Lupus and Cancer

    Lupus & Cancer-Are They Connected

    Lupus and cancer have a tricky connection. For some cancers, having lupus raises your risk, while for others, it lowers it.

    Even the medicines for lupus can change your risk.

    Let’s dig into how lupus and cancer are linked, and learn how you can lower your own risk.

    What is Lupus?

    Lupus is a chronic autoimmune disease, which means that your body’s immune system attacks your own tissues and organs. The exact cause of lupus is unknown, but it’s likely a combination of genetics and environment.

    Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart, and lungs.

    Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus.

    There are four types of lupus:

    1. Systemic Lupus Erythematosus (SLE) – This is the most common type of lupus, and it can affect many parts of the body including the skin, joints, and internal organs.

    2. Cutaneous Lupus Erythematosus – This form of lupus is limited to the skin.

    3. Drug-induced Lupus – This is a lupus-like disease caused by certain prescription drugs.

    4. Neonatal Lupus – This is a rare condition that affects infants of women who have lupus.

    While there’s no cure for lupus, treatments can help control symptoms.

    Warning Signs of Lupus

    Warning Signs of Lupus

    Lupus is a chronic autoimmune disease with a wide range of symptoms that can vary greatly from person to person.

    Some people may experience only a few mild symptoms, while others may have many severe symptoms. The most common symptoms of lupus include:

    1. Fatigue: A feeling of being extremely tired or exhausted is often one of the first symptoms of lupus.

    2. Joint pain, stiffness, and swelling: Lupus can cause pain, swelling, and stiffness in your joints, particularly in the morning.

    3. Skin rashes: A butterfly-shaped rash across the cheeks and nose (malar rash) is a distinctive sign of lupus. Other types of rashes may also occur.

    4. Skin lesions: These typically occur (or worsen) when exposed to the sun.

    5. Fever: People with lupus may experience unexplained fevers.

    6. Chest pain: Lupus can cause inflammation of the chest cavity lining (pleurisy) leading to sharp chest pain, especially during deep breathing.

    7. Shortness of breath: This can be caused by inflammation or fluid in the lungs.

    8. Headaches, confusion, and memory loss: Some people with lupus have these symptoms.

    9. Dry eyes: Lupus can cause dryness in eyes, mouth and other body parts.

    10. Raynaud’s phenomenon: Fingers and toes turn white or blue when exposed to cold or during stressful periods.

    Lupus, Cancer, and their Interconnection

    For a long time, researchers have been trying to figure out why some people with lupus seem to have a higher chance of getting cancer than others.

    They’ve also discovered that for some cancers, the risk is actually lower if you have lupus, making this a tough puzzle to solve.

    By studying different types of cancer, they’re hoping to get a clearer picture of who with lupus is most likely to get cancer, and why?

    While lupus itself is not a cancer, research indicates that people with lupus may have an increased risk for certain types of cancer, especially hematological cancers and to a lesser extent some specific solid tumors.

    1. Leukemia: Some studies indicate an elevated risk of leukemia in lupus patients.

    2. Lung Cancer: Some research suggests that people with lupus may have an elevated risk of lung cancer. Lung cancer appears to be more common in lupus patients compared to the general population, with a notable occurrence of rare lung cancer types. However, many lupus patients who develop lung cancer are smokers, highlighting the importance of smoking cessation for this group.

    3. Cervical Cancer: Women with lupus might have a slightly increased risk of cervical cancer, particularly if they are treated with immunosuppressive drugs. Some women with lupus having more abnormal PAP tests. This could be due to a reduced ability to fight off the human papilloma virus (HPV).

    4. Breast Cancer: Evidence suggests that women with lupus may face a higher risk of breast cancer, possibly due to increased estrogen levels. 
    • The Lupus-Lymphoma Link

    People with lupus have been found to be at a higher risk of developing both Hodgkin’s and non-Hodgkin lymphoma. This higher risk could be due to the lupus disease process itself, such as overactive B-cells and defects in the immune system’s ability to monitor and control these cells. Immunosuppressive drugs could also contribute to this increased risk, especially after long-term use. Another important consideration is the presence of Sjogren’s syndrome, often seen in lupus patients, which further heightens the risk of lymphoma.

