November is a month of awareness for a few cancers. I will discuss each briefly but you can find more detail in the links given below. 

I'm going to start with the worst here, pancreatic cancer. 

Pancreatic Cancer:
Pancreatic cancer is the 11th most common cancer in the UK accounting for about 10,000 cases each year. The incidence has been steadily increasing over the last 10 years, more so in women than in men. It only accounts for about 5% of cancer-related deaths each year but here's the kicker...less than 1% of pancreatic patients will survive 10 years or more. The five-year survival rate? 3%. And finally only 20% of patients will survive their first year. That is a loss on average of around 8,000 lives a year just down to one cancer type.  

So why is this cancer type so bad. There are a number of reasons, the first being your pancreas is pretty important for your survival. Your pancreas does two vital things, it produces enzymes which help you digest your food and it produces hormones to regulate your blood glucose levels. Hormones like insulin. The second reason pancreatic cancer is so hard to treat is its location. Your pancreas is embedded deep in your abdomen between your stomach and your spine. The third reason is your pancreas doesn't regenerate and it's very difficult to replace with a donor. And finally and possibly most importantly for cancer treatment, pancreatic cancer usually presents at a very late stage meaning very little can be done. 

Symptoms:
Again with a lot of cancers the symptoms are vague and can include:

• Pain in the stomach or back
• Jaundice
• Weight loss 

Type of pancreatic cancer:

1. Endocrine: start in cells that are involved in hormone production. These types of cancer are no common, only about 5% of cases are endocrine tumours.
2. Exocrine: the more common type of pancreatic cancer (95%) originates in the "head" of the pancreas where cells that produce digestive fluids. The most common form of these is Pancreatic Ductal Adenocarcinoma (PDAC). 

Diagnosis and treatment:
Diagnosis of pancreatic cancer is mainly through examination of the pancreas using an ultrasound or CT scan accompanied by blood tests and a biopsy. The majority of patients are diagnosed at stage IV, which is why the survival rate is so low. The treatments for pancreatic cancer are the standard: surgery, chemotherapy and/or radiotherapy. Unfortunately lack of response to treatment and recurrence is high. There are many ongoing clinical trails to find new targeted therapies for pancreatic cancer.

Screening and prevention:
Currently there are no screening programmes for pancreatic cancer and early diagnostic tools like CA19-9 are unreliable as a proportion of pancreatic cancers don't release this marker. 

This is a terrible disease with a shocking survival rate and it is only getting worse. Pancreatic cancer research is one of the most underfunded research areas today. But with more awareness hopefully charities like Pancreatic Cancer UK can raise more funds for vital research. 

To keep with the theme of vastly underfunded research areas I will next talk about 

Lung Cancer:
You would expect through all the campaigns about quitting smoking etc. that lung cancer would be one of the most funded cancer research areas but it is sadly not. 

Lung cancer is the third most commonly diagnosed cancer in the UK accounting for about 46,000 new cases a year. But just like pancreatic cancer, the 10-year survival rate is only 5%. The sad thing is CRUK estimates about 89% of lung cancer cases could be prevented. I won't lie to you we all know the biggest risk factor for lung cancer is smoking. We've seen the ads and the photos on cigarette packets. The statistic here to remember is that while only 10% of smokers will get lung cancer a whopping 86% of lung cancer patients are smokers, former smokers or passive smokers. 

Symptoms of Lung Cancer:​

• Persistent cough for more than a few weeks
• Shortness of breath
• Coughing up blood
• Ongoing chest infections
• Loss of appetite and/or weight
• Chest pains

Types of lung cancer:
The "types" of lung cancer are grouped together because of the size of cell the cancer originated in but they are not all the same cancer. 

• Small cell lung cancer (SCLC): accounts for about 15% of all lung cancer however only 12% of cases are in smokers. 
• Non-small cell lung cancer (NSCLC): accounts for about 85% of lung cancers. 

Diagnosis and treatment:​
Usually once you have presented with symptoms which indicate lung cancer a patient will receive a chest x-ray and/or bronchoscopy accompanied by a biopsy. It must be noted that treatment for the two cancer types are different, depending on where it is and the stage. But the standard treatments for lung cancer is standard: surgery (which could be as little as removing the tumour to as much as removing a lung), chemotherapy, radiotherapy, photodynamic therapy and ablation. There are targeted therapies available for advanced lung cancer patients which target pathways such as EGFR (erlotinib) or tyrosine kinases (genfitinib). 

