Foods for Extramammary Paget Disease!

Introduction

Foods for Extramammary Paget Disease 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.

Extramammary Paget’s disease, a rare skin cancer that typically affects areas with a high density of apocrine glands, presents unique challenges in diagnosis and treatment. This condition can occur in both males and females, with notable occurrences in the vulva for women and the genital or perianal areas in men. The pathology outlines of extramammary Paget’s disease provide critical insights into its cellular characteristics and help guide treatment decisions. Treatment typically involves surgical excision, and in some cases, topical therapies or radiotherapy may be considered. The ICD-10 code for extramammary Paget’s disease facilitates standardized reporting and treatment tracking. DermNet and other dermatological resources offer valuable information regarding the clinical presentation and management of the disease. While extramammary Paget’s disease primarily affects the skin, its prognosis and the question of whether it is fatal depend on several factors, including the presence of invasive disease or underlying malignancies. The rarity of extramammary Paget’s disease adds to the complexity of studying and understanding it, making it a subject of ongoing research. In summary, effective management of extramammary Paget’s disease requires a thorough understanding of its pathology, careful consideration of treatment options, and awareness of its potential severity, especially in advanced or invasive cases.

For Extramammary Paget Disease 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 Extramammary Paget Disease 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 Extramammary Paget Disease?

For example does it matter if vegetable Carrot is consumed more compared to Malabar Spinach? Does it make any difference if fruit Black Elderberry is preferred over Evergreen Blackberry? Also if similar choices are made for nuts/seeds like Japanese Walnut over European Chestnut and for pulses like Black-eyed Pea over Common Bean. And if what I eat matters – then how does one identify foods which are recommended for Extramammary Paget Disease and is it the same answer for everyone with the same diagnosis or genetic risk?

Yes! Foods you eat matters for Extramammary Paget Disease!

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 Black Elderberry contains active ingredients Curcumin, Daidzein, Formononetin, Cinnamaldehyde, Melatonin. And Evergreen Blackberry contains active ingredients Ellagic Acid, Cinnamaldehyde, Eugenol, Myricetin, Linalool and possibly others.

A common mistake made when deciding and choosing foods to eat for Extramammary Paget Disease – 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 Extramammary Paget Disease.

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

Skills Needed for Nutrition Personalization for Extramammary Paget Disease?

Personalized nutrition for cancers like Extramammary Paget Disease 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 Extramammary Paget Disease 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 Extramammary Paget Disease

All cancers like Extramammary Paget Disease can be characterized by a unique set of biochemical pathways – the signature pathways of Extramammary Paget Disease. Biochemical pathways like PI3K-AKT-MTOR Signaling, Growth Factor Signaling, Chromatin Remodeling, MAPK Signaling are part of the signature definition of Extramammary Paget Disease. Each individual’s cancer genetics can be different and hence their specific cancer signature could be unique.

The treatments which are effective for Extramammary Paget Disease 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 Extramammary Paget Disease when taking cancer treatment Pazopanib, 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.

ERBB2, PPP2R1A and SMARCA4 are the top ranked reported genes for Extramammary Paget Disease. ERBB2 is reported in 33.3 % of the representative patients across all clinical trials. And PPP2R1A is reported in 33.3 %. The combined population patient data cover ages from to . 50.0 % of the patient data are identified as men. The Extramammary Paget Disease 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 Extramammary Paget Disease

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 CARROT or MALABAR SPINACH?

Vegetable Carrot contains many active ingredients or bioactives such as Curcumin, Gamma-linolenic Acid, Daidzein, Formononetin, Cinnamaldehyde. These active ingredients manipulate various biochemical pathways like PI3K-AKT-MTOR Signaling and others. Carrot is recommended for Extramammary Paget Disease when ongoing cancer treatment is Pazopanib. This is because Carrot modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Pazopanib.

Some of the active ingredients or bioactives in vegetable Malabar Spinach are Curcumin, Daidzein, Formononetin, Cinnamaldehyde, Melatonin. These active ingredients manipulate various biochemical pathways like PI3K-AKT-MTOR Signaling and others. Malabar Spinach is not recommended for Extramammary Paget Disease when ongoing cancer treatment is Pazopanib because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

VEGETABLE CARROT IS RECOMMENDED OVER MALABAR SPINACH FOR Extramammary Paget Disease AND TREATMENT Pazopanib.

Choose Fruit EVERGREEN BLACKBERRY or BLACK ELDERBERRY?

Fruit Evergreen Blackberry contains many active ingredients or bioactives such as Ellagic Acid, Cinnamaldehyde, Eugenol, Myricetin, Linalool. These active ingredients manipulate various biochemical pathways like PI3K-AKT-MTOR Signaling and others. Evergreen Blackberry is recommended for Extramammary Paget Disease when ongoing cancer treatment is Pazopanib. This is because Evergreen Blackberry modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Pazopanib.

Some of the active ingredients or bioactives in fruit Black Elderberry are Curcumin, Daidzein, Formononetin, Cinnamaldehyde, Melatonin. These active ingredients manipulate various biochemical pathways like PI3K-AKT-MTOR Signaling and others. Black Elderberry is not recommended for Extramammary Paget Disease when ongoing cancer treatment is Pazopanib because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

FRUIT EVERGREEN BLACKBERRY IS RECOMMENDED OVER BLACK ELDERBERRY FOR Extramammary Paget Disease AND TREATMENT Pazopanib.

Choose Nut JAPANESE WALNUT or EUROPEAN CHESTNUT?

