pancreas cancer : RESEARCHERS FIND REGION OF GENE FOR INHERITED PANCREATIC CANCER ( 2 )

Researchers were able to gather sufficient genetic data for this study through the cooperation of a large Northwestern family known in scientific communities as "Family X." Family X is the largest pancreatic cancer family ever studied. Twenty affected family members were studied; nine have died of the disease, including five out of six brothers. Dr. Brentnall has been working with Family X for more than seven years.

The DNA samples collected by Brentnall's University of Washington group from Family X were genotyped by a team of researchers at the University of Pittsburgh, led by Dr. Whitcomb. The Pitt group sequenced DNA from hundreds of areas of the genome known to contain a high degree of genetic variability. This information was then sent to Kruglyak's group at Fred Hutchinson, who, by using sophisticated computer software, were able to determine which genetic variations are always present in the family members with pancreatic cancer or its precursor, dysplasia.

Virtually every member of Family X with pancreatic cancer or its precursor was found to harbor a specific genetic marker on the long arm of chromosome 4, where the single-gene mutation responsible for pancreatic cancer is thought to exist. None of the unaffected family members inherited this marker, supporting the significance of the findings.

According to researchers, identifying these markers may lead to the discovery of a specific pancreatic cancer gene - a finding that will allow doctors to screen people for genetic risk for pancreatic cancer with a simple blood test.

Dr. Whitcomb stresses the importance of the collaborative effort that resulted in this advancement. "Those of us who are working with complex and mysterious medical problems like pancreatic cancer recognize that no independent physician or scientists can go from the bed to the bench and back again alone. It takes physician-scientist teamwork, as demonstrated here, to make the big breakthroughs."

Of the 29,000 Americans who this year will learn they have pancreatic cancer, all but 100 will die within 12 months of diagnosis. While pancreatic cancer is the fifth leading cause of cancer death in the United States, it is one of the least well-funded areas of cancer research.

Due to the limited knowledge about pancreatic cancer, researchers stress that patients seeking treatment for pancreatic cancer or who are looking to be screened for the disease should visit a center that specializes in pancreatic disorders such as the Digestive Disease Center at the University of Pittsburgh or the University of Washington.
Support for this study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases; the National Institute of Mental Health; the National Pancreas Foundation; the Lustgarten Foundation; the Center for Genomic Sciences, University of Pittsburgh; and the Chiron Corporation.

http://www.cancer-info.com/pancreas.htm

pancreas cancer : RESEARCHERS FIND REGION OF GENE FOR INHERITED PANCREATIC CANCER ( 1 )

Researchers at the University of Pittsburgh School of Medicine, in collaboration with the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine have mapped the location of a gene associated with inherited pancreatic cancer, which accounts for about 10 percent of all such malignancies.

Study co-directors David C. Whitcomb, M.D., Ph.D., director of the division of gastroenterology, hepatology and nutrition at the University of Pittsburgh; Leonid Kruglyak, Ph.D., a Fred Hutchinson statistical geneticist; and Teresa Brentnall, M.D., a UW gastroenterologist report their findings in an early electronic edition of the April issue of the
American Journal of Human Genetics. The discovery marks the identification of the first genetic defect that is directly linked to pancreatic cancer. By locating the region of the mutation, researchers will now be able to sequence the gene, which has the potential to yield promising new insights into pancreatic cancer.

"By understanding the genetics of pancreatic cancer, we can begin to understand the mechanism by which the disease develops, availing new methods of how to detect, prevent and treat this deadly cancer," said Dr. Whitcomb, who is also director of the University of Pittsburgh Center for Genomic Sciences.

Pancreatic cancer is one of the most difficult cancers to treat in that it is undetectable by a physical exam, asymptomatic, and progresses quickly - most patients die within 6 months of diagnosis. These factors also limit the amount of data available for research, hindering significant advances in the understanding of the disease.

"Pancreatic cancer is a very aggressive cancer with extremely low survival rates," said Ronald B. Herberman, M.D., associate vice chancellor for research, health sciences at the University of Pittsburgh and director of the University of Pittsburgh Cancer Institute. "Until now, we have had very limited ability to identify people at high risk for this disease or to make the diagnosis of the disease before it has invaded the rest of the body. This discovery represents a significant finding that may permit identification of individuals at risk so that they can be monitored regularly, to detect the cancer when it can be treated while still in an early stage, which might substantially enhance the likelihood of survival."

http://www.cancer-info.com/pancreas.htm

pancreas cancer : What are the side effects of treatment for cancer of the pancreas?

The methods used to treat pancreatic cancer are very powerful. It is hard to limit the effects of treatment so that only cancer cells are destroyed. Healthy tissue may also be damaged. That is why treatment often causes unpleasant side effects. Side effects depend on the type of treatment used and on the part of the body being treated.

