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1 Pancreatic Cancer By Ronald Steriti, NMD, PhD Overview Pancreatic cancer is the fifth leading cause of cancer mortality in the United States. The American Cancer Society (ACS) estimates that 29,000 Americans died from pancreatic cancer in 1998. Conventional medicine's inability to effectively treat pancreatic cancer is evidenced by survival rates of only 18% at 1 year and 4% at 5 years - one of the poorest 5-year survival rates of any cancer . The tumor results in the death of more than 98% of afflicted patients. The pancreas can be divided into two basic parts, the exocrine and endocrine pancreas. Each has a different function. The exocrine pancreas produces juices ( pancreatic enzymes) that help break down and digest food. The endocrine pancreas produces hormones (such as insulin) that regulate how the body stores and uses food. About 95% of pancreatic ...

January/February 2004, Vol. 11, No. 1 50 Cancer Control Krzyzanowska MK, Weeks JC, Earle CC. Treatment of locally advanced pancreatic cancer in the real world: population-based practices and effective- ness. J Clin Oncol . 2003;21:3409-3414. This analysis supports the effectiveness of cancer - directed treatment in elderly patients with locally advanced pancreatic cancer , but use is low. Receipt of treatment is strongly correlated with non-disease–related factors, especially sociodemographic characteristics, indi- cating possible disparities in access to care. Moore MJ, Hamm J, Dancey J, et al. Comparison of gemcitabine versus the matrix metalloproteinase inhibitor BAY 12-9566 in patients with advanced or metastatic adenocarcinoma of the pancreas: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol ...

Palliative Care in Pancreatic Cancer Frank J. Brescia, MD, MA, FACP Background: Pancreatic cancer is a formidable health problem, representing the 10th most common malignancy in the United States and the 4th most common cause of all cancer deaths. The overall 5-year survival rate is 4%, making this disease a model tumor in which to address the specialized care issues of palliative medicine. Methods: General considerations in both medical decision-making and symptom management are reviewed. Treatment of patients with locally unresectable, recurrent, or metastatic disease is individualized, based on considerations that include patient age, patient wishes, family influence, insurance constraints, and geographic practice variations. Results: Success in managing progressive symptoms is needed to palliate patients with advanced pancreatic cancer . Common problems include ...

Applications of Endoscopic Ultrasonography in Pancreatic Cancer Shyam Varadarajulu, MD, and Michael B. Wallace, MD, MPH Background: Accurate staging of pancreatic cancer is essential for surgical planning and for identification of locally advanced and metastatic disease that is incurable by surgery. Advances in endoscopic sonography (EUS), computed tomography (CT), and positron emission tomography have improved the accuracy of staging and reduced the number of incomplete surgical resections. Tissue acquisition is necessary in nonsurgical cases when chemoradiotherapy is considered. The complex regional anatomy of the pancreas makes cytologic diagnosis of malignancy at this region difficult without exploratory surgery. Although CT-guided fine-needle aspiration (FNA) is used for this purpose, reports of an increased risk of peritoneal dissemination of cancer cells and a false-negative ...

Surgical Management of Early-Stage Pancreatic Cancer Emmanuel E. Zervos, MD, Alexander S. Rosemurgy, MD, Osama Al-Saif, MD, and Alan J. Durkin, MD Background: Pancreatic cancer remains a difficult disease to treat. Diagnosis at an early stage may allow curative treatment with resection. In the past, the mortality associated with surgical treatment of pancreatic carcinoma was prohibitive but mortality associated with resection is now commensurate with all other major oncologic resections. Thus, the focus of surgical management has shifted to address several issues: the diagnosis and evaluation of patients with suspected pancreatic cancer , the role of preoperative endobiliary stenting, the role of laparoscopy, the extent of resection, the role of adjuvant and neoadjuvant treatment, and the role of specialized centers in treating the disease. Methods: The current literature ...

