Foods for Extrahepatic Cholangiocarcinoma!

Introduction

Foods for Extrahepatic Cholangiocarcinoma should be personalized for each individual and also must adapt when cancer treatment or tumor genetic change. The personalization and adaptation must consider all the active ingredients or bioactives contained in different foods with respect to cancer tissue biology, genetics, treatments, lifestyle conditions and diet preferences. Hence while nutrition is one of the very important decisions for a cancer patient and individual at risk of cancer to make – how to choose foods to eat is not an easy task.

Extrahepatic cholangiocarcinoma, a type of cancer that originates in the bile ducts outside the liver, poses significant diagnostic and treatment challenges. The ICD-10 code for extrahepatic cholangiocarcinoma aids in its standardized documentation and tracking. Pathology outlines and radiology, particularly MRI, play crucial roles in diagnosing this cancer, revealing its unique cellular structure and aiding in determining its extent. Staging, based on the AJCC 8 criteria and the TNM classification system, is vital for assessing the cancer’s progression and planning treatment, which often includes surgery as a key component. The pathology report, following the CAP protocol, provides detailed information essential for a comprehensive understanding of the cancer. Prognosis and survival rate vary depending on the stage at diagnosis, with early detection being critical for a more favorable outcome. Treatment strategies for extrahepatic cholangiocarcinoma typically involve a combination of surgery, chemotherapy, and radiotherapy, tailored to the individual patient’s condition. The role of immunohistochemistry in diagnosis and treatment planning is increasingly recognized, offering deeper insights into the molecular characteristics of the tumor. Symptoms of extrahepatic cholangiocarcinoma can include jaundice, abdominal pain, and weight loss, making early recognition and intervention crucial. For surgeons, understanding the intricate details of extrahepatic cholangiocarcinoma, including its anatomy and potential spread, is essential for effective surgical management and improving patient outcomes.

For Extrahepatic Cholangiocarcinoma does it matter what vegetables, fruits, nuts, seeds one eats?

A very common nutrition question asked by cancer patients and individuals at-genetic risk of cancer is – for cancers like Extrahepatic Cholangiocarcinoma does it matter what foods I eat and which I do not? Or if I follow a plant-based diet is that enough for cancer like Extrahepatic Cholangiocarcinoma?

For example does it matter if vegetable New Zealand Spinach is consumed more compared to Swamp Cabbage? Does it make any difference if fruit Strawberry Guava is preferred over Red Raspberry? Also if similar choices are made for nuts/seeds like Butternut over Chestnut and for pulses like Gram Bean over Catjang Pea. And if what I eat matters – then how does one identify foods which are recommended for Extrahepatic Cholangiocarcinoma and is it the same answer for everyone with the same diagnosis or genetic risk?

Yes! Foods you eat matters for Extrahepatic Cholangiocarcinoma!

Food recommendations may not be the same for everyone and can be different even for the same diagnosis and genetic risk.

All foods (vegetables, fruits, nuts, seeds, pulses, oils etc.) and nutritional supplements are made up of more than one active molecular ingredient or bio-actives in different proportions and quantities. Each active ingredient has a unique mechanism of action – which can be activation or inhibition of different biochemical pathways. Simply stated foods and supplements which are recommended are those which do not cause an increase of molecular drivers of cancer but reduce them. Else those foods should not be recommended. Foods contain multiple active ingredients – hence when evaluating foods and supplements you need to consider the impact of all active ingredients cumulatively rather than individually.

For example Strawberry Guava contains active ingredients Quercetin, Ellagic Acid, Myricetin, Curcumin, Apigenin. And Red Raspberry contains active ingredients Quercetin, Ellagic Acid, Curcumin, Formononetin, Beta-sitosterol and possibly others.

A common mistake made when deciding and choosing foods to eat for Extrahepatic Cholangiocarcinoma – is to evaluate only selected active ingredients contained in foods and ignore the rest. Because different active ingredients contained in foods may have opposing effects on cancer drivers – you cannot cherry pick active ingredients in foods and supplements for making a nutrition decision for Extrahepatic Cholangiocarcinoma.