Surgery for cancer of the pancreas is a major operation. While in the hospital, the patient will need special medications and may be fed only liquids. During recovery from surgery, the patient's diet and weight will be checked carefully.

During radiation therapy, the patient may become very tired as the treatment continues. Resting as much as possible is important. Skin reactions (redness or dryness) in the treated area are also common. Good skin care is important at this time, but the patient should not use any lotions or creams on the skin without checking with the doctor. Radiation therapy to the upper abdomen can cause nausea and vomiting. Usually, dietary changes or medications can ease these problems.

The side effects of chemotherapy depend on the drugs that are given. In addition, each person reacts differently. Chemotherapy affects rapidly growing cells, such as blood-forming cells, those that line the digestive tract, and those in the skin and hair. As a result, patients can have side effects such as a lowered resistance to infection, less energy, loss of appetite, nausea, vomiting, or mouth sores. Patients may also lose their hair.

Weight loss can be a serious problem for patients being treated for cancer of the pancreas. Researchers are learning that well- nourished patients usually feel better and may be better able to withstand the side effects of their treatment. Therefore, nutrition is an important part of the treatment plan, and doctors may have a number of suggestions to help their patients get enough calories and protein. In many cases, patients feel better if they take food and beverages in very small amounts. Many patients find that eating several small meals and snacks throughout the day is easier than having three large meals.

In addition, treatment for cancer of the pancreas may interfere with production of insulin and pancreatic juices. The patient must take medicines to replace these; otherwise the level of blood sugar may be wrong and digestion may be affected. Even so, taking these medicines can often upset digestion. Careful planning and checkups are important to help the patient avoid weight loss and the weakness and lack of energy caused by poor nutrition.

Patients and family members are often afraid that cancer will cause pain. Cancer patients do not always have pain, but if it does occur, there are many ways to relieve or reduce it. It is important for the patient to let the doctor know about pain, because uncontrolled pain can cause loss of sleep and poor appetite. These problems can make it difficult for the patient to respond to treatment.

The side effects that patients have during cancer therapy vary for each person. They may even be different from one treatment to the next. Attempts are made to plan treatment to keep problems to a minimum. Fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and can suggest ways to deal with them. Helpful information about cancer treatment and coping with side effects is given in the National Cancer Institute publications Radiation Therapy and You, Chemotherapy and You, and Eating Hints.

©1996-2006 MedicineNet, Inc. All rights reserved.

pancreas cancer : What are the side effects of treatment for cancer of the pancreas?

The methods used to treat pancreatic cancer are very powerful. It is hard to limit the effects of treatment so that only cancer cells are destroyed. Healthy tissue may also be damaged. That is why treatment often causes unpleasant side effects. Side effects depend on the type of treatment used and on the part of the body being treated.

Surgery for cancer of the pancreas is a major operation. While in the hospital, the patient will need special medications and may be fed only liquids. During recovery from surgery, the patient's diet and weight will be checked carefully.

During radiation therapy, the patient may become very tired as the treatment continues. Resting as much as possible is important. Skin reactions (redness or dryness) in the treated area are also common. Good skin care is important at this time, but the patient should not use any lotions or creams on the skin without checking with the doctor. Radiation therapy to the upper abdomen can cause nausea and vomiting. Usually, dietary changes or medications can ease these problems.

The side effects of chemotherapy depend on the drugs that are given. In addition, each person reacts differently. Chemotherapy affects rapidly growing cells, such as blood-forming cells, those that line the digestive tract, and those in the skin and hair. As a result, patients can have side effects such as a lowered resistance to infection, less energy, loss of appetite, nausea, vomiting, or mouth sores. Patients may also lose their hair.

Weight loss can be a serious problem for patients being treated for cancer of the pancreas. Researchers are learning that well- nourished patients usually feel better and may be better able to withstand the side effects of their treatment. Therefore, nutrition is an important part of the treatment plan, and doctors may have a number of suggestions to help their patients get enough calories and protein. In many cases, patients feel better if they take food and beverages in very small amounts. Many patients find that eating several small meals and snacks throughout the day is easier than having three large meals.

In addition, treatment for cancer of the pancreas may interfere with production of insulin and pancreatic juices. The patient must take medicines to replace these; otherwise the level of blood sugar may be wrong and digestion may be affected. Even so, taking these medicines can often upset digestion. Careful planning and checkups are important to help the patient avoid weight loss and the weakness and lack of energy caused by poor nutrition.

Patients and family members are often afraid that cancer will cause pain. Cancer patients do not always have pain, but if it does occur, there are many ways to relieve or reduce it. It is important for the patient to let the doctor know about pain, because uncontrolled pain can cause loss of sleep and poor appetite. These problems can make it difficult for the patient to respond to treatment.