Screening and prevention:
While there is no national screening taking place for lung cancer the best way to prevent it is to quit smoking. Anti-smoking campaigns are one of the most successful awareness campaigns out there. 

And the big question you've been burning to ask - why is lung cancer so underfunded? Sadly I have no answer for you. The funding process is a difficult and complex system which I know very little about. The good news is that CRUK at least have pledged to put more funding into these poorly researched cancers like Lung and Pancreatic. 

And finally let's talk about Movember. Now November isn't the month for awareness on testicular cancer or prostate cancer so I won't be talking about these. However it has become a month where awareness and funds are raised for all men's cancers. And awareness to me is more important that a single penny. I have spoken on this before but just to hit it home once again, prevention is better than cure. Not all cancers can be prevented I'm afraid but if we can reduce the numbers of people being diagnosed we can reduce the numbers who lose their lives. 

The fact the Movember has come about is particularly important. The most funded cancer research area to date is breast cancer. And it is thought that part of the reason for this is women. Women who had/have breast cancer or women who have lost a family member or friend to breast cancer. These women are the driving force behind every awareness campaign, behind new drugs being made available to patients and behind vastly successful national screening. To me it seems women are, interestingly, the major focus of cancer awareness campaigns because they are usually the driving force behind them. I'm not going to go into gender biases about how "women talk more about their problems than men" because if cancer screening has taught me anything its not true (take a look at bowel cancer screening statistics). But what I am saying is that men as a whole (sorry to put it like that) have less opportunities to avail of screening services and may not know what they are really supposed to be looking out for. Which is why Movember is so brilliant. It encourages men to get involved and to talk about male cancers. It puts male-specific cancers in focus while allowing men to actively participate by growing beards (super manly).  

I like to highlight charities and companies that inspire me and to me show genius and innovative ways of raising cancer awareness and funds. And the underwear company OddBalls encompasses this completely. The company, started in 2014, designs and creates underwear (not just for men but for women as well). And with your new boxers you also receive a handy guide to checking yourself for testicular cancer. They have become so popular they now design underwear for rugby clubs including The Welsh International Team AND have set up their own charitable foundation. 
If you want to know more or maybe by a pair for yourself, check out:  www.myoddballs.com/
They also do socks, bobble hats, rugby jerseys and more!

If you have any questions please don't hesitate to contact me.
​For more information visit:
www.pancreaticcancer.org.uk/
www.cancerresearchuk.org/about-cancer/pancreatic-cancer?ds_kids=p3584232188&adc=cpc&gclid=EAIaIQobChMImP__2rjG2AIVyrftCh0JBwOcEAAYAiAAEgLai_D_BwE&dclid=CMSp4ty4xtgCFVBuGwodM9sKyg​​
www.cancerresearchuk.org/about-cancer/lung-cancer
​www.blf.org.uk/?gclid=EAIaIQobChMIqZy7osLG2AIVzbztCh2LnAvCEAAYASAAEgIt3fD_BwE
uk.movember.com/

October is breast cancer awareness month. I want to tell you in this post some information about breast cancer symptoms, diagnosis and treatments. I have worked in various areas of breast cancer research in the last 5 years, most notably my PhD is focused on understanding diabetic drugs in order to prevent breast cancer. It's an area close to my heart.
 
Breast cancer is the most commonly diagnosed cancer in the UK. About 55,000 new cases are diagnosed every year and 7% of all cancer-related deaths can be attributed to breast cancer. There is some good news and bad news about breast cancer survival. The overall 5-year survival is around 86% but when you break this down by stage of the cancer type, this value falls dramatically for those with higher stage cancers. 5-year survival for women with stage IV cancer is approximately 15%. The survival rate has doubled in the last 40 years due to better preventative measures, better diagnosis and better therapies. 

Breast cancer types:
I've already spoken a bit on the different cancer types and how tumours can be classed by their origin but also molecular differences ("What the Hell? - Cancer Part 2).

I've also talked before about risk factors, which are lifestyle or genetic factors that can increase or decrease the likelihood of developing a certain disease. There are a number of risk factors associated with breast cancer (some are in image 3).

Symptoms:
Most women know the symptoms of breast cancer:

• Lump in the breast
• Change in size, feel, shape or skin (e.g colour/rash or puckering/dimpling) - this is sudden and not due to usual hormone fluctuations during periods etc.
• Fluid leaking from nipple
• Breast pain
• Swelling in the armpit
• Nipple placement has changed

If you or someone you know experiences these symptoms you should talk to your doctor about them. 

