Jobs tried to cure his pancreatic cancer with diet for 6 months. This might have given him more direction.

Pancreatic cancer has taken quite a few famous people:

    Randy Pausch - Last Lecture
    Steve Jobs
    Patrick Swayze
    Sally Ride - astronaut
    Piers Sellers - astronaut 
    Hans Rosling
    Richard Hatch
    Bill Hicks - Comedian
    Jef Raskin - Macintosh 
    Iain M Banks - Author
In the 12 years since Randy’s Last Lecture, we’ve made little progress:


Steve Jobs had one of the mildest, non-aggressive forms of pancreatic cancer; had he taken chemo, he would be 99% here today. Instead he let it grow until there was no hope anymore. Fruitarian diet seems like the worst possible one for pancreas...

I guess that's the downside of a contrarian "Think different" mindset.

Sometimes if you "zig" while the whole world "zags", you build the biggest company in the world. And sometimes you die from very treatable cancer.

Another famous person currently fighting it is Alex Trebek. Stage IV. And sadly, he just had a relapse.

I'm surprised no one has mentioned Satoru Iwata or Satoshi Kon yet. Both were fairly high-profile losses because of their reputations and how suddenly they left us. Kon's farewell letter was also somewhat remarkable because of the Japanese taboo, at the time, of speaking about cancer: https://www.makikoitoh.com/journal/satoshi-kons-last-words

You're right. And thank you for that link.

Ruth Bader-Ginsburg, Aretha Franklin, Pavarotti, Sharon Jones, Alan Rickman, Dizzie Gillespie, Patrick Swayze, Benoit Mandelbrot, Wernher von Braun, John von Neumann...

I hope they lick this thing along with so many other forms of this that just destroy quality of life.

RBG is still alive...

Indeed! Originally had a few other folks on that list (Trebek, my mom) that were alive and forgot to remove RBG. Please forgive my error.

Iain (M) Banks died of gall bladder cancer that had spread to his pancreas and liver [1]. This research concerns cancer that originates in the pancreas, so I don't think it would have helped him.

Still my favourite author. Six years. Hard to believe.

[1] https://www.iain-banks.net/2013/04/03/a-personal-statement-f...

I thought he sublimed with the rest of the Gzilt?

What an amazing author.

Didn't Jobs have the same?

Is it possible to avoid this fungus? What are the sources of this fungus?

fungi in general are pretty ubiquitous. Not sure about this particular one.

PDA tumours in humans and mouse models of this cancer displayed an increase in fungi of about 3,000-fold compared to normal pancreatic tissue. The composition of the mycobiome of PDA tumours was distinct from that of the gut or normal pancreas on the basis of alpha- and beta-diversity indices. Specifically, the fungal community that infiltrated PDA tumours was markedly enriched for Malassezia spp. in both mice and humans.

Are there any treatments to remove fungi ? I thought they were impossible to get rid off passed a certain threshold.

Hm, given it's Malassezia, is there a connection to seborrheic dermatitis (the same underlying organism)? Is there a correlation between patients with pancreatic cancer and seborrheic dermatitis? I lost auntie a month ago due to pancreatic cancer, it took less than a year from diagnosis to death.

I still put my money on K-Ras being much more important than any fungi.

we've cured cancer in mice more times than people can count. It doesn't really represent forward progress in human cancer research.

We have made truly incredible process in cancer treatment. From 1990 to 2010 the number of cases breast cancer stayed about the same, but the number of deaths dropped by about 1/3. https://www.sciencedirect.com/science/article/pii/S221353831...

It’s hard to say what current rates are as treatment lasts so long. However, approximately 99% of people with localized breast cancer, which is ~62% of diagnoses, survive 5 years. 85% with regional cancer, spread to nearby lymph nodes or other tissue, survive 5 years. Even metastatic breast cancer has which is 6% of diagnoses has a 27% chance of surviving 5 years.

Now various other types have had more or less success, but amazing work has been done.

Your comment is almost completely orthogonal to dekhn's. The point is that, regardless of progress/stagnation in cancer research, success in mouse models is not a strong indicator of eventual success in humans.