The side effects that patients have during cancer therapy vary for each person. They may even be different from one treatment to the next. Attempts are made to plan treatment to keep problems to a minimum. Fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and can suggest ways to deal with them. Helpful information about cancer treatment and coping with side effects is given in the National Cancer Institute publications Radiation Therapy and You, Chemotherapy and You, and Eating Hints.

©1996-2006 MedicineNet, Inc. All rights reserved.

pancreas cancer : What are symptoms of cancer of the pancreas

Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms. If the tumor blocks the common bile duct and bile cannot pass into the digestive system, the skin and whites of the eyes may become yellow, and the urine may become darker. This condition is called jaundice.

As the cancer grows and spreads, pain often develops in the upper abdomen and sometimes spreads to the back. The pain may become worse after the person eats or lies down. Cancer of the pancreas can also cause nausea, loss of appetite, weight loss, and weakness.

A rare type of pancreatic cancer, called islet cell cancer, begins in the cells of the pancreas that produce insulin and other hormones. Islet cells are also called the islets of Langerhans. Islet cell cancer can cause the pancreas to produce too much insulin or hormones. When this happens, the patient may feel weak or dizzy and may have chills, muscle spasms, or diarrhea.

These symptoms may be caused by cancer or by other, less serious problems. If an individual is experiencing symptoms, a doctor should be consulted

©1996-2006 MedicineNet, Inc. All rights reserved.

pancreas cancer : CA 19-9

How is it used?
CA 19-9 is not sensitive or specific enough to be considered useful as a tool for cancer screening. Its main use is as a tumor marker:

to help differentiate between cancer of the pancreas and bile ducts and other non-cancerous conditions, such as pancreatitis;
to monitor a patient's response to pancreatic cancer treatment; and
to watch for pancreatic cancer recurrence.
CA 19-9 can only be used as a marker if the cancer is producing elevated amounts of it; if CA 19-9 is not initially elevated, then it usually cannot be used later as a marker.

When is it ordered?
CA 19-9 may be ordered along with other tests, such as carcinoembryonic antigen (CEA), bilirubin, and/or a liver panel, when a patient has symptoms that may indicate pancreatic cancer, including abdominal pain, nausea, weight loss, and jaundice.

If CA 19-9 is initially elevated in pancreatic cancer, then it may be ordered several times during cancer treatment to monitor response and, on a regular basis following treatment, to help detect recurrence
What does the test result mean?
Low amounts of CA 19-9 can be detected in a certain percentage of healthy people, and many conditions that affect the liver or pancreas can cause temporary elevations.

Moderate to high levels are found in pancreatic cancer, other cancers, and in several other diseases and conditions. The highest levels of CA 19-9 are seen in excretory ductal pancreatic cancer -- cancer that is found in the pancreas tissues that produce food-digesting enzymes and in the ducts that carry those enzymes into the small intestine. This tissue is where 95% of pancreatic cancers are found.

Serial measurements of CA 19-9 may be useful during and following treatment because rising or falling levels may give your doctor important information about whether the treatment is working, whether all of the cancer was removed successfully during surgery, and whether the cancer is likely returning.
Is there anything else I should know?
Unfortunately, early pancreatic cancer gives few warnings. By the time a patient has symptoms and significantly elevated levels of CA 19-9, their pancreatic cancer is usually at an advanced stage.

©2001-2006 American Association for Clinical Chemistry

pancreas cancer : Pancreas Function Tests

Secretin stimulation test
The secretin stimulation test measures the ability of the pancreas to respond to the hormone secretin. The small intestines produce secretin in the presence of partially digested food. Normally, secretin stimulates the pancreas to secrete a fluid with a high concentration of bicarbonate. This fluid neutralizes stomach acid and is necessary for a number of enzymes to function in the breakdown and absorption of food. People with diseases involving the pancreas (for example, cystic fibrosis or pancreatic cancer) might have abnormal pancreatic function.

In performing a secretin stimulation test, a health care professional places a tube down the throat, into the stomach, then into the duodenum (upper section of small intestine). Secretin is administered and the contents of the duodenal secretions are aspirated (removed with suction) and analyzed over a period of about two hours.

Fecal elastase test
The fecal elastase test measures elastase, an enzyme found in fluids produced by the pancreas. Elastase digests and degrades various kinds of proteins. During this test, a patient’s stool sample is analyzed for the presence of elastase.

Computed tomography (CT) scan with contrast dye
This scan can help rule out other causes of abdominal pain and also can determine whether tissue is dying (pancreatic necrosis). CT can identify complications such as fluid around the pancreas, a collection of pus (abscess), or a collection of tissue, fluid, and pancreatic enzymes (pseudocyst).