    The Role of NSAIDs

    Non-steroidal anti-inflammatory drugs

    Interestingly, it has been observed that patients with rheumatoid arthritis, another autoimmune disease, have a lower incidence of colorectal cancer.

    This may be attributed to long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin.

    Long-term aspirin and NSAID use may also reduce the risk of colorectal, breast, and prostate cancer in the general population. However, while these benefits might extend to people with lupus, it does not mean that aspirin and NSAIDs should be taken specifically for this purpose.

    Long-term use of NSAIDs can raise cardiovascular disease risk, so it’s important to only take medications as directed by a healthcare provider.

    Significance of Routine Cancer Checks

    Cancer Check up

    Even though individuals with lupus face a higher risk of cancer, research shows they often have the same or even fewer cancer screenings than the general public.

    As a result, it’s crucial that you discuss lupus and its potential connection to cancer with your doctor.

    This will help ensure you get the right cancer screenings at the recommended times.

    Risk factors and Preventions

    Various risk factors, like

    • Smoking
    • Obesity
    • Hormone replacement therapy
    • The use of immunosuppressive drugs

    can boost the likelihood of getting cancer. As such, it’s crucial to maintain a healthy lifestyle.

    • Being overweight can also raise the risk for certain cancers, so aim to consume a diet that supports a healthy body weight.
    • Sunlight can trigger lupus flare-ups and increase skin cancer risk. Those with lupus should try to stay out of the sun as much as possible.
    • When outside, use sunscreen with an SPF of 85 or higher, and make sure it includes Helioplex for protection against both UV-A and UV-B rays.

    Cancer Therapy Considerations in Lupus Patients

    When cancer strikes, special care must be taken while planning and administering cancer treatments, like chemotherapy, in those with lupus.

    If a person has both antiphospholipid antibodies and cancer, for instance, they may not be able to use certain breast cancer treatments like aromatase inhibitors or other estrogen analogs due to a heightened risk of blood clots.

    Medical professionals may even choose to halt all lupus treatment during chemotherapy to avoid potential health risks, despite the possibility of lupus flare-ups. In such cases, the urgency of cancer treatment might outweigh the risks of lupus flares.

    However, pausing lupus treatment could carry risks that go beyond triggering a lupus flare. According to a 2021 study published in Arthritis Care & Research, while lupus patients have a lower risk of breast cancer, older women with lupus who do develop the disease face a higher risk of early-stage mortality.

    Interestingly, the elevated death risk might not be directly linked to cancer itself. Researchers suggest that the higher mortality rate might be due to stopping lupus treatment during chemotherapy, which can increase the likelihood of other health complications.

    In the past, lupus patients sometimes received radiation therapy, a common cancer treatment, to manage their lupus symptoms.

    However, this practice is now infrequent due to concerns over long-term toxicity, making it typically unsuitable as a cancer treatment option for those with lupus.

    Wrapping Up

    Although the prospect of cancer can be frightening, it’s important to remember that it only poses a relatively minor increased risk for most people living with lupus.

    Just like lupus, cancer affects everyone differently. If you are at a higher risk, your healthcare provider can monitor any substantial changes to your symptoms and adjust your lupus treatment plan accordingly.

    Understanding your own risks and actively collaborating with your healthcare team can significantly reduce anxiety and help ensure the best possible health outcomes for you!

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    Non-Invasive Treatment of Liver Tumors: The Revolutionary Role of Histotripsy