YES – FOOD CHOICES MATTER FOR CANCER. NUTRITION DECISIONS MUST CONSIDER ALL ACTIVE INGREDIENTS OF FOODS.

Skills Needed for Nutrition Personalization for Extrahepatic Cholangiocarcinoma?

Personalized nutrition for cancers like Extrahepatic Cholangiocarcinoma consists of recommended foods / supplements; not recommended foods / supplements with example recipes which prioritize use of recommended foods. An example of personalized nutrition can be seen at this link.

Deciding which foods are recommended or not is extremely complicated, requiring expertise in Extrahepatic Cholangiocarcinoma biology, food science, genetics, biochemistry along with good understanding of how cancer treatments work and associated vulnerabilities by which the treatments could stop being effective.

MINIMUM KNOWLEDGE EXPERTISE NEEDED FOR NUTRITION PERSONALIZATION FOR CANCER ARE: CANCER BIOLOGY, FOOD SCIENCE, CANCER TREATMENTS AND GENETICS.

Characteristics of cancers like Extrahepatic Cholangiocarcinoma

All cancers like Extrahepatic Cholangiocarcinoma can be characterized by a unique set of biochemical pathways – the signature pathways of Extrahepatic Cholangiocarcinoma. Biochemical pathways like RAS-RAF Signaling, mRNA Splicing, Cell Cycle Checkpoints, PI3K-AKT-MTOR Signaling are part of the signature definition of Extrahepatic Cholangiocarcinoma. Each individual’s cancer genetics can be different and hence their specific cancer signature could be unique.

The treatments which are effective for Extrahepatic Cholangiocarcinoma need to be cognizant of the associated signature biochemical pathways for each cancer patient and individual at genetic risk. Therefore different treatments with different mechanisms of actions are effective for different patients. Similarly and for the same reasons foods and supplements need to be personalized for each individual. Hence some foods and supplements are recommended for Extrahepatic Cholangiocarcinoma when taking cancer treatment Bleomycin, and some foods and supplements are not recommended.

Sources like cBioPortal and many others provide population representative patient anonymized data from clinical trials for all cancer indications. This data consists of clinical trial study details like sample size / number of patients, age groups, gender, ethnicity, treatments, tumor site and any genetic mutations.

TP53, SMAD4, CDKN2A, ARID2 and KMT2C are the top ranked reported genes for Extrahepatic Cholangiocarcinoma. TP53 is reported in 44.2 % of the representative patients across all clinical trials. And SMAD4 is reported in 14.7 %. The combined population patient data cover ages from 29 to 79. 61.2 % of the patient data are identified as men. The Extrahepatic Cholangiocarcinoma biology along with reported genetics together define the population represented signature biochemical pathways for this cancer. If the individual cancer tumor genetics or genes contributing to the risk are also known then that should also be used for nutrition personalization.

NUTRITION CHOICES SHOULD MATCH WITH EACH INDIVIDUAL’S CANCER SIGNATURE.

Food and Supplements for Extrahepatic Cholangiocarcinoma

For Cancer Patients

Cancer patients on treatment or on palliative care need to make decisions on food and supplements – for the needed dietary calories, for managing any treatment side effects and also for improved cancer management. All plant-based foods are not equal and choosing and prioritizing foods which are personalized and customized to ongoing cancer treatment is important and complicated. Here are some examples providing guidelines for making nutrition decisions.

Choose Vegetable NEW ZEALAND SPINACH or SWAMP CABBAGE?

Vegetable New Zealand Spinach contains many active ingredients or bioactives such as Quercetin, Myricetin, Curcumin, Apigenin, Formononetin. These active ingredients manipulate various biochemical pathways like MAPK Signaling, DNA Repair, NFKB Signaling and Microtubule Dynamics and others. New Zealand Spinach is recommended for Extrahepatic Cholangiocarcinoma when ongoing cancer treatment is Bleomycin. This is because New Zealand Spinach modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Bleomycin.

