Diabetes and Cancer
Cancer incidence and mortality are higher in diabetic patients. Although epidemiological data on the diabetes-cancer association mainly concern type 2 diabetes, recent data confirm that cancer is increase also in type 1.
The increased incidence of cancer in diabetic patients is documented for many organs (i.e., liver, pancreas, stomach, kidney, endometrium, breast) but not for all (prostate, lung).
Diabetes promotes cancer by multiple mechanisms that are both general (i.e., hyperinsulinemia and hyperglycemia) and site specific (i.e., increased hepatosteatosis and hepatitis in diabetes favor liver cancer).
Also the increased cancer mortality in diabetic patients is due to several mechanisms that, on one side, can make the cancer more aggressive and, on the other side, make the patient a fragile subject because of the frequent chronic complications of diabetes. Moreover, because of these complications, many diabetic patients receive less than optimal cancer therapy.
A matter of concern for cancer promotion is all conditions causing hyperinsulinemia, both endogenous (insulin-resistant diseases with compensatory hyperinsulinemia, like obesity and prediabetes) and exogenous. Treatments with high doses of insulin (with special attention to long-acting analogs) and with secretagogues like sulfonylureas may promote the growth of silent, subclinical tumors. In contrast, metformin, the most used first-line hypoglycemic agents, can decrease cancer risk because of its indirect effect (insulin sensitizer, reducing insulin resistance and hyperinsulinemia) and also with a direct effect, reducing cancer cell proliferation with multiple actions.
One additional problem in patients with diabetes and cancer is the hyperglycemic effect of many cancer drugs. Glucocorticoids, antiandrogens, and recent biological drugs targeting the insulin and IGF-1 signaling pathways may cause hyperglycemia, sometimes severe. This complication can concern patients unaware of diabetes or prediabetes and may adversely affect both patient well-being and cancer progression.
In conclusion, cancer and diabetes are two very prevalent diseases and each one can negatively influence the other one. Cancer-related death accounts for approximately one third of deaths in diabetic patients. It is important, therefore, to promote all preventive measures (often similar for the two diseases) and personalize the treatment according to the features of the diseases and the characteristics of the patient.
KeywordsDiabetes and cancer Hyperglycemia and cancer Insulin and cancer Hypoglycemic agent and cancer Cancer drugs and hyperglycemia Insulin receptor and cancer
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