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Tumor-Associated Macrophages (TAMs): TAMs are a subset of macrophages that are recruited to the tumor site and are educated by the tumor microenvironment to adopt a pro-tumor phenotype. These cells can promote tumor growth, angiogenesis, and metastasis while suppressing anti-tumor immune responses. Histotripsy’s ability to target and modulate TAMs is of significant interest. By disrupting the tumor microenvironment, histotripsy can potentially reprogram TAMs from a pro-tumor M2 phenotype to an anti-tumor M1 phenotype, thereby reversing their tumor-promoting effects. b. Myeloid-Derived Suppressor Cells (MDSCs): MDSCs are a heterogeneous group of immature myeloid cells that expand during cancer, inflammation, and infection. In the context of cancer, MDSCs play a crucial role in suppressing T cell responses and promoting tumor growth. Preliminary studies suggest that histotripsy may reduce the number and suppressive function of MDSCs in the tumor microenvironment, thereby enhancing anti-tumor immunity. c. Regulatory T cells (Tregs): Tregs are a subset of CD4+ T cells that play a critical role in maintaining immune homeostasis by suppressing excessive immune responses. However, in the tumor microenvironment, Tregs can inhibit anti-tumor immune responses, thereby facilitating tumor growth. The impact of histotripsy on Tregs is an area of active research. By disrupting the tumor microenvironment and releasing tumor antigens, histotripsy may modulate the function and recruitment of Tregs, potentially enhancing anti-tumor immunity. d. The Interplay with Other Immune Cells: Apart from the aforementioned pro-tumor immune cells, the tumor microenvironment also contains other immune cells like dendritic cells, natural killer cells, and B cells. 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Damage Associated Molecular Patterns (DAMPs) are a group of intracellular molecules that have garnered significant attention in the realm of immunology and cellular biology. These molecules, under normal circumstances, reside within the confines of the cell and perform essential functions. However, when cells undergo stress, trauma, or damage, DAMPs are released into the extracellular environment, where they assume a new and critical role. One of the primary functions of DAMPs upon their release is to signal the immune system of potential threats. They act as distress signals, alerting the body to the presence of damaged or dying cells. This is particularly evident in procedures like histotripsy, a non-invasive technique that mechanically disrupts tissue structures. During histotripsy, the cellular damage leads to the liberation of various DAMPs, each with its unique role in the ensuing immune response. For instance, Calreticulin (CRT) is not just a mere bystander in this process. When released, CRT moves to the cell surface, where it aids in antigen presentation. This action effectively marks the damaged cells for elimination, kickstarting an adaptive immune response tailored to address the specific threat.  High Mobility Group  is another pivotal DAMP. As a nuclear protein, its primary role within the cell is to stabilize DNA structures. However, once outside, HMGB1 becomes a potent pro-inflammatory agent. It binds to receptors on immune cells, amplifying the inflammatory response, which is crucial in situations where rapid immune action is needed. Adenosine Triphosphate (ATP), commonly recognized as the primary energy currency of the cell, also plays a role in this immune signaling process. When found outside the cell, ATP acts as a danger signal. Immune cells, recognizing the abnormal presence of extracellular ATP, are prompted to migrate to the site of injury, further intensifying the immune response. 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    Histotripsy: A Revolution in Precise Tissue Ablation