Diagnosis:
There are a number of ways a breast tumour is identified:

1. Mammogram: this is basically an x-ray where they look for a lump and physical changes associated with breast cancer. 
2. Ultrasound: alternatively to a mammogram, patients may receive an ultrasound 
3. ​Biopsy: a section of the tumour is taken for analysis. There are a number of different types of biopsy depending on the symptoms e.g. fine needle aspiration, needle biopsy, punch biopsy, vacuum assisted biopsy or wire guided excision biopsy. 
4. Pathology: staining of the tumour sample and visualisation under the microscope helps define tumour type ("What the Hell? - Cancer Part 2)
5. Hormone receptor tests: hormones are detected either by genetic tests, looking for the protein or FISH (fluorescent in situ hybridisation - for Her2+. If the gene is present it will glow when exposed to UV light).

Treatment:
​Treatment depends on the stage/grade of your tumour, the molecular subtype and the willingness of the patient. There are the standard treatment practices (1-3) but also more personalised therapies (4-5)

1. Surgery
2. Chemotherapy
3. Radiotherapy
4. Hormone therapy: hormone therapy targets the hormones and receptors that can contribute to cancer growth. The most well know of these therapies is Tamoxifen (targets the oestrogen receptor). Other therapies such as Anastrozole, Exemestane and Letrozole all target oestrogen, reducing the levels of oestrogen in the blood and thereby reducing the amount of oestrogen the cancer cell can use to grow. All of these hormone therapies are for ER+ breast cancers only. Tamoxifen is also used following cancer treatment once the cancer is in remission. It's been shown that taking tamoxifen for about 10 years after having your primary tumour can reduce the risk of recurrence or a secondary breast tumour.
5. Targeted therapy: targeted therapies are for ER- tumours (mainly Her2+). The most commonly used is Trastuzumab (Herceptin) which targets HER2 receptors, preventing the cells from getting key growth signals. Another drug, Pertuzumab, also targets Her2+ breast tumours. 

Prevention:
Prevention is key. You will hear my harp on about prevention is the cure to cancer but really it's one of the key areas we as individuals can look after for our own health. In fact it’s estimated that about 27% of all breast cancers could be prevented and there are a number of prevention techniques you can adopt

• Checking your breasts: by far the easiest thing you can do. It's quick, simple and non-invasive. Below is a handy video from Coppafeel! to show you how. You should never be embarrassed to keep yourself healthy!! 
• Mammogram: this a country-wide screening programme typically offered to women over 50 years of age that is commonly adopted in countries across the world. In the UK the age you are offered your first mammogram is 47 and typically you are asked to return every 3 years if nothing is detected. 
• Genetic testing: familial breast cancer can affect both females and males. The most common familial breast cancer is caused by BRCA1/BRCA2 mutations. BRCA proteins are involved in DNA repair. If these proteins are functional DNA repair becomes less efficient, meaning cancer causing mutations are more likely to occur and won't be fixed. Genetic testing if there is a history of breast cancer in the family is an effective way of identifying individuals at high risk of developing breast cancer and taking the necessary steps to prevent this from occurring. 

All rights to this video belong to Coppafeel!.org

And let's not forget the men here! Men can suffer with breast cancer. While only about 400 men are diagnosed each year that is still a significant number. Male breast cancer is quite similar to female breast cancer in terms of risks (though an additional risk factor is Klinefelter's syndrome), diagnosis,  symptoms and treatments. 

Finally I would like to talk to you about a charity which inspires me to keep doing the work I do. This charity was set up by a young woman who was diagnosed with breast cancer in her early 20's. Instead of wallowing in her diagnosis of metastatic breast cancer she decided to set up a charity to better educate young women to CHECK YOUR BREASTS! That charity was set up over 8 years ago and despite multiple metastatic tumours Kris is still alive and more vibrant than ever. This charity is called Coppafeel! (a genius name). If you have time please check out their website https://coppafeel.org/ and check out Kris's story (https://coppafeel.org/our-charity/kris-story/). A truly inspirational woman backed by the most incredible fundraisers and supporters. I haven't had the chance to work with coppafeel but it is one of the charities I would most like to get involved in. 

For more information on any of the areas I've discussed visit:
about-cancer.cancerresearchuk.org/about-cancer/breast-cancer
www.breastcancernow.org