Abdominal ultrasound
An abdominal ultrasound can detect gallstones and fluid from inflammation in the abdomen (ascites). It also can show an enlarged common bile duct, an abscess, or a pseudocyst.

Endoscopic retrograde cholangiopancreatography (ERCP)
During an ERCP, a health care professional places a tube down the throat, into the stomach, then into the small intestine. Dye is used to help the doctor see the structure of the common bile duct, other bile ducts, and the pancreatic duct on an X-ray.

Endoscopic ultrasound
During this test, a probe attached to a lighted scope is placed down the throat and into the stomach. Sound waves show images of organs in the abdomen. Endoscopic ultrasound might reveal gallstones and can be helpful in diagnosing severe pancreatitis when an invasive test such as ERCP might make the condition worse.

Magnetic resonance cholangiopancreatography
This kind of magnetic resonance imaging (MRI) can be used to look at the bile ducts and the pancreatic duct.

© Copyright 1995-2006 The Cleveland Clinic Foundation. All rights reserved

pancreas cancer : Screening and diagnosis

Detecting pancreatic cancer in its early stages is difficult. Signs and symptoms usually don't appear until the cancer is large or has spread (metastasized) to other tissues. And because your pancreas is relatively hidden — tucked behind your stomach and inside a loop of your small intestine — small tumors can't be seen or felt during routine exams.

For this reason, and because pancreatic cancer spreads so quickly, researchers have focused on finding a reliable screening test. At one time, scientists thought a substance called CA 19-9 was the answer. CA 19-9 is produced by pancreatic cancer cells and can be detected by a blood test. But by the time blood levels are high enough to be measured, the cancer is no longer in its early stages. Currently there is no effective screening test for pancreatic cancer.

If your doctor suspects pancreatic cancer, you may have one or more of the following tests to diagnose the cancer:

Ultrasound imaging. In this test, a device called a transducer is placed on your upper abdomen. High-frequency sound waves from the transducer reflect off your abdominal tissues and are translated by a computer into moving images of your internal organs, including your pancreas. Ultrasound tests are safe, noninvasive and relatively brief — a typical test takes less than an hour.
Computerized tomography (CT) scan. This imaging test allows your doctor to visualize your organs, including your pancreas, in two-dimensional slices. Split-second computer processing creates these images as a series of very thin X-ray beams pass through your body. Sometimes you may have a dye (contrast medium) injected into a vein before the test. The clearer images produced with the dye make it easier to distinguish a tumor from normal tissue. A CT scan exposes you to more radiation than do conventional X-rays, but in most cases, the benefits of the test outweigh the risks.
Magnetic resonance imaging (MRI). Instead of X-rays, this test uses a powerful magnetic field and radio waves to create images of your pancreas. During the test, you're placed in a cylindrical tube that can seem confining to some people. The machine also makes a loud thumping noise you might find disturbing. In most cases you'll be given headphones for the noise.
Endoscopic retrograde cholangiopancreatiography (ERCP). In this procedure, a thin, flexible tube (endoscope) is gently passed down your throat, through your stomach and into the upper part of your small intestine. Air is used to inflate your intestinal tract so your doctor can more easily see the openings of your pancreatic and bile ducts. The bile ducts are thin tubes that carry bile, a fluid produced in your liver that helps digest fats. These ducts are often the site of pancreatic tumors. A dye is then injected into the ducts through a small hollow tube (catheter) that's passed through the endoscope. Finally, X-rays are taken of the ducts. Your throat may be sore for a time after the procedure, and you may feel bloated from the air introduced into your intestine.
Endoscopic ultrasound (EUS). In this test, an ultrasound device is passed through an endoscope into your stomach. The device directs sound waves to your pancreas. A computer then translates the sound waves into close-up images of your pancreas and your bile and pancreatic ducts. The images are superior to those produced by standard ultrasound and are particularly useful for detecting small pancreatic tumors.
Percutaneous transhepatic cholangiography (PTC). In this test, your doctor carefully inserts a thin needle into your liver while you lie on a movable X-ray table. A dye is then injected into the bile ducts in your liver, and a special X-ray machine (fluoroscope) tracks the dye as it moves through the ducts. Any obstructions should show up on the X-ray. The table is rotated several times during the procedure so you can assume a variety of positions. During the test, you may have a feeling of pressure or fullness, or have slight discomfort in the right side of your back.
Biopsy. In this procedure, a small sample of tissue is removed and examined for malignant cells under a microscope. It's the only way to make a definitive diagnosis of cancer. Biopsies of the pancreas and bile ducts can be performed in several ways. If you have a mass that can be reached with a needle, your doctor may choose to perform a fine-needle aspiration (FNA) — a procedure in which a very thin needle is inserted through your skin and into your pancreas. An ultrasound or CT scan is often used to guide the needle's placement. When the needle has reached the tumor, cells are withdrawn and sent to a lab for further study. Tissue samples can also be removed during ERCP or EUS. Sometimes, in a procedure similar to ERCP, your surgeon uses an endoscope to pass a catheter into your bile duct where it empties into your small intestine. But instead of injecting dye, your surgeon uses a small brush introduced through the catheter to scrape cells and bits of tissue from the lining of the duct.
Laparoscopy. This procedure uses a small, lighted instrument (laparoscope) to view your pancreas and surrounding tissue. The instrument is attached to a television camera and inserted through a small incision in your abdomen. The camera allows your surgeon to clearly see what's happening inside you. During laparoscopy, your surgeon can take tissue samples to help confirm a diagnosis of cancer. Laparoscopy may also be used to determine how far cancer has spread. Risks include bleeding and infection and a slight chance of injury to your abdominal organs or blood vessels.
Staging pancreatic cancer
Staging tests help determine the size and location of cancer and whether it has spread. They're crucial in helping your doctor determine the best treatment for you. Pancreatic cancer may be staged in several ways. One method is to use these terms:

Resectable. All the tumor nodules can be removed.
Locally advanced. Because the cancer has spread to tissues around the pancreas or into the blood vessels, it can no longer be completely removed.
Metastatic. At this stage, the cancer has spread to distant organs, such as the lungs and liver.
Your doctor may also refer to your cancer as stage 1, 2, 3, or 4:

Stage 1 pancreatic cancer is confined to the pancreas.
Stage 2 pancreatic cancer has spread somewhat, possibly to the lymph nodes, but not into large blood vessels nearby.
Stage 3 pancreatic cancer has invaded large blood vessels, may be in the lymph nodes, but hasn't spread to distant sites.
Stage 4 means the cancer has spread to a distant site or sites in your body

This center sponsored by: Chemotherapy.com

pancreas cancer : Risk factors

The vast majority of pancreatic cancers occur in people older than 65. Other important risk factors include:

Race. Black men and women have a higher risk of pancreatic cancer.
Sex. More men than women develop pancreatic cancer.
Cigarette smoking. If you smoke, you're two to three times more likely to develop pancreatic cancer than nonsmokers are. This is probably the greatest known risk factor for pancreatic cancer, with smoking associated with almost one in three cases of pancreatic cancer.
Abnormal glucose metabolism. Having diabetes may increase your risk of pancreatic cancer. Insulin resistance or high insulin levels may also be risk factors for pancreatic cancer.
Hereditary pancreatitis. Your chances of developing pancreatic cancer increase if you have hereditary chronic pancreatitis. Hereditary pancreatitis (HP) is a rare genetic condition marked by recurrent attacks of pancreatitis — a painful inflammation of your pancreas.
Excess weight. People who are very overweight or obese may have a greater risk of developing pancreatic cancer than do people of normal weight.
Diet. A diet high in animal fat and low in fruits and vegetables may increase your risk of pancreatic cancer.
Chemical exposure. People who work with petroleum compounds, including gasoline and other chemicals, have a higher incidence of pancreatic cancer than people not exposed to these chemicals.

This center sponsored by: Chemotherapy.com

pancreas cancer : Medical Treatment

Unfortunately, many cancers of the pancreas are not resectable at the time of diagnosis. Chemotherapy and radiation therapy are the main treatments offered to patients whose entire tumor cannot be removed surgically ("unresectable cancers"). The chemotherapeutic agent most commonly used to treat cancer of the pancreas is Gemzar®, but Dr.Dan Laheru is currently exploring new approaches.
A particularly novel method now being developed at Hopkins by Dr. Elizabeth Jaffee is immunotherapy. This method employs an anti-cancer "vaccine" made from the cancer cells themselves, and preliminary data suggest that this vaccine can be an effective and safe treatment for pancreatic cancer.

Basic Science Research
Despite these successes there is clearly a great need to improve our understanding of the fundamental nature of cancer of the pancreas. The paradigm currently being examined in basic science laboratories here at Johns Hopkins is that cancer of the pancreas is caused by the accumulation of mutations (changes in the DNA code) in specific cancer-causing genes. Researchers, therefore, are looking at genes at both the level of the chromosome and at the DNA level.
One way to detect chromosome abnormalities in cancer is to measure the DNA content in each tumor cell. This can be done by either flow cytometry or absorption photocytometry, two techniques that measure the nucleic acid content of the individual cells. Ploidy analyses are, however, only a gross measurement of the overall loss or gain of large numbers of chromosomes. With this in mind, Dr. Constance Griffin in the Department of Pathology has karyotyped over 70 cancers of the pancreas, looking at the patterns of genetic changes in these tumors. Karyotyping is the process of analysing chromosomes for abnormalities, as is done with fetal chromosomes to assess for the presence of Down Syndrome or other changes in the number or structure of the chromosomes. Dr. Griffin has found that most cancers of the pancreas have abnormal chromosome patterns and that the chromosomes numbered 18, 13, 12 and 6 are frequently lost. These findings suggest that genes which cause cancer of the pancreas may be located on these chromosomes.