Some of the active ingredients or bioactives in vegetable Swamp Cabbage are Curcumin, Formononetin, Beta-sitosterol, Daidzein, Lycopene. These active ingredients manipulate various biochemical pathways like Oncogenic Cancer Epigenetics and Oxidative Stress and others. Swamp Cabbage is not recommended for Extrahepatic Cholangiocarcinoma when ongoing cancer treatment is Bleomycin because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

VEGETABLE NEW ZEALAND SPINACH IS RECOMMENDED OVER SWAMP CABBAGE FOR Extrahepatic Cholangiocarcinoma AND TREATMENT Bleomycin.

Choose Fruit RED RASPBERRY or STRAWBERRY GUAVA?

Fruit Red Raspberry contains many active ingredients or bioactives such as Quercetin, Ellagic Acid, Curcumin, Formononetin, Beta-sitosterol. These active ingredients manipulate various biochemical pathways like MAPK Signaling, DNA Repair, PI3K-AKT-MTOR Signaling and Oxidative Stress and others. Red Raspberry is recommended for Extrahepatic Cholangiocarcinoma when ongoing cancer treatment is Bleomycin. This is because Red Raspberry modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Bleomycin.

Some of the active ingredients or bioactives in fruit Strawberry Guava are Quercetin, Ellagic Acid, Myricetin, Curcumin, Apigenin. These active ingredients manipulate various biochemical pathways like DNA Repair, Heat Stress Response and Oxidative Stress and others. Strawberry Guava is not recommended for Extrahepatic Cholangiocarcinoma when ongoing cancer treatment is Bleomycin because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

FRUIT RED RASPBERRY IS RECOMMENDED OVER STRAWBERRY GUAVA FOR Extrahepatic Cholangiocarcinoma AND TREATMENT Bleomycin.

Choose Nut BUTTERNUT or CHESTNUT?

Butternut contains many active ingredients or bioactives such as Myricetin, Curcumin, Apigenin, Formononetin, Beta-sitosterol. These active ingredients manipulate various biochemical pathways like MAPK Signaling, DNA Repair, NFKB Signaling and Microtubule Dynamics and others. Butternut is recommended for Extrahepatic Cholangiocarcinoma when ongoing cancer treatment is Bleomycin. This is because Butternut modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Bleomycin.

Some of the active ingredients or bioactives in Chestnut are Ellagic Acid, Myricetin, Curcumin, Apigenin, Formononetin. These active ingredients manipulate various biochemical pathways like PI3K-AKT-MTOR Signaling and Oxidative Stress and others. Chestnut is not recommended for Extrahepatic Cholangiocarcinoma when ongoing cancer treatment is Bleomycin because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

BUTTERNUT IS RECOMMENDED OVER CHESTNUT FOR Extrahepatic Cholangiocarcinoma AND TREATMENT Bleomycin.

For Individuals with Genetic Risk of Cancer

The question asked by individuals who have genetic risk of Extrahepatic Cholangiocarcinoma or familial history is “What Should I Eat Differently from Before?” and how they should choose foods and supplements to manage risks of the disease. Since for cancer risk there is nothing actionable in terms of treatment – decisions of foods and supplements become important and one of the very few actionable things which can be done. All plant-based foods are not equal and based on identified genetics and pathway signature – the choices of food and supplements should be personalized.

Choose Vegetable GIANT BUTTERBUR or RADISH?

Vegetable Giant Butterbur contains many active ingredients or bioactives such as Curcumin, Apigenin, Lupeol, Daidzein, Formononetin. These active ingredients manipulate various biochemical pathways like MAPK Signaling, TGFB Signaling, Stem Cell Signaling and PI3K-AKT-MTOR Signaling and others. Giant Butterbur is recommended for risk of Extrahepatic Cholangiocarcinoma when associated genetic risk is ARID2. This is because Giant Butterbur increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in vegetable Radish are Curcumin, Apigenin, Quercetin, Lupeol, Daidzein. These active ingredients manipulate various biochemical pathways like Cell Cycle, TGFB Signaling, Stem Cell Signaling and PI3K-AKT-MTOR Signaling and others. Radish is not recommended when risk of Extrahepatic Cholangiocarcinoma when associated genetic risk is ARID2 because it increases the signature pathways of it.