Center for Environmental Health Studies (617) 482-9485 44 Farnsworth Street, Boston, MA 02210 http://www.jsi.com Pancreatic Cancer and Exposure to Ionizing Radiation 1 Pancreatic Cancer and Exposure to Ionizing Radiation Summary : Some evidence has been recorded of a possible connection between cancers of the pancreas and exposure to ionizing radiation. This possible connection is supported by evidence from studies conducted at Los Alamos National Laboratory and other studies of nuclear workers at other sites who have been exposed to ionizing radiation. The National Research Council’s, on the other hand, has determined that the pancreas is relatively insensitive to ionizing radiation. Pancreatic cancers are designated as “specified” cancers under the Energy Employees Occupational Illness Compensation Program Act. Historically, incidence of pancreatic ...

pancreatic cancer Pancreatic Cancer Cheryl McConnell RN MSN Incidence One of the leading causes of cancer mortality 28,000 new cases per year Incidence increases with age Rarely before 50 y/o – usually 60 to 70 y/o Slightly more in men Less than 20% live longer than one year Etiology of Pancreatic Cancer Exact cause unknown Smokers at high risk High fat, high protein, high caffeine, hi alcohol diets May be genetic Pathophysiology Usually arises from epithelial cells of the pancreatic ducts Tumor discovered in late stages so has spread throughout pancreas Can be a result of metastatic disease from lung, breast, thyroid, kidney, or skin Rapid growing with spread to surrounding tissue ...

[ CANCER RESEARCH 61, 4655– 4659, June 15, 2001] Advances in Brief Heparanase Expression in Primary and Metastatic Pancreatic Cancer 1 Alexander Koliopanos, Helmut Friess, 2 Jo¨rg Kleeff, Xin Shi, Quan Liao, Iris Pecker, Israel Vlodavsky, Arthur Zimmermann, and Markus W. Bu ¨ chler Department of Visceral and Transplantation Surgery [A. K., H. F., J. K., X. S., Q. L., M. W. B.] and Institute of Pathology [A. Z.], University of Bern, Inselspital, CH-3010 Bern, Switzerland, Department of Molecular Biology, Insight Ltd., Rehovo 76121, Israel [I. P.] and Department of Oncology, Hadassah-Hebrew University Hospital, Jerusalem 91120, Israel [I. V.] Abstract The human endoglycosidase heparanase (hpa) degrades heparan- sulfate proteoglycans, which constitute prominent components of base- ment membranes and extracellular matrix. Due to ...

Cancers of the pancreas made up 2.2 percent of the incident (newly diagnosed) cancers reported to the Ohio Cancer Incidence Surveillance System (OCISS) for the years 1996 through 2000 (Table 1). The average annual age-adjusted pancreatic cancer incidence rate during this time period was 10.1 cases per 100,000 residents, which is about nine percent lower than the average annual age-adjusted U.S. (SEER 1 ) incidence rate of 11.1 cases per 100,000 residents. Average annual numbers and rates represent the number of cases diagnosed per year on average, not the total number of cases diag- nosed during the five-year time period. Completeness of reporting of invasive pancreatic cancer is estimated to be 91.0 percent in 1996-2000, which is less than the national standard of 95 percent for complete case ascertainment. Therefore, the pancreatic cancer incidence rate in Ohio ...

NICE Technology Appraisal 25 Gemcitabine for pancreatic cancer Product Clinical condition Indicated for: Not indicated in: Impact of use on NHS Audit data to be collected NICE review date Gemcitabine Pancreatic cancer Patients with advanced or metastatic adenocarcinoma of the pancreas with Karnofsky performance score of 50 or more as first line chemotherapy Patients suitable for potentially curable surgery Patients with Karnofsky score less than 50 Insufficient evidence on use as second-line treatment of pancreatic adenocarcinoma Estimated 600-840 patients a year may be suitable Estimated total additional costs £816,000 - £3m per year Record management plans for each ...

Research Study for Pancreatic Cancer Evaluating a New Biotherapy The Effectiveness of Opioid Growth Factor (OGF) in patients with adenocarcinoma of the pancreas This study is conducted on patients who have failed previous treatment Physicals, Blood work and Monthly 24-hour urine collection, Diary and Questionnaires are involved To be in the study you must: • Have failed previous therapy • Have documented adenocarcinoma of pancreas • Have laboratory values within range • Have a CT scan within for 4 weeks • Be willing to keep a daily diary • Be physically active Principal Investigator Jill P. Smith, M.D. Gastroenterology & Hepatology Hershey Medical Center Sub Investigator Ian S. Zagon, Ph.D. Contact Sandra I. Bingaman, R.N. 717- 531-8108 Costs of medication and office visits are paid by the study. ...