    Histotripsy has emerged as a beacon of innovation in the ever-evolving landscape of medical technology. It  promises a future where precise tissue ablation can be achieved without the invasiveness of traditional surgical methods. But what makes histotripsy stand out? The answer lies in its unique mechanism of action, which harnesses the power of ultrasound to mechanically disrupt tissue structures. This article delves deep into the mechanism of histotripsy and how it paves the way for precise tissue ablation, especially in the realm of cancer treatment. What is Histotripsy? Histotripsy, a groundbreaking medical technique, is rapidly gaining traction in the healthcare sector due to its potential to revolutionise tissue ablation procedures. The term “histotripsy” is derived from the Greek words “histo,” meaning tissue, and “tripsy,” meaning to break. Histotripsy is a non-invasive approach to tissue disruption, and its unique mechanism of action  sets it apart from any other innovations. . The concept of histotripsy was first introduced at the University of Michigan in 2004. Since its inception, the technique has undergone significant advancements, with researchers continually exploring its potential applications and refining its methodology. The term itself encapsulates the essence of the procedure: a method to break down soft tissue. How does Histotripsy work? The Fundamental Mechanism: Cavitation  Cavitation, a phenomenon central to histotripsy, refers to the formation, growth, and subsequent collapse of gas or vapour-filled bubbles within a liquid medium when subjected to rapid pressure changes. In the context of histotripsy, the human body’s tissue serves as this liquid medium, and high-intensity, short-duration ultrasound pulses induce the rapid pressure changes. When tissues are exposed to these potent ultrasound pulses, the alternating high and low pressures lead to the creation of minuscule bubbles or cavities. These bubbles might initially form around pre-existing gas pockets or microscopic impurities within the tissue. As the ultrasound pulses persist, these bubbles expand due to the negative pressure phases of the ultrasound wave. Bubble Dynamics: The Heart of Tissue Disruption  The true essence of histotripsy is realised during the bubble collapse phase. Following the negative phase, the positive pressure phase of the ultrasound wave causes the expanded bubbles to undergo a swift and violent implosion. This rapid collapse generates potent local shock waves and produces high-velocity liquid jets. These intense mechanical forces, stemming from both the shock waves and the jets, act upon the surrounding tissue. The outcome is a mechanical breakdown of the tissue at a cellular level, resulting in the tissue being fractionated into a liquefied form. This liquid consists of a homogenised blend of cell debris and the extracellular matrix. How does Histotripsy achieve precision in action? In the realm of medical interventions, precision is paramount. The ability to target specific tissues or cells without affecting the surrounding structures can be the difference between successful treatment and unintended complications. Histotripsy, with its groundbreaking approach to tissue ablation, exemplifies this principle of precision in action. Let’s delve deeper into how histotripsy achieves such unparalleled accuracy. Histotripsy employs high-intensity ultrasound pulses to induce cavitation within the targeted tissue. The beauty of this technique lies in the ability to focus these ultrasound beams to a specific point, known as the focal zone. Within this focal zone, the energy of the ultrasound waves is concentrated, ensuring that the cavitation-induced tissue disruption occurs primarily within this localised area. This means that only the tissue within the focal zone is affected, while the surrounding structures remain untouched. One of the standout features that bolster histotripsy’s precision is the integration of real-time imaging. As the ultrasound waves are administered, they not only induce cavitation but also provide a live visual feed of the treatment area. This dual capability allows clinicians to monitor the formation and collapse of bubbles in real-time. Such immediate feedback ensures that the treatment is progressing as intended and allows for on-the-fly adjustments. If, for instance, the bubbles are not forming in the desired location or pattern, the clinician can instantly modify the parameters to achieve the desired effect. The precision of histotripsy can be likened to the accuracy of a surgeon’s scalpel, but without the invasiveness of a blade. The controlled generation and collapse of microbubbles ensure that only the targeted cells or tissues are disrupted. This selectivity is especially crucial when treating tumours or lesions located close to vital organs or critical structures. For example, when targeting a tumour adjacent to a major blood vessel, the precision of histotripsy ensures that the vessel remains unharmed, reducing the risk of bleeding or other complications. In many medical treatments, especially those involving radiation or surgery, there’s always a concern about collateral damage to healthy tissues. Histotripsy’s precision minimises this risk. By confining the tissue disruption to the focal zone, histotripsy ensures that the surrounding healthy tissues are spared. This not only enhances the safety profile of the treatment but also promotes faster healing and recovery. What sets Histotripsy apart from other cancer treatments? Histotripsy’s distinctive non-thermal approach to tissue ablation offers a fresh perspective in the realm of medical interventions. While many therapeutic ultrasound techniques, such as High-Intensity Focused Ultrasound (HIFU), rely on generating heat to achieve therapeutic effects, histotripsy stands apart. Traditional methods work by raising the temperature of the targeted tissue to a point where cellular proteins denature, leading to cell death. Although effective, this thermal approach has inherent risks. Elevated temperatures can inadvertently damage surrounding healthy tissues, especially if the heat spreads beyond the targeted area. Moreover, tissues sensitive to heat, like neural tissues, can be at risk of unintended damage. In contrast, histotripsy operates on a fundamentally different principle. Instead of using heat, it employs mechanical forces to achieve tissue disruption. This is achieved through the controlled generation and violent collapse of microbubbles within the tissue, a process known as cavitation. The implosive collapse of these bubbles generates intense local shock waves and produces high-speed liquid jets. These forces act on the tissue, leading to mechanical breakdown at the cellular level without the need for heat. The non-thermal nature of histotripsy offers