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.

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