P.O.Box 2345, Beijing 100023,China World J Gastroenterol 2003;9(12):2745-2750 Fax: +86-10-85381893 World Journal of Gastroenterology E-mail: wjg@wjgnet.com www.wjgnet.com Copyright © 2003 by The WJG Press ISSN 1007-9327 • BASIC RESEARCH • Oil A induces apoptosis of pancreatic cancer cells via caspase activation, redistribution of cell cycle and GADD expression Mi-Lian Dong, Yue-Chun Zhu, John V. Hopkins Mi-Lian Dong , Affiliated Taizhou Hospital, Wenzhou Medical College, Linhai 317000, Zhejiang, Provice China Yue-Chun Zhu, John V. Hopkins , Northwestern University Medical School, Chicago, IL60611-3008, U.S.A Supported by the National Cancer Institute of USA, No. CA72712, and Special Funds for Zhejiang 151 Talent Project of China, No. 98-2095 Correspondence to: Dr Mi-Lian Dong, Taizhou Hospital of Wenzhou Medical College, 150 Ximen Street, Linhai 317000, ...

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pancreatic cancer NCI AWARDS 3 PANCREATIC CANCER SPORES In 2000, the National Cancer Institute (NCI) pledged to develop a national research agenda for pancreatic cancer . Leading scientists, clinicians and advocates, including The Lustgarten Foundation, joined together to participate in the first-ever NCI Pancreatic Cancer Progress Review Group (PRG). The National Cancer Institute responded to the recommendations of the PRG with unprecedented commitment and in 2002, announced ?10 steps? to increase support for pancreatic cancer research. Included as part of the NCI?s ?10-step? plan was a commitment by NCI to fund at least three Pancreatic Cancer Specialized Programs of Research Excellence (SPOREs), assuming that three applications receive meritorious scores following peer review. SPOREs are five-year funding commitments to academic centers, which are then required to make significant ...

pancreatic cancer Potential Use of Biomarkers or QoL Parameters in Colorectal Cancer Drug Approval Charles D. Blanke, M.D., F.A.C.P. Director, G.I. Malignancies Program Oregon Health & Science University Cancer Institute Biomarkers and QOL in CRC Drug Approval Biomarkers CEA CA 19-9 + others QoL issues How symptomatic are modern advanced disease patients? Instruments Problems with QoL analysis Recommendations + group discussion CEA: Background Serum glycoprotein member of the immunoglobulin gene superfamily Intercellular adhesion molecule promoting aggregation of malignant cells; involved in immunity, apoptosis, and metastasis Elevated in a variety of inflammatory diseases Malignant: Breast, lung, gastric, cervical, kidney, bladder carcinomas &nb...

pancreatic cancer STAGING OF PANCREATIC CANCER Andrew L. Warshaw, M.D. Surgeon-in-Chief and Chairman Department of Surgery Massachusetts General Hospital W. Gerald Austen Professor of Surgery Harvard Medical School No screening test Late appearance of symptoms Rapid growth and spread The Challenge of Pancreatic Cancer Head 60% Body/Tail 40% 20% resectable <5% resectable 20% 5-yr survival <15% 5-yr survival ...

pancreatic cancer Preoperative (Neoadjuvant) Therapy Douglas B. Evans University of Texas M. D. Anderson Cancer Center June 17, 2003 Initial surgery is the correct treatment for the 10% to 20% without extra- pancreatic disease In the 80% with occult extra- pancreatic disease surgery delays systemic therapy 20% Additional concerns: angiogenesis / immune suppression Delivery of Neoadjuvant Therapy Surgical Oncology Diagnostic Imaging Gastroenterology Cytopathology Gastrointestinal Medical Oncology Radiation Oncology Nutrition Support Rationale for preop therapy Multimodality therapy superior to surgery alone Delayed recovery may prevent the delivery of postoperative adjuvant therapy A logical strategy for the high incidence ...

pancreatic cancer Adjuvant Treatment for Resected Pancreas Adenocarcinoma Murray F. Brennan, M.D. Peripancreatic Adenocarcinoma - Resected Overall Survival - Site MSKCC 10/15/1983 - 4/14/2003 n = 1165 p < 0.0001 Pancreas n = 760 Ampulla n = 210 Bile Duct n = 102 Duodenum n = 93 Adenocarcinoma of the Pancreas - Resected Overall Survival MSKCC 10/15/1983 - 4/14/2003 n = 760 Peripancreatic Adenocarcinoma Actual Survival after Resection Alive Alive DOD n >3 ...

Abstract. It has been reported that vascular endothelial growth factor (VEGF) is a potent angiogenic factor that also has the ability to increase vascular permeability. VEGF plays an important role in the development of malignant ascites in various cancers. Gemcitabine has been prescribed for patients with inoperable human pancreatic ductal carcinoma as a first- line chemotherapy. However, the response rates of patients with malignant ascites who were undergoing systemic chemotherapy were extremely limited. In the present study, we investigated the role of VEGF and the effects of gemcitabine on malignant ascites of human pancreatic ductal carcinoma. As an in vitro assay, the human pancreatic cancer cell line (SUIT-2) was incubated in DMEM supplemented with serially diluted concentrations of gemcitabine for 24 h. The expression levels of VEGF in culture media were assayed ...

