The Official Patient's Sourcebook on Pancreatic Cancer: A Revised and Updated Directory for the Internet Age

THE OFFICIAL PATIENT’S SOURCEBOOK on ANCREATIC ANCER J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITO...

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THE OFFICIAL PATIENT’S SOURCEBOOK

on

ANCREATIC ANCER J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Pancreatic Cancer: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83468-7 1. Pancreatic Cancer-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.

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Dedication To the healthcare professionals dedicating their time and efforts to the study of pancreatic cancer.

Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to pancreatic cancer. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

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About ICON Health Publications In addition to pancreatic cancer, Official Patient’s Sourcebooks are available for the following related topics: ·

The Official Patient's Sourcebook on Adult Primary Liver Cancer

·

The Official Patient's Sourcebook on Anal Cancer

·

The Official Patient's Sourcebook on Colon Cancer

·

The Official Patient's Sourcebook on Esophageal Cancer

·

The Official Patient's Sourcebook on Extrahepatic Bile Duct Cancer

·

The Official Patient's Sourcebook on Gallbladder Cancer

·

The Official Patient's Sourcebook on Gastric Cancer

·

The Official Patient's Sourcebook on Gastrointestinal Carcinoid Tumor

·

The Official Patient's Sourcebook on Rectal Cancer

·

The Official Patient's Sourcebook on Small Intestine Cancer

To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

Contents vii

Table of Contents INTRODUCTION...................................................................................... 1

Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4

PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON PANCREATIC CANCER: GUIDELINES ............................................................................................................... 9

Overview............................................................................................................... 9 What Is Pancreatic Cancer? ............................................................................... 11 Stages of Pancreatic Cancer................................................................................ 15 Treatment Option Overview .............................................................................. 16 Treatment Options by Stage............................................................................... 19 To Learn More .................................................................................................... 21 About PDQ......................................................................................................... 22 More Guideline Sources ..................................................................................... 23 Vocabulary Builder............................................................................................. 27

CHAPTER 2. SEEKING GUIDANCE ....................................................... 33

Overview............................................................................................................. 33 Associations and Pancreatic Cancer................................................................... 33 Finding More Associations................................................................................. 37 Cancer Support Groups...................................................................................... 39 The Cancer Information Service ......................................................................... 41 Finding Cancer Resources in Your Community................................................ 43 Finding Doctors Who Specialize in Cancer Care ............................................... 47 Selecting Your Doctor ........................................................................................ 49 Working with Your Doctor ................................................................................ 51 Finding a Cancer Treatment Facility ................................................................. 52 Additional Cancer Support Information ............................................................ 54 Vocabulary Builder............................................................................................. 54

CHAPTER 3. CLINICAL TRIALS AND PANCREATIC CANCER .............. 57

Overview............................................................................................................. 57 Recent Trials on Pancreatic Cancer ................................................................... 60 Benefits and Risks............................................................................................... 90 Clinical Trials and Insurance Coverage ............................................................. 93 Clinical Trials and Medicare Coverage .............................................................. 96 Increasing the Likelihood of Insurance Coverage for Trials ............................... 97 If Your Insurance Claim Is Denied after the Trial Has Begun .......................... 99 Government Initiatives to Expand Insurance Coverage for Trials .................. 102 Keeping Current on Clinical Trials.................................................................. 103

viii Contents

General References............................................................................................ 104 Vocabulary Builder........................................................................................... 105

PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL................................................ 109 CHAPTER 4. STUDIES ON PANCREATIC CANCER .............................. 111

Overview........................................................................................................... 111 The Combined Health Information Database ................................................... 111 Federally Funded Research on Pancreatic Cancer............................................ 115 E-Journals: PubMed Central ............................................................................ 131 The National Library of Medicine: PubMed .................................................... 133 Vocabulary Builder........................................................................................... 152

CHAPTER 5. PATENTS ON PANCREATIC CANCER............................. 161

Overview........................................................................................................... 161 Patents on Pancreatic Cancer........................................................................... 162 Patent Applications on Pancreatic Cancer....................................................... 169 Keeping Current ............................................................................................... 172 Vocabulary Builder........................................................................................... 173

CHAPTER 6. BOOKS ON PANCREATIC CANCER ................................ 175

Overview........................................................................................................... 175 Book Summaries: Federal Agencies .................................................................. 175 The National Library of Medicine Book Index ................................................. 179 Chapters on Pancreatic Cancer......................................................................... 179 General Home References ................................................................................. 186 Vocabulary Builder........................................................................................... 187

CHAPTER 7. PERIODICALS AND NEWS ON PANCREATIC CANCER .. 193

Overview........................................................................................................... 193 News Services & Press Releases ....................................................................... 193 Newsletter Articles ........................................................................................... 204 Academic Periodicals Covering Pancreatic Cancer.......................................... 204 Vocabulary Builder........................................................................................... 207

CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES ................... 209

Overview........................................................................................................... 209 NIH Guidelines................................................................................................. 209 What Is Pancreatic Cancer? ............................................................................. 210 Cellular Classification ...................................................................................... 212 Stage Information ............................................................................................. 212 TNM Definitions.............................................................................................. 213 AJCC Stage Groupings..................................................................................... 214 Treatment Option Overview ............................................................................ 214 Stage I Pancreatic Cancer................................................................................. 215 Stage II Pancreatic Cancer ............................................................................... 218 Stage III Pancreatic Cancer .............................................................................. 220

Contents

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Stage IVA Pancreatic Cancer ........................................................................... 222 Stage IVB Pancreatic Cancer ........................................................................... 225 Recurrent Pancreatic Cancer............................................................................ 228 NIH Databases.................................................................................................. 229 Other Commercial Databases ........................................................................... 236 The Genome Project and Pancreatic Cancer .................................................... 236 Specialized References....................................................................................... 240 Vocabulary Builder........................................................................................... 241

CHAPTER 9. DISSERTATIONS ON PANCREATIC CANCER .................. 243

Overview........................................................................................................... 243 Dissertations on Pancreatic Cancer ................................................................. 243 Keeping Current ............................................................................................... 244 Vocabulary Builder........................................................................................... 244

PART III. APPENDICES .................................................. 245 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 247

Overview........................................................................................................... 247 Your Medications: The Basics .......................................................................... 248 Learning More about Your Medications .......................................................... 249 Commercial Databases...................................................................................... 250 Drug Development and Approval .................................................................... 251 Understanding the Approval Process for New Cancer Drugs......................... 252 The Role of the Federal Drug Administration (FDA)...................................... 253 Getting Drugs to Patients Who Need Them .................................................... 257 Contraindications and Interactions (Hidden Dangers) ................................... 259 A Final Warning .............................................................................................. 260 General References............................................................................................ 260

APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 263

Overview........................................................................................................... 263 What Is CAM? ................................................................................................. 264 What Are the Domains of Alternative Medicine?............................................ 265 Finding CAM References on Pancreatic Cancer.............................................. 270 Additional Web Resources................................................................................ 282 General References............................................................................................ 285 Vocabulary Builder........................................................................