Drs. Scott Kern, Mike Goggins and Ralph Hruban in the Departments of Pathology and Oncology are looking at the genetic changes in cancer of the pancreas using "molecular biologic" techniques. Molecular biology uses techniques such as the "PCR" reaction to look at the actual DNA code in cancers. Dr. Kern's laboratory has found frequent mutations in specific cancer-causing genes (called "K-ras," "p53" and "p16") in cancers of the pancreas, and his laboratory is now hunting for new, previously undiscovered genes. It is hoped that a better understanding of the genetic changes which cause cancer of the pancreas will lead to the development of new techniques to diagnose and treat this disease. Dr. Goggins' laboratory is dedicated to finding new screening tests to detect pancreas cancer early.

The National Familial Pancreas Tumor Registry
Family studies can add a great deal to our understanding of the genetic changes responsible for the development of a cancer. While most cancers of the pancreas do not run in families, we can learn a lot about this cancer by studying the families in which more than one family member has been stricken by this disease. Because of the relative rarity but extreme value of families afflicted by pancreas cancer, a national registry for the study of familial pancreas cancer has been established here at Johns Hopkins. This registry is called The National Familial Pancreas Tumor Registry, it is directed by Dr. Alison Klein. It is supported by Michael Landon, Jr., the son of the late TV actor, and it is currently urging persons from families in which more than one family member has had cancer of the pancreas to register their families.

Copyright ©1996-2006 The Johns Hopkins University, Baltimore, Maryland

pancreas cancer : Overview of Pancreas Cancer

Cancer of the pancreas is the fourth leading cause of cancer death in the United States. This year approximately 32,000 Americans will die from cancer of the pancreas. The disease is not only common, it is also extremely difficult to treat. For these and other reasons, cancer of the pancreas has been called "the challenge of the twenty-first century." Recently Published Article Provides Comprehensive Overview of PC
Current Problems in Cancer: Pancreatic Cancer
July/August 2002 • Volume 26 • Number 4
Theresa Pluth Yeo, MSN, MPH, et al.

The Johns Hopkins Medical Institutions has become the leading center for the treatment and study of pancreas cancer. We created this web page to:

Educate patients and family members with the hope of empowering them as they make complex medical decisions; and
Provide a virtual Web family of support and caring for those facing this disease.
This site details the research and clinical developments in the fight against pancreatic cancer (with the very latest described in the "What's New" page), and introduces you to the members of the multidisciplinary team of clinicians and scientists assembled here at Johns Hopkins to fight pancreas cancer. It also has a very active "chat room" for patients and family members to share ideas and support, and an "Ask our Social Worker" page where our Social Worker Maureen Coyle provides resource information and other social work related support. This web site also contains an extensively illustrated frequently asked questions section, written for the layperson. We also wish to inform the public of the National Familial Pancreas Tumor Registry based at Johns Hopkins, in the hopes of encouraging persons having more than one family member afflicted with pancreas cancer to register their families.
Cancer of the pancreas is a major clinical and research focus here at The Johns Hopkins Medical Institutions. We hope you find this web site not only educational, but also a source of support. Numerous links are provided throughout the site, so please click on the highlighted headings for more detailed information.

Surgical Treatment
Surgical removal ("resection") of the cancer is currently the only chance for a cure for patients with cancer of the pancreas. Fortunately, great strides have been made in the surgical treatment of this disease. The surgical resection of most pancreas cancers is called a "pancreaticoduodenectomy" or "Whipple procedure." These operations are very complex, and unless performed by surgeons specially trained and experienced in this procedure, they can be associated with very high rates of operative morbidity and mortality. Close to 1,000 resections have been performed here at Hopkins since 1970, and the surgery is now safe and effective at our center. The five-year survival rate for patients who underwent a Whipple procedure for cancer of the pancreas here at Hopkins is now approaching 25% (40% for some patient subgroups), compared with a five-year survival rate of less than 3% overall for patients who do not receive treatment. Furthermore, because the procedure is safer when performed at Hopkins, patients treated here have fewer complications, and the overall hospital charges are significantly lower than when it is performed at less experienced institutions. The surgeons with a strong interest in treating cancers of the pancreas at Johns Hopkins include Drs. Kurtis Campbell, John Cameron, Frederick Eckhauser, Christopher Wolfgang, and Richard Schulick.