Mouse models are almost the only indicator for future success. So while many fail, most progress comes through research just like this.

Just remember, successful means lower the rates of deaths they don’t generally eliminate it. So, yay study 1357 got the survival rate from 5% to 10% that’s real progress. (Reported as curing cancer). Study 2217 got the survival rate from 10% or 15% wow progress. (Reported as curing cancer). Study 3... I mean grated they did help some specific individual within that study so it’s not meaningless, but come on.

> Mouse models are almost the only indicator for future success.

What do you mean by this? The vast, vast majority of things that work in mice do not work in humans. Even if effectiveness in mice is (approximately) necessary for eventual effectiveness in humans (say, because of our research methods), this does not make it a good indicator. "Drug doesn't immediately melt your brain" is also a necessary property, but it doesn't do a good job of predicting effectiveness.

If you only look at everything that has already passed the test then sure the test does not seem important.

The set of all possible cancer treatments however are not just the set of treatments that pass animal models. Drugs etc need to go though several hoops before they are even tested in mice, and even more fail in mice. Everything that’s made it to this stage is extremely promising relative to the baseline.

If the baseline is success probability 10^-8, raising it to 10^-5 is extremely promising at a relative level, but not at an absolute level.

That’s fair though 10^-5 is wildly off base.

About 1/3 of drugs that show promise on mouse models are ever tested in humans. After that Oncology has a 8.3 percent success rate for 2015. So, when looking at ‘cured cancer in mice’ something like 2.5% is about the right ballpark, which I would consider promising as a general baseline.

For some comparisons the success rate in clinical trials averages around 14% though it ranges from around 33.4 percent in vaccines for infectious diseases to 3.4 depending on the type of treatment being tested. https://www.centerwatch.com/cwweekly/2018/02/05/new-mit-stud...

Baseline is harder to calculate, but 10^-8 is probably reasonable depending on what’s considered.

> About 1/3 of drugs that show promise on mouse models are ever tested in humans.

Do you have a citation? This seems totally off to me. In so far as the number refers to something real, I suspect "shows promise" must mean something much stricter than the threshold that this particular treatment has passed. That is, I would bet against a 2.5% chance that this particular study leads to an actual drug approved to treat pancreatic cancer.

if your proxy metric correlates less than 0.5 with the system of interest (roughly correct for mouse models), then the indicator is less than useful- it causes systematic and random false negatives and positives at a higher rate than true positives.

Great idea! Let's lock people in those cages instead, transplant a prostate tumor in them and feed them human chow with 1 mg/ml Amphotericin B (with 0.5mg/ml on the side to drink). Do you volunteer?

That sounds a little rude, but we could find ourselves with the ability to grow human organs in the lab.

The last company I worked for grew organoids. They're useful, but not a full proxy for human biology.

Does this imply anything regarding the consumption of yeast? Specifically nutritional yeast which many vegans tend to eat.

In the coming decades, we'll find that many more diseases than previously thought are caused by yet-unknown pathogens.

There's good theoretical reason to think that. Evolution should eliminate diseases caused by self-defects, but arms races with pathogens can keep diseases around (either directly, caused by the pathogen, or indirectly, as a tradeoff due to things being selected for to resist the pathogens.)

If diseases caused by self defects arise mainly after reproducing (say in your 50s/60s/70s), would there be much evolutionary pressure to eliminate it?

> Researchers were surprised by the presence of fungi in the typical pancreas and immense increase in their numbers in disease. “The pancreas was considered a sterile organ until a couple years ago”

I'm surprised that after decades of treating pancreatic cancer, nobody noticed this earlier. You'd think they take biopsies and take a look at them.

Is this why people are trying to cure their cancer with dog deworming products?

It seems like every week research finds a new carcinogen or anti-carcinogen.

It seems like every week that the mainstream press, in search of clickbait content and with no understanding of statistics, misstates the results of some study or another.

It's either 'a Common Fungus' or 'Common Fungi'.

The NYT either had it right, or corrected it. The linked article says "common fungi" without the "a".

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