Pancreatic cancer treatment

Pancreatic cancer is the second most common gastroenterologic cancer with over 29000 new cases diagnosed each year.Pancreatic cancer is a malignant tumor of the pancreas. Each year in the United States, about 37,680 individuals are diagnosed with this condition and 34,290 die from the disease each year[citation needed]. In Europe more than 60,000 are diagnosed each year. Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with less than 5 percent of those diagnosed still alive 3 months after diagnosis, and complete remission still extremely rare. About 95 percent[citation needed] of pancreatic tumors are adenocarcinomas. The remaining 5 percent include other tumors of the exocrine pancreasacinar cell cancers, and pancreatic neuroendocrine tumors. These tumors have a completely different diagnostic and therapeutic profile, and generally a more favorable prognosis.Pain is present in 80 to 85 percent of patients with locally advanced or advanced metastic disease. The pain is usually felt in the upper abdomen as a dull ache that radiates straight through to the back. It may be intermittent and made worse by eating. Weight loss can be profound; it can be associated with anorexia, early satiety, diarrhea, or steatorrhea. Jaundice is often accompanied by pruritus and dark urine. Painful jaundice is present in approximately one-half of patients with locally unresectable disease, while painless jaundice is present in approximately one-half of patients with a potentially resectable and curable lesion. The initial presentation varies according to tumor location. Tumors in the pancreatic body or tail usually present with pain and weight loss, while those in the head of the gland typically present with steatorrhea, weight loss, and jaundice. The recent onset of atypical diabetes mellitus, a history of recent but unexplained thrombophlebitis, or a previous attack of pancreatitis are sometimes noted. Courvoisier sign 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 gallstones. Pancreatic cancer is usually discovered during the course of the evaluation of aforementioned symptoms. Liver function tests can show a combination of results indicative of bile duct obstruction. CA19-9 is a tumor marker that is frequently elevated in pancreatic cancer. However, it lacks sensitivity and specificity. When a cutoff above 37 U/mL is used, this marker has a sensitivity of 77% and specificity of 87% in discerning benign from malignant disease. CA 19-9 might be normal early in the course, and could be elevated due to benign causes of biliary obstruction. Imaging studies, such as ultrasound or abdominal CT, can be used to identify tumors. Endoscopic ultrasound is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis. Endoscopic retrograde cholangiopancreatography is also used.Treatment of pancreatic cancer depends on the stage of the cancer. The Whipple procedure is the most common surgical treatment for cancers involving the head of the pancreas. It can only be performed if the patient is likely to survive major surgery and if the tumor is localised without invading local structures or metastasizing. It can therefore only be performed in the minority of cases. Recent advances have made possible resection of tumors that were previously unresectable due to blood vessel involvement. Tumors of the tail of the pancreas can be resected using a procedure known as a distal pancreatectomy. Recently, localized tumors of the pancreas have been resected using minimally invasive approaches. After surgery, adjuvant chemotherapy with gemcitabine may be offered to eliminate whatever tumor tissue may remain in the body. This has been shown to increase 5-year survival rates. Addition of radiation therapy is a hotly debated topic, with groups in the US often favoring the use of adjuvant radiation therapy, while groups in Europe do not. Surgery can be performed for palliation, if the tumor is invading or compressing the duodenum or colon. In that case, bypass surgery might overcome the obstruction and improve quality of life, but it is not intended as a cure.In patients not suitable for resection with curative intent, palliative chemotherapy may be used to improve quality of life and gain a modest survival benefit. Gemcitabine was approved by the US FDA in 1998 after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer. This marked the first FDA approval of a chemotherapy drug for a non-survival clinical trial endpoint. Gemcitabine is administered intravenously on a weekly basis. Addition of oxaliplatin conferred benefit in small trials, but is not yet standard therapy. Fluorouracil<5fu> may also be included. On the basis 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 regimen for pancreatic cancer. This trial compared the action of gemcitabine/erlotinib vs gemcitabine/placebo and demonstrated improved survival rates, improved tumor 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. A trial of anti-angiogenesis agent bevacizumab as an addition to chemotherapy has shown no improvement in survival of patients with advanced pancreatic cancer. It may cause higher rates of high blood pressure, bleeding in the stomach and intestine, and intestinal perforations. A phase II clinical trial studying the effect of curcumin on pancreatic cancer was completed in 2007 and the results were published in 2008. The study used eight grams per day in 21 patients and stopped treatment if the tumor size increased. The conclusion of the study was "Oral curcumin is well tolerated and, despite its limited absorption, has biological activity in some patients with pancreatic cancer. According to the American Cancer Society, there are no established guidelines for preventing pancreatic cancer, although cigarette smoking has been reported as responsible for 20-30% of pancreatic cancers. The ACS recommends keeping a healthy weight, and increasing consumption of fruits, vegetables, and whole grains while decreasing red meat intake, although there is no consistent evidence that this will prevent or reduce pancreatic cancer specifically. In 2006 a large prospective cohort study of over 80,000 subjects failed to prove a definite association.[26] 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%. Several studies, including one published on 1 June 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.