A NEW technique to study tissue samples in 3D has revealed that pancreatic cancers can start and grow in two distinct ways, solving a decades-old mystery of how tumours form.
The new method could help researchers to get more information from tissue biopsies and may lead to improved treatments for pancreatic cancers. The technique was developed by scientists at the Francis Crick Institute, and their results are published in Nature. The work was supported by the European Research Council and core funding from the MRC (one of the Crick’s founding partners).
The pancreas is a crucial organ that sits behind our stomach and plays a key role in digestion. It relies on a network of ducts linking it to other digestive organs, and the most common pancreatic cancers are found in the ducts. However, until now it has only been possible to see 2D slices of these ductal cancers, which contained an unexplained variety of abnormal shapes.
“To investigate the origins of pancreatic cancer, we spent six years developing a new method to analyse cancer biopsies in three dimensions,” explains Dr Hendrik Messal from the Francis Crick Institute, co-lead author of the research paper. “This technique revealed that cancers develop in the duct walls and either grow inwards or outwards depending on the size of the duct. This explains the mysterious shape differences that we’ve been seeing in 2D slices for decades.”
By analysing developing cancers in 3D, the team defined two distinct types of cancer formation: ‘endophytic’ tumours which grow inwards and ‘exophytic’ tumours which grow outwards. To find out what makes cancer cells grow in a particular way, they analysed detailed 3D images and worked with biophysicists at the Crick who created sophisticated computer models.
“We made a simulation of the ducts, describing individual cell geometry to understand tissue shape,” explains biophysicist Dr Silvanus Alt, co-lead author of the paper. “The model and experimental results both confirmed that cancer grew outwards when the diameter of the duct was less than approximately 20 micrometres, around a fiftieth of a millimetre.”
The work was made possible by an interdisciplinary collaboration between two research groups at the Crick, led by Dr Axel Behrens and Dr Guillaume Salbreux. Axel’s group works on stem cells and pancreatic cancer, while Guillaume focuses on using physics to understand biological processes.
“I think we first started discussing this when we bumped into each other in the bike shed,” says Axel. “It’s amazing what can come out of a chance encounter, we now have a patented technique to see the three-dimensional shapes of cancers and a biophysical understanding of the emergence of tumours. Now that we know pancreatic cancer can develop in these two different ways, we can start looking at whether one is likely to be more aggressive or spread in a different way. Many years from now, this could lead to improved diagnostic or treatment options.”
The team also applied the technique to other organs and found that cancers in the airways of the lungs and ducts in the liver behave in the same way. This shows that the mechanism the teams discovered is not specific to the pancreas and also applies to other cancers.
“Both the data and our models indicate that the two different mechanisms of tumour growth are purely down to the innate physics of the system,” explains Dr Guillaume Salbreux. “Like most cancers, ductal pancreatic cancer starts with a single defective cell that starts dividing. We found that very quickly, when there are only a few cells, the tumour has already started to grow either inwards or outwards depending on duct diameter. Defining this fundamental process will help us to better understand how cancer grows in many places across the body.”
Dr Mariana Delfino-Machin, Programme Manager for Cancer at the MRC, said: “Pancreatic cancer remains a very difficult disease to treat but understanding that it can grow in different ways will inform the development of more accurate treatments in the future.
“These findings came about thanks to researchers working in very different fields coming together to successfully tackle the same problem.”
Older people missing out on benefits
AGE CYMRU helped older people in Wales claim more than £6.5m in benefits last year; additional income that could have a massive impact on the quality of life for those individuals who came forward seeking help.
However, this is just the tip of the iceberg as it’s estimated that more than £3.5 billion of state benefits available to older people in the UK goes unclaimed each year. In Wales this would equate to approximately £175 million of unclaimed benefits; a significant amount of money that could help bring about positive changes to thousands of older people in Wales.
Additionally, a recent study by the National Assembly for Wales found that more than 120,000 older people in Wales are living in poverty.
To help combat such levels of poverty amongst older people, Age Cymru has updated More Money In Your Pocket for 2019/2020; a bi-lingual guide to help older people and their carers claim benefit entitlements in later life.
The guide covers a wide range of benefits and entitlements, including state pensions, Pension Credit, help with Council Tax, help with heating costs, Attendance Allowance and Carers’ Allowance.
Take the case of Jack, who contacted one of Age Cymru’s partners for help in 2018.
Jack is 82 and lives with his wife Gwen who is 73. Jack has suffered six heart attacks and has several other debilitating diseases. As a result he has limited mobility and little stamina so rarely leaves his home.
An Age Cymru adviser undertook a thorough exploration of Jack and Gwen’s circumstances and identified that they were not claiming all their benefit entitlements.
In summary, Jack was awarded the highest rate of the Disability Living Allowance care component at £85.60 per week; Pension Credit for the couple was awarded at £119.00 a week and their Council Tax payments were reduced from £155 to £25 a month. They also received a number of backdated amounts, totalling £5,587.46.
As a result, their life has changed for the better. They can now afford to pay for food and heating and can also pay for transport if they need to go somewhere and therefore no longer feel trapped in their home.
Gavin Thomas, who manages the charity’s information and advice services across Wales says: “Poverty can have a devastating effect on an older person’s quality of life forcing many to choose between eating and heating. It can also keep an older person trapped in their homes leading to loneliness and isolation and, in many cases, poor mental and physical health.”
“Some people miss out on benefits because they mistakenly believe they don’t qualify or are put off by the claims process.
“However, older people might be surprised to learn what help is available to them. I would urge any older person in Wales to claim all their benefit entitlements and to use our guide as a useful tool to start the process.”