Laparoscopic Staging for Potentially Resectable and Locally Advanced Pancreatic Cancer Richard S. Swanson, M.D. Brigham and Women’s Hospital Harvard Medical School Page 2 Pancreatic Cancer Surgeons’ Philosophy Regarding Staging Laparoscopy • Ardent Opponents: – Pisters and Evans: • Nothing beats a good CT scan – Yeo: • It does not help the Hopkins’ algorithm • Die-hard Proponents: – It is vitally important in the management of pancreatic cancer • In-between: – Use it selectively – Don’t use it but can see why others do – Use it, but beginning to question the value Page 3 Staging Laparoscopy for Pancreatic Cancer • First suggested by Bernheim – Ann Surg 53:764, 1911 • Introduced by Cuschieri et al. – Gut 19:672, ...

pancreatic cancer PANCREATIC CANCER GENETIC EPIDEMIOLOGY (PACGENE) CONSORTIUM. Gloria M. Petersen1, Mariza de Andrade1, Michael Goggins2, Melissa Bondy3, Jeannette Korczak4, Steven Gallinger5, Henry T. Lynch6, Kari Rabe1, and Ralph Hruban2. 1Mayo Clinic, Rochester, MN; 2Johns Hopkins University, Baltimore, MD; 3MD Anderson Cancer Center, Houston, TX; 4Wayne State University, Detroit, MI; 5Mt. Sinai Hospital, Toronto, Canada; 6Creighton University, Omaha, Nebraska Purpose: We are a multicenter, multidisciplinary Consortium designed to identify susceptibility genes in high risk familial pancreatic cancer (FPC) pedigrees, containing two or more affected relatives. Methods: The PACGENE Consortium comprises six data collection centers, a statistical genetics Core, and a pathology/archival genotyping Core. We will identify high risk FPC pedigrees for genetic linkage ...

pancreatic cancer Functional Isolation of Pancreatic Tumor Suppressor Genes. Young Mi Park, M.D, Ryan George, Julie Mackey, Katherine Pogue-Geile, Ph.D.*, University of Pittsburgh, Pittsburgh, PA. Recent evidence suggests that many unidentified tumor suppressor genes are involved in pancreatic cancer development. Purpose: The purpose of this work is to isolate novel, functional pancreatic cancer -tumor suppressor gene(s) from two regions of the genome at 12q21 and 12q23.1 that have been shown to be frequently lost in pancreatic cancer (Kimura et al. Cancer Research 58:2456-60, 1998). Methods: Functional tumor suppressor genes will be identified in the following manner: 1) Human clones in Yeast Artificial Chromosomes (YACs) that map to the human genome at 12q21-23.1, will be ?retrofitted? with the neomycin resistance gene (NeoR), a mammalian cell selectable marker. 2) These ...

pancreatic cancer Comprehending high-risk individuals? perception of the impact of cigarette smoking on the risk of developing pancreatic cancer A.P.Klein, Ph.D., M.H.S.1, L. Juliano,Ph.D.2, K.A. Brune3, A. Maitra3, A.B. Lowenfels4 R.H. Hruban, M.D.3,5 1Inherited Disease Research Branch, NHGRI, NIH, Baltimore.2 Department of Psychology, College of Arts and Sciences, American University, Washington DC 3 Department of Pathology, 5Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore 4Department of Surgery, New York Medical College, Valhalla Purpose: Cigarette smoking is the leading preventable risk factor for pancreatic cancer (PC), accounting for 25% of all cases. A family history of PC is a strong independent risk factor for this disease with some studies suggesting that cigarette smoking and a family history of the disease may act synergistically ...

pancreatic cancer Identification of novel genes in the development and progression of Pancreatic Cancer by transcript profiling. Andrew V. Biankin1, 2, Davendra Segara1, James G. Kench3, Amanda C. Dawson1, Sandra A. Biankin3, Maxwell J. Coleman2, Robert L. Sutherland1 and Susan M. Henshall1. 1Cancer Research Program, Garvan Institute of Medical Research and 2Department of Surgery, St. Vincent's Hospital Campus, Darlinghurst, Sydney, Australia. 3Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, Australia. Purpose: Pancreatic Cancer (PC) is the fifth largest cause of cancer death in Western societies. Despite improvements in therapy, the 5-year survival for PC remains under 10%. Recent technological advances have led to the availability of microarrays that can interrogate the mRNA expression of over 44K genes. The data obtained can be used to identify genes ...

