The presence of oral bacteria in so-called cystic pancreatic tumors is associated with the severity of the tumor, according to researchers at Karolinska Institutet in Sweden, who hope that their findings can help to improve the diagnose and treatment of pancreatic cancer.
Not all pancreatic tumors are cancerous. Many cystic pancreatic tumors are benign, though some can become cancerous. It also is difficult to differentiate between these tumors. To rule out cancer, many patients undergo surgery. The presence of bacteria inside the tumors may indicate how severe the tumor is, however, possibly precluding the need for surgery.
“We find most bacteria at the stage where the cysts are starting to show signs of cancer,” said the study’s corresponding author, Margaret Sällberg Chen, docent and senior lecturer at the Department of Dental Medicine, Karolinska Institutet.
“What we hope is that this can be used as a biomarker for the early identification of the cancerous cysts that need to be surgically removed to cure cancer. This will, in turn, also reduce the amount of unnecessary surgery of benignant tumors. But first, studies will be needed to corroborate our findings,” Sällberg Chen said.
The researchers examined the presence of bacterial DNA in fluid from pancreatic cysts in 105 patients and compared the type and severity of the tumors. Doing this, they found that the fluid from the cysts with high-grade dysplasia and cancer included much more bacterial DNA than that from benign cysts.
To identify the bacteria, the researchers sequenced the DNA of 35 of the samples that had high amounts of bacterial DNA. They found large variations in the bacterial composition between different individuals, but also a greater presence of certain oral bacteria in fluid and tissue from cysts with high-grade dysplasia and cancer.
“We were surprised to find oral bacteria in the pancreas, but it wasn’t totally unexpected,” said Sällberg Chen. “The bacteria we identified has already been shown in an earlier, smaller study to be higher in the saliva of patients with pancreatic cancer.”
The results can help to reappraise the role of bacteria in the development of pancreatic cysts, Sällberg Chen said. If further studies show that the bacteria actually affects the pathological process, it could lead to new therapeutic strategies using antibacterial agents.
The researchers also studied different factors that could conceivably affect the amount of bacterial DNA in the tumor fluid. The presence of bacterial DNA was higher in patients who had undergone invasive pancreas endoscopy, which involves the insertion of a flexible tube into the mouth to examine and treat pancreatic conditions, possibly transferring oral bacteria into the pancreas.
“The results were not completely unequivocal, so the endoscopy can’t be the whole answer to why the bacteria is there,” Sällberg Chen said. “But maybe we can reduce the risk of transferring oral bacteria to the pancreas by rinsing the mouth with an antibacterial agent and ensuring good oral hygiene prior to examination. That would be an interesting clinical study.”
The study, “Enrichment of Oral Microbiota in Early Cystic Precursors to Invasive Pancreatic Cancer,” was published by Gut.