Japanese Walnut contains many active ingredients or bioactives such as Curcumin, Ellagic Acid, Daidzein, Cinnamaldehyde, Formononetin. These active ingredients manipulate various biochemical pathways like PI3K-AKT-MTOR Signaling and others. Japanese Walnut is recommended for Extramammary Paget Disease when ongoing cancer treatment is Pazopanib. This is because Japanese Walnut modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Pazopanib.

Some of the active ingredients or bioactives in European Chestnut are Curcumin, Ellagic Acid, Daidzein, Cinnamaldehyde, Formononetin. These active ingredients manipulate various biochemical pathways like PI3K-AKT-MTOR Signaling and others. European Chestnut is not recommended for Extramammary Paget Disease when ongoing cancer treatment is Pazopanib because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

JAPANESE WALNUT IS RECOMMENDED OVER EUROPEAN CHESTNUT FOR Extramammary Paget Disease AND TREATMENT Pazopanib.

For Individuals with Genetic Risk of Cancer

The question asked by individuals who have genetic risk of Extramammary Paget Disease 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 NEW ZEALAND SPINACH or CUCURBITA?

Vegetable New Zealand Spinach contains many active ingredients or bioactives such as Curcumin, Apigenin, Delphinidin, Quercetin, Lycopene. These active ingredients manipulate various biochemical pathways like MAPK Signaling, Phospholipase Signaling, Growth Factor Signaling and MYC Signaling and others. New Zealand Spinach is recommended for risk of Extramammary Paget Disease when associated genetic risk is ERBB2. This is because New Zealand Spinach increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in vegetable Cucurbita are Curcumin, Delphinidin, Daidzein, Lupeol, Formononetin. These active ingredients manipulate various biochemical pathways like MYC Signaling and PI3K-AKT-MTOR Signaling and others. Cucurbita is not recommended when risk of Extramammary Paget Disease when associated genetic risk is ERBB2 because it increases the signature pathways of it.

VEGETABLE NEW ZEALAND SPINACH IS RECOMMENDED OVER CUCURBITA FOR ERBB2 GENETIC RISK OF CANCER.

Choose Fruit BILBERRY or PUMMELO?

Fruit Bilberry contains many active ingredients or bioactives such as Curcumin, Apigenin, Delphinidin, Quercetin, Lycopene. These active ingredients manipulate various biochemical pathways like MAPK Signaling, Cell Cycle Checkpoints, Phospholipase Signaling and MYC Signaling and others. Bilberry is recommended for risk of Extramammary Paget Disease when associated genetic risk is ERBB2. This is because Bilberry increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in fruit Pummelo are Curcumin, Apigenin, Delphinidin, Naringenin, Hesperetin. These active ingredients manipulate various biochemical pathways like Cell Cycle Checkpoints and Epithelial to Mesenchymal Transition and others. Pummelo is not recommended when risk of Extramammary Paget Disease when associated genetic risk is ERBB2 because it increases the signature pathways of it.

FRUIT BILBERRY IS RECOMMENDED OVER PUMMELO FOR ERBB2 GENETIC RISK OF CANCER.

Choose Nut COMMON HAZELNUT or CHESTNUT?

Common Hazelnut contains many active ingredients or bioactives such as Curcumin, Delphinidin, Quercetin, Lycopene, Daidzein. These active ingredients manipulate various biochemical pathways like MAPK Signaling, Phospholipase Signaling, Growth Factor Signaling and MYC Signaling and others. Common Hazelnut is recommended for risk of Extramammary Paget Disease when associated genetic risk is ERBB2. This is because Common Hazelnut increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in Chestnut are Curcumin, Ellagic Acid, Apigenin, Delphinidin, Lycopene. These active ingredients manipulate various biochemical pathways like Cell Cycle Checkpoints and Epithelial to Mesenchymal Transition and others. Chestnut is not recommended when risk of Extramammary Paget Disease when associated genetic risk is ERBB2 because it increases the signature pathways of it.

COMMON HAZELNUT IS RECOMMENDED OVER CHESTNUT FOR ERBB2 GENETIC RISK OF CANCER.

In Conclusion

Foods and Supplements chosen are important decisions for cancers like Extramammary Paget Disease. Extramammary Paget Disease 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 Extramammary Paget Disease, 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 Carrot 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 Extramammary Paget Disease?”. The addon multi-disciplinary team includes cancer physicians, clinical scientists, software engineers and data scientists.

References

• Msk Impact 2017
• Mutational landscape of metastatic cancer revealed from prospective clinical sequencing of 10,000 patients.
• Daidzein exerts anti-tumor activity against bladder cancer cells via inhibition of FGFR3 pathway.
• Shikimic acid promotes estrogen receptor(ER)-positive breast cancer cells proliferation via activation of NF-κB signaling.
• Aqueous cinnamon extract (ACE-c) from the bark of Cinnamomum cassia causes apoptosis in human cervical cancer cell line (SiHa) through loss of mitochondrial membrane potential.
• Preventive effects of butyric acid, nicotinamide, calcium glucarate alone or in combination during the 7, 12-dimethylbenz (a) anthracene induced mouse skin tumorigenesis via modulation of K-Ras-PI3K-AKTpathway and associated micro RNAs.
• Research progress on the anticancer effects of vitamin K2.
• https://my.clevelandclinic.org/health/diseases/24266-extramammary-pagets-disease
• https://www.ncbi.nlm.nih.gov/books/NBK493224