More Money In Your Pocket is available free of charge from Age Cymru and local partners throughout Wales. You may call the Advice Line free on 08000 223 444 or email email@example.com to order a copy. You may also download the free guide from our website: www.agecymru.org.uk/
The charity’s expert advisers can also carry out a full benefits check to find out what you might be entitled to claim. Age Cymru also offers a range of information guides and factsheets on many other topics.
Diabetes’ effect on mental health explored
NEW research from Diabetes UK has found that seven out of ten people feel overwhelmed by the demands of living with diabetes, significantly affecting their mental and physical health.
The survey of more than 2,000 adults with Type 1, Type 2 and other types of diabetes from across the UK shows that the majority (three quarters) of those who feel overwhelmed say that this affects how well they can manage the condition.
In order to explore the links between mental health and diabetes, the charity collected extensive insights from people affected by the condition and healthcare professionals from across the UK.
The findings, published in the report “Too often missing: Making emotional and psychological support routine in diabetes care”, show that diabetes is much more than a physical condition.
Management of physical symptoms 24/7 – for example checking blood glucose levels, or managing diet – alongside the continual need to make decisions and take actions in order to reduce the likelihood of short and long-term complications, can affect every aspect of day-to-day life.
The research revealed that the relentless nature of diabetes can impact people’s emotional, mental and psychological wellbeing and health, from day-to-day frustration and low mood, to specific psychological and mental health difficulties such as clinical depression and anxiety.
Three-quarters of those needing specialist mental health support to help manage the condition, such as from a counsellor or psychologist, could not access it. Seven out of ten people with diabetes also reported that they are not helped to talk about their emotional wellbeing by their diabetes teams.
Healthcare professionals surveyed also revealed that there was more to be done in this area. Specifically, 40 per cent of GPs say they are not likely to ask about emotional wellbeing and mental health in routine diabetes appointments, while only 30 per cent feel there is enough emotional and psychological support for people living with diabetes when needed.
The report marks the launch of a Diabetes UK campaign to make the emotional and psychological demands of living with diabetes recognised and provide the right support to everyone who needs it.
Diabetes UK Cymru is marking the launch with an event on Wednesday 22 May at the Norwegian Church in Cardiff Bay from 12 pm to 2 pm.
The charity is urgently calling on each of the four nations’ health services to create national standards for diabetes emotional and mental healthservices. These should ensure that everyone is asked how they are feeling as part of every diabetes appointment and that a mental healthprofessional with knowledge of diabetes is part of every diabetes care team.
Dai Williams, National Director, Diabetes UK Cymru, said: “The day-to-day demands of managing diabetes can be a constant struggle, affecting people’s emotional wellbeing and mental health. In turn, people tell us that struggling emotionally can make it even more difficult to keep on top of self-management. And when diabetes cannot be well managed, the risk of dangerous complications, such as amputations, kidney failure and stroke increases.
“Diabetes services that include emotional and psychological support can help people improve both their physical and mental health, reduce pressure on services, and save money.
“Mental health and physical health go hand in hand, but services for people with diabetes don’t always reflect this. We need to bridge the divide between physical and mental health services to ensure those with emotional and psychological difficulties related to their condition do not have their needs overlooked. It is critical that all diabetes care sees and supports the whole person, and explores what matters most to them.”
Diabetes UK is launching a petition to call for national standards for diabetes mental health support and services.
To find out more about the campaign and sign the petition go to www.diabetes.org.uk/missing
Important step for Welsh cancer treatment
THE FIRST NHS Wales cancer patient to receive proton beam therapy in Wales has started treatment at the Rutherford Cancer Centre South Wales in Newport.
The Newport centre is approved by the Welsh Health Specialised Services Committee (WHSSC) to provide high energy proton beam therapy to adult patients, referred from the NHS in south Wales.
Professor Roger Taylor, Senior Clinical Advisor and Consultant Clinical Oncologist at the Rutherford Cancer Centre South Wales, said: “The availability of proton beam therapy at a local clinic is an important step forward in cancer care in the UK and we are pleased to be able to provide treatment for this young man.
“Whilst proton therapy is not a panacea for all types of cancer, we have seen where it can be beneficial in treating a range of tumours. Working with the NHS in Wales means that adult patients have an option to be treated closer to home.”
Jamie Powell, Centre Manager at the Rutherford Cancer Centre South Wales, said: “Providing access to the Rutherford Cancer Centres for NHS patients is something we have been working towards and we are pleased to announce this on World Cancer Day. Our centre and services in Newport are supported by NHS Wales clinical, hospital and research facilities and we look forward to continuing to provide excellent care in a high-quality and technologically advanced environment.”
The Rutherford Cancer Centre South Wales was the first clinic in the UK to provide high energy proton beam therapy and treated the first non-NHS patient with high energy proton beam therapy in the UK in April of last year.
Rupert Lowe, chairman of Proton Partners International, said: “As someone who had to travel abroad to receive proton beam therapy, I am delighted to be reporting on World Cancer Day today that the situation is changing at last in the UK.
“We were extremely proud to treat the first proton beam therapy patient in the UK last April and scores more have benefited from this treatment without having to travel abroad. We are also pleased to see the development of proton beam therapy facilities within the NHS.
“We are delighted to have been commissioned by health commissioners in Wales to treat adult NHS patients with proton beam therapy and are very proud that our first NHS patient began treatment today.
“The UK Government recently set out an ambitious 10-year plan for the NHS which includes major commitments to tackling cancer. We firmly believe that given the magnitude of the challenge, a collaborative approach among healthcare providers will achieve the best results for patients.”
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