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Type 2 Diabetes Mellitus As A Risk Factor In Causation Of Renal Cell Carcinoma
Patients with Type 2 Diabetes Mellitus suffer from a significantly higher risk of cancer involving the breast, endometrium, stomach, colorectal, liver, pancreas, urinary bladder and lymphoid tissue. The mechanism for such an increased cancer risk in the studied diabetic patients may be accounted to insulin resistance, hyperinsulinemia, pro-inflammatory status and increased oxidative stress. Though, ethnic differences and other co-morbidities may exist when perusing risks involved in the causation of specific cancers and drawing a comparison between two groups: patients with diabetes mellitus and individuals without diabetes mellitus. Because hypertension and obesity are established risk factors for Renal Cell Carcinoma and in turn are also known to be strongly linked with type 2 diabetes, accounting for these conditions in evaluating the association of type 2 diabetes and RCC is critical.
The fact that both type 2 diabetes and cancer are increasingly prevalent with age and obesity complicates determining a cause-and-effect link. Obesity raises the risk of some cancers, such as endometrial cancer, breast cancer, kidney cancer, colorectal cancer, and pancreas cancer, as well as the risk of dying from cancer. As a result, it has been hypothesised that metabolic dysfunctional alterations linked with obesity, insulin resistance, hyperinsulinaemia, and also hyperglycemia have a role in cancer connected to type 2 diabetes, at least in part. Type 1 diabetes increases the risk of cancer, although the cancer types differ from type 2 diabetes in that the stomach, cervix, and endometrium are the most common sites. These factors can impact the overall incidence of specific cancers in diabetic individuals.
Kidney cancer is among the 10 most common cancers affecting the general population. Phenacetin-containing analgesics, smoking, obesity, hypertension, advanced kidney disease and genetic factors remain to be some of the identified potential risk factors. Epidemiological research looking into the link between diabetes and kidney cancer risk has been shown to be inconclusive. Advanced kidney disease (diabetic nephropathy and end-stage renal disease), on the other hand, is a well-known risk factor for kidney cancer. Diabetes mellitus impacts renal health by affecting renal function, inducing glomerulosclerosis changes, and ultimately leading to chronic renal failure.
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The response of immunomodulators in the management of renal cancer gives an indication of the potential role of the body's immune system in the development and control of this cancer. Diabetes itself is considered as an immunocompromised state which might reverberate as a contributory factor. Also, studies predict improvement in Insulin resistance and strict chronic glycaemic control as a positive thread and have been known to decrease the progression of Renal cell carcinoma. Insulin activates insulin-like growth factor-1, which increases tumour cell mitosis and proliferation. Changes in adipocytes in response to insulin resistance result in the activation of pro-inflammatory cytokines, which can induce DNA damage and contribute to carcinogenesis. Indeed, when compared to the latter group, RCC in people with type 2 diabetes has been revealed to have higher DNA changes.
As a result, the link between diabetes mellitus and the risk of kidney cancer deserves more research and critical thought, particularly in Asian populations, where it could be of considerable preventative and therapeutic significance. To sum up, proper glycemic management reduces the likelihood of developing RCC and also slows the evolution of those who already have it (though other confounding factors need to be excluded).
(The article is contributed by Dr Anadi Pachaury, Consultant - Surgical Oncology, HCMCT Manipal Hospital, Dwarka, New Delhi)