pancreatic cancer The Role of ATDC in Radioresistance of Pancreatic Adenocarcinoma Charles Binkley 1, Diane Simeone1,2, Craig D. Logsdon2 Department of Surgery1 and Molecular and Integrative Physiology2, University of Michigan, Ann Arbor MI 48109 Background Recently we have determined that the gene Ataxia-Telangiectasia Group D Associated (ATDC) is significantly over- expressed in >90% of human pancreatic adenocarcinomas. The role of ATDC in tumorigenesis is unknown. We hypothesize that ATDC promotes growth and confers radiation resistance in pancreatic cancer . Methods: Stable NIH 3T3 cells expressing ATDC were established. Additionally, BxPC-3 cell lines, a pancreatic cancer cell line with high endogenous ATDC expression, stably expressing an anti-ATDC small inhibitory RNA (siRNA), which silences ATDC, were established. ATDC expression in NIH 3T3 cells and silencing ...

Endowing Human Pancreatic Ribonuclease with Toxicity for Cancer Cells* Received for publication, July 16, 2001 Published, JBC Papers in Press, September 12, 2001, DOI 10.1074/jbc.M106636200 Peter A. Leland‡§, Kristine E. Staniszewski‡ ¶ , Byung-Moon Kim‡ , and Ronald T. Raines‡**‡‡ From the Departments of ‡ Biochemistry and ** Chemistry, University of Wisconsin-Madison, Madison, Wisconsin 53706 Onconase ® is an amphibian protein that is now in Phase III clinical trials as a cancer chemotherapeutic. Human pancreatic ribonuclease (RNase 1) is homolo- gous to Onconase ® but is not cytotoxic. Here, ERDD RNase 1, which is the L86E/N88R/G89D/R91D variant of RNase 1, is shown to have conformational stability and ribonucleolytic activity similar to that of the wild-type enzyme but >10 ...

Clinical & Experimental Metastasis 18: 379–384, 2001. © 2001 Kluwer Academic Publishers. Printed in the Netherlands. 379 Antimetastatic efficacy of adjuvant gemcitabine in a pancreatic cancer orthotopic model Natalie C. Lee 1,3 , Michael Bouvet 2 , Stephanie Nardin 2 , Ping Jiang 1 , Eugene Baranov 1 , Babak Rashidi 1 , Meng Yang 1 , Xiaoen Wang 1 , A.R. Moossa 2 & Robert M. Hoffman 1,2 1 AntiCancer, Inc., San Diego, California, USA; 2 Department of Surgery, University of California San Diego Medical Center, San Diego, California, USA; 3 Department of Surgery, University of California San Francisco Medical Center, San Francisco, California, USA Received 11 December ...

A Novel Red Fluorescent Protein Orthotopic Pancreatic Cancer Model for the Preclinical Evaluation of Chemotherapeutics Matthew H. Katz, M.D.,* Shinako Takimoto, B.S.,* Daniel Spivack, M.D.,* A. R. Moossa, M.D.,* Robert M. Hoffman, Ph.D.,* , † and Michael Bouvet, M.D.* ,1 * Department of Surgery, University of California at San Diego, San Diego, California; and † AntiCancer, Inc., San Diego, California Submitted for publication April 18, 2003 Background. Realistic models of pancreatic cancer are necessary to develop effective drugs for the dis- ease. More aggressive tumor models enhanced by brighter fluorescent biomarkers to follow the disease in real time would enhance the ability to predict ac- curately the effect of novel therapeutics on this par- ticularly malignant human cancer . Materials and methods. A novel, highly fluorescent, ...

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September 22, 2003 Vaccine may help pancreatic cancer patients Reuters Health; www.reutershealth.com ; Patricia Reaney COPENHAGEN (Reuters) - Early tests of an experimental vaccine for pancreatic cancer have produced encouraging results and raised hopes for a new treatment for one of the deadliest cancers, a leading scientist said on Monday. Pancreatic cancer is not as common as other types of the disease but it is one of the most difficult to treat, because often by the time it is diagnosed it has already spread. More than 95 percent of sufferers die within two years of diagnosis. But three out of 10 patients who were treated in a pilot study by researchers at the Memorial Sloan-Kettering Cancer Centre in New York with the Oncophage vaccine made by Antigenics Inc are still alive between two and five years after treatment. "It is very early data but at least it is ...