VEGETABLE GIANT BUTTERBUR IS RECOMMENDED OVER RADISH FOR ARID2 GENETIC RISK OF CANCER.

Choose Fruit JAVA PLUM or PUMMELO?

Fruit Java Plum contains many active ingredients or bioactives such as Curcumin, Apigenin, Ellagic Acid, Lupeol, Daidzein. These active ingredients manipulate various biochemical pathways like MAPK Signaling, TGFB Signaling, Stem Cell Signaling and PI3K-AKT-MTOR Signaling and others. Java Plum is recommended for risk of Extrahepatic Cholangiocarcinoma when associated genetic risk is ARID2. This is because Java Plum increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in fruit Pummelo are Curcumin, Apigenin, Quercetin, Lupeol, Daidzein. These active ingredients manipulate various biochemical pathways like Cell Cycle Checkpoints, TGFB Signaling and Stem Cell Signaling and others. Pummelo is not recommended when risk of Extrahepatic Cholangiocarcinoma when associated genetic risk is ARID2 because it increases the signature pathways of it.

FRUIT JAVA PLUM IS RECOMMENDED OVER PUMMELO FOR ARID2 GENETIC RISK OF CANCER.

Choose Nut COMMON WALNUT or EUROPEAN CHESTNUT?

Common Walnut contains many active ingredients or bioactives such as Curcumin, Quercetin, Ellagic Acid, Lupeol, Daidzein. These active ingredients manipulate various biochemical pathways like MAPK Signaling, Cell Cycle Checkpoints, TGFB Signaling and MYC Signaling and others. Common Walnut is recommended for risk of Extrahepatic Cholangiocarcinoma when associated genetic risk is ARID2. This is because Common Walnut increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in European Chestnut are Curcumin, Apigenin, Quercetin, Ellagic Acid, Lupeol. These active ingredients manipulate various biochemical pathways like TGFB Signaling and Stem Cell Signaling and others. European Chestnut is not recommended when risk of Extrahepatic Cholangiocarcinoma when associated genetic risk is ARID2 because it increases the signature pathways of it.

COMMON WALNUT IS RECOMMENDED OVER EUROPEAN CHESTNUT FOR ARID2 GENETIC RISK OF CANCER.

In Conclusion

Foods and Supplements chosen are important decisions for cancers like Extrahepatic Cholangiocarcinoma. Extrahepatic Cholangiocarcinoma patients and individuals with genetic-risk always have this question: “What foods and nutritional supplements are recommended for me and which are not?” There is a common belief which is a misconception that all plant-based foods could be beneficial or not but would not be harmful. Certain foods and supplements can interfere with cancer treatments or promote molecular pathway drivers of cancer.

There are different types of cancer indications like Extrahepatic Cholangiocarcinoma, each with different tumor genetics with further genomic variations across each individual. Further every cancer treatment and chemotherapy has a unique mechanism of action. Each food like New Zealand Spinach contains various bioactives in different quantities, which have an impact on different and distinct sets of biochemical pathways. The definition of personalized nutrition is individualized food recommendations for the cancer indication, treatments, genetics, lifestyle and other factors. Nutrition personalization decisions for cancer require knowledge of cancer biology, food science and an understanding of different chemotherapy treatments. Finally when there are treatment changes or new genomics is identified – the nutrition personalization needs re-evaluation.

The addon nutrition personalization solution makes the decision making easy and removes all the guesswork in answering the question, “What foods should I choose or not choose for Extrahepatic Cholangiocarcinoma?”. The addon multi-disciplinary team includes cancer physicians, clinical scientists, software engineers and data scientists.

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• Msk Impact 2017
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• Melatonin and vitamin D3 synergistically down-regulate Akt and MDM2 leading to TGFβ-1-dependent growth inhibition of breast cancer cells.
• Betulinic acid inhibits prostate cancer growth through inhibition of specificity protein transcription factors.