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is a
Malignant Tumour within the
Pancreatic Gland . Each year about 33,000 individuals in the
United States are diagnosed with this condition, and more than 60,000 in
Europe . Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with few victims still alive 5 years after diagnosis, and complete remission still extremely rare.
1
About 95 percent of pancreatic tumors are
Adenocarcinoma s (). The remaining 5 percent include other tumors of the exocrine pancreas (e.g. serous cystadenomas), acinar cell cancers, and pancreatic
Neuroendocrine Tumor s (such as
Insulinoma s, , ). These tumors have a completely different diagnostic and therapeutic profile, and generally a more favorable prognosis.
Early diagnosis of pancreatic cancer is difficult because the symptoms are so non-specific and varied. Common symptoms include
Pain In The Upper Abdomen that typically radiates to the back and is relieved by leaning forward (seen in carcinoma of the body or tail of the pancreas),
Loss Of Appetite , significant
Weight Loss and painless
Jaundice related to
Bile Duct obstruction (carcinoma of the head of the pancreas). All of these symptoms can have multiple other causes. Therefore, pancreatic cancer is often not diagnosed until it is advanced.
Jaundice occurs when the tumor grows and obstructs the
Common Bile Duct , which runs partially through the head of the pancreas. Tumours of the head of the pancreas (approximately 60% of cases) are more likely to cause jaundice by this mechanism.
Trousseau's Sign , in which blood clots form spontaneously in the
Portal Blood Vessels , the deep veins of the extremities, or the superficial veins anywhere on the body, is sometimes associated with pancreatic cancer.
Clinical Depression has been reported in association with pancreatic cancer, sometimes presenting before the cancer is diagnosed. However, the mechanism for this association is not known.Carney CP, Jones L, Woolson RF, Noyes R Jr, Doebbeling BN. Relationship between depression and pancreatic cancer in the general population. ''Psychosom Med'' 2003;65:884-8. PMID 14508036..
Risk factors for pancreatic cancer include:http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_pancreatic_cancer_34.asp?sitearea=
Courvoisier's Law defines the presence of jaundice and a painlessly distended
Gallbladder as strongly indicative of pancreatic cancer, and may be used to distinguish pancreatic cancer from
Gallstone s.
Pancreatic cancer is usually discovered during the course of the evaluation of aforementioned symptoms.
Liver Function Test s may show a combination of results indicative of bile duct obstruction (raised
Conjugated Bilirubin ,
γ-glutamyl Transpeptidase and
Alkaline Phosphatase levels).
CA19-9 (carbohydrate antigen 19.9) is a
Tumor Marker that is frequently elevated in pancreatic cancer.
Imaging studies, such as
Ultrasound or abdominal
CT may be used to identify tumors.
Endoscopic Ultrasound (EUS) is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.
Recent research indicates that in pancreatic cancer test profile, which would be an innovation in this cancer; and 2) also possible new, creative and more effective therapies based on the various microRNA levels. This opens an exciting new front in confronting a very deadly disease.
Treatment of pancreatic cancer depends on the stage of the cancer.http://www.cancersupportivecare.com/pancreas.html#stage Recent advances have made possible resection (surgical removal) of tumors that were previously unresectable due to blood vessel involvement. The
Whipple Procedure is the most common surgical treatment for cancers involving the head of the pancreas.
Fluorouracil ,
Gemcitabine , and
Erlotinib are the chemotherapeutic drug agents of choice.
Gemcitabine was approved by the US
FDA in 1998 after a clinical trial reported improvements in
Quality Of Life in patients with advanced prostate cancer. This marked the first
FDA approval of a
Chemotherapy drug for a non-survival
Clinical Trial endpoint.
On the back of the results of a Canadian led Phase III Randomised Controlled trial involving 569 patients with advanced pancreatic cancer, the US FDA has licensed the use of
Erlotinib (Tarceva) in combination with
Gemcitabine as a palliative agent for this tumour. This trial compared the action of gemcitabine/erlotinib vs gemcitabine/placebo and demonstrated improved survival rates, improved tumour response and improved progression free survival rates. The survival improvement with the combination is on the order of less than four weeks, leading some
Cancer experts to question the incremental value of adding
Erlotinib to
Gemcitabine treatment. New trials are now investigating the effect of the above combination in the adjuvant and neoadjuvant setting.
FDA approval briefing
In September 2006, it was announced that a new
Vaccine had been developed to fight pancreatic cancer, with testing on human patients showing promising results.http://abclocal.go.com/kgo/story?section=edell&id=4605575http://abclocal.go.com/kgo/story?section=edell&id=4605594
Patients diagnosed with pancreatic cancer typically have a poor
Prognosis partly because the cancer usually causes no symptoms early on, leading to metastatic disease at time of diagnosis. Median survival from diagnosis is around 3 to 6 months; 5-year survival is much less than 5%http://www.who.int/tobacco/research/cancer/en/ With 32,180 new diagnoses in the United States every year, and 31,800 deaths, mortality approaches 99%, giving pancreatic cancer the highest fatality rate of all cancers and the fourth highest cancer killer in the United States amongst both men and women.http://pancan.org/About/pancreaticCancerStats.html
Pancreatic cancer occasionally may result in
Diabetes . Insulin production is hampered and it has been suggested that the cancer can also prompt the onset of diabetes and vice versa.http://www.molecular-cancer.com/content/2/1/4
Prevention of pancreatic cancer consists of avoiding risk factors when possiblehttp://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_pancreatic_cancer_be_prevented_34.asp?rnav=cri
Cigarette Smoking is considered to be the most significant and avoidable risk factor for pancreatic cancer. Maintaining a healthy weight and exercising may be helpful.
The
American Cancer Society recommends increasing consumption of fruits, vegetables, and whole grains while decreasing red meat intake. This has been questioned by several research groups.
3 4
In 2006 a large prospective cohort study of over 80,000 subjects failed to prove a definite association.
5 The evidence in support of this lies mostly in small case-control studies.
In September 2006, a long-term study concluded that taking
Vitamin D can substantially cut the risk of pancreatic cancer (as well as other cancers) by up to 50%.http://news.bbc.co.uk/1/hi/health/5334534.stmhttp://www.webmd.com/content/article/127/116673.htmhttp://www.forbes.com/forbeslife/health/feeds/hscout/2006/09/14/hscout534925.html More studies of this have been called for.
Several studies, including one published
June 1 ,
2007 , indicate that B vitamins such as
B12 ,
B6 , and
Folate , can reduce the risk of pancreatic cancer when consumed in food, but not when ingested in vitamin tablet form.
67
- November is Pancreatic Cancer Awareness Month
- Purple is the traditional color chosen to represent pancreatic cancer awareness.
- The National Cancer Institute’s cancer research budget was $4.824 billion in 2004, an estimated $52.7 million of which was devoted to pancreatic cancer.http://pancan.org/About/pancreaticCancerStats.html
- Research spending per pancreatic cancer patient is $1145, the lowest of any leading cancer.http://pancan.org/About/pancreaticCancerStats.html
- For a list of celebrities who have succumbed to this disease, see
- The Pancreatic Cancer Action Network ( PanCAN ) was created as an advocacy group for pancreatic cancer.
- The national charity Pancreatic Cancer UK works to raise awareness in the UK