Copyright ©1996-2006 The Johns Hopkins University, Baltimore, Maryland

pancreas cancer ; Stages Of Cancer Of The Pancreas

Once cancer of the pancreas is found, more tests will be done to find out if the cancer has spread from the pancreas to the tissues around it or to other parts of the body. This is called staging. The following stages are used for cancer of the pancreas:

Stage I Cancer is found only in the pancreas itself, or has started to spread just to the tissues next to the pancreas, such as the small intestine, the stomach, or the bile duct.

Stage II Cancer has spread to nearby organs such as the stomach, spleen, or colon, but has not entered the lymph nodes. (Lymph nodes are small, bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).

Stage III Cancer has spread to lymph nodes near the pancreas. The cancer may or may not have spread to nearby organs.

Stage IV Cancer has spread to places far away from the pancreas, such as the liver or lungs.

Recurrent Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the pancreas or in another part of the body.

How Cancer Of The Pancreas Is Treated

There are treatments for all patients with cancer of the pancreas. Three kinds of treatment are used: surgery (taking out the cancer or relieving symptoms caused by the cancer) radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells) chemotherapy (using drugs to kill cancer cells).

The use of biological therapy (using the body's immune system to fight cancer) is being tested for pancreatic cancer.

Surgery may be used to take out the tumor. Your doctor may take out the cancer using one of the following operations:

A Whipple procedure removes the head of the pancreas, part of the small intestine, and some of the tissues around it. Enough of the pancreas is left to continue making digestive juices and insulin.

Total pancreatectomy takes out the whole pancreas, part of the small intestine, part of the stomach, the bile duct, the gallbladder, spleen, and most of the lymph nodes in the area.

Distal pancreatectomy takes out only the tail of the pancreas.

If your cancer has spread and it cannot be removed, your doctor may do surgery to relieve symptoms. If the cancer is blocking the small intestine and bile builds up in the gallbladder, your doctor may do surgery to go around (bypass) all or part of the small intestine. During this operation, your doctor will cut the gallbladder or bile duct and sew it to the small intestine. This is called biliary bypass. Surgery or x-ray procedures may also be done to put in a tube (catheter) to drain bile that has built up in the area. During these procedures, your doctor may make the catheter drain through a tube to the outside of the body or the catheter may go around the blocked area and drain the bile to the small intestine. In addition, if the cancer is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so you can continue to eat normally.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the pancreas.

Biological therapy tries to get your own body to fight cancer. It uses materials made by your own body or made in a laboratory to boost, direct, or restore your body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. Biological therapy is being tested in clinical trials.

http://www.cancer-info.com/pancreas.htm

pancreas cancer : Description of Pancreatic Cancer

Cancer of the pancreas is a disease in which cancer (malignant) cells are found in the tissues of the pancreas. The pancreas is about 6 inches long and is shaped something like a thin pear, wider at one end and narrowing at the other. The pancreas lies behind the stomach, inside a loop formed by part of the small intestine. The broader right end of the pancreas is called the head, the middle section is called the body, and the narrow left end is the tail.

The pancreas has two basic jobs in your body. It produces juices that help you break down (digest) your food, and hormones (such as insulin) that regulate how your body stores and uses food. The area of the pancreas that produces digestive juices is called the exocrine pancreas. About 95% of pancreatic cancers begin in the exocrine pancreas. The hormone-producing area of the pancreas is called the endocrine pancreas. Only about 5% of pancreatic cancers start here. This statement has information on cancer of the exocrine pancreas. For more information on cancer of the endocrine pancreas (also called islet cell cancer) see the PDQ Patient Information Statement on Islet Cell Carcinoma.

Cancer of the pancreas is hard to find (diagnose) because the organ is hidden behind other organs. Organs around the pancreas include the stomach, small intestine, bile ducts (tubes through which bile, a digestive juice made by the liver, flows from the liver to the small intestine), gallbladder (the small sac below the liver that stores bile), the liver, and the spleen (the organ that stores red blood cells and filters blood to remove excess blood cells). The signs of pancreatic cancer are like many other illnesses, and there may be no signs in the first stages. You should see your doctor if you have any of the following: nausea, loss of appetite, weight loss without trying to lose weight, pain in the upper or middle of your abdomen, or yellowing of your skin (jaundice).
If you have symptoms, your doctor will examine you and order tests to see if you have cancer and what your treatment should be. You may have an ultrasound, a test that uses sound waves to find tumors. A CT scan, a special type of x-ray that uses a computer to make a picture of the inside of your abdomen, may also be done. Another special scan called magnetic resonance imaging (MRI), which uses magnetic waves to make a picture of the inside of your abdomen, may be done as well.

A test called an ERCP (endoscopic retrograde cholangiopancreatography) may also be done. During this test, a flexible tube is put down the throat, through the stomach, and into the small intestine. Your doctor can see through the tube and inject dye into the drainage tube (duct) of the pancreas so that the area can be seen more clearly on an x-ray. During ERCP, your doctor may also put a fine needle into the pancreas to take out some cells. This is called a biopsy. The cells can then be looked at under a microscope to see if they contain cancer.

PTC (percutaneous transhepatic cholangiography) is another test that can help find cancer of the pancreas. During this test, a thin needle is put into the liver through your right side. Dye is injected into the bile ducts in the liver so that blockages can be seen on x-rays.

In some cases, a needle can be inserted into the pancreas during an x-ray or ultrasound so that cells can be taken out to see if they contain cancer. You may need surgery to see if you have cancer of the pancreas. If this is the case, your doctor will cut into the abdomen and look at the pancreas and the tissues around it for cancer. If you have cancer and it looks like it has not spread to other tissues, your doctor may remove the cancer or relieve blockages caused by the tumor.

For more information on pancreatic cancer and other diseases of the pancreas, visit www.pancreas.org or the National Pancreas Foundation at www.pancreasfoundation.org. For more information about the University of Pittsburgh divisionof gastroenterology, hepatology and nutrition visit their Web site at http://www.gi.pitt.edu.

pancreas cancer : Spanish singer Rocío Jurado dies after long illness

Rocío Jurado, a well-known and much loved Spanish singer from Andalucía, died at her Madrid home early on Thursday morning after a long illness. The 61-year-old singer had been diagnosed with cancer of the pancreas two years ago and had been treated at Houston, Texas.
Her brother and manager, Amador Mohedano, visibly affected by his sister’s death, made the announcement to the media waiting outside the singer’s home at La Moraleja. He added that she had died “peacefully” and “surrounded by her family as she wished”.

After a private wake in her home, at 11.17 on Thursday morning her body arrived under police escort at Madrid Cultural Centre for the general public to pay their last respects to the singer considered the greatest in the country in her genre. Her coffin was covered with the Spanish and the Andalusian flags. Her remains are to be flown to Jerez de la Frontera airport and then transferred to Chipiona, her birthplace, by road today, Friday, for burial in San José Cemetery at 5 p.m.

Flags on the Cadiz Provincial Government building were at half-mast, as they were in Chipiona, where the Mayor, Manuel García, announced three days of mourning for the singer

Rocío Mohedano Jurado was born in 1945 in the town of Chipiona, in the province of Cadiz, and started her career singing flamenco, especially fandangos, before branching out into a more popular style. In her youth she also worked as an actress in a number of Spanish-style musical films - extremely popular in their day. Her fame and success as a singer spread to Latin America and the USA..

In 1986 she was awarded the Andalusian Medal for exceptional merit and services to the region.

In her personal life she was married first to boxer Pedro Carrasco, by whom she had a daughter, Rocío, and second, in 1995, to classical bullfighter José Ortega Cano from Cartagena, Murcia. The couple adopted a boy and a girl in 1999 and the singer also had two grandchildren, the children of her elder daughter.

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pancreas cancer : Aspirin May Ward Off Pancreas Cancer

Aspirin, already widely used by people hoping to ward off a heart attack, may also be helpful in preventing pancreatic cancer.
In recent years reports of the benefits of aspirin have increased, including modest reductions in the polyps that can lead to colon cancer.

Now, University of Minnesota researchers report an apparent association between taking aspirin and reducing rates of often-deadly pancreatic cancer by as much as 43 percent. "This is an intriguing study, more along the lines of hypothesis generating as opposed to testing," said Dr. Ernest Hawk of the National Cancer Institute, who was not part of the research group.

"I think that aspirin may very well have this sort of activity but I wouldn’t consider it definitive that this point," he said. "They will have to work out the risks and benefits." Hawk noted that this was an observational study, not a randomized, controlled trial.

"It provides information that needs to be tested in a controlled study," he said. There have been prior studies of pancreatic cancer that didn’t see any statistical effect in aspirin use, Hawk added.

Because aspirin can also have side effects, he said that people may not want to run out and start taking it just on the basis of this study, but added that "researchers may want to run out and do (more) studies."

The research team, led by Kristin E. Anderson and Dr. Aaron R. Folsom, studied the use of aspirin and other nonsteroidal anti-inflammatory drugs by 28,283 postmenopausal women who responded to health questionnaires in the Iowa Women’s Health Study from 1992 to 1999.

Women who took aspirin had a 43 percent lower rate of pancreatic cancer than nonusers and the risk of the cancer declined with increasing frequency of aspirin use, the team reported.

Of 80 cases of pancreatic cancer found in the study, 33 were women who never used aspirin and 27 used it less than once a week. There were 10 cases among women who took aspirin two to five times a week and 10 among those using it six times or more weekly.

Risk factors for pancreatic cancer are not known and it is often rapidly fatal with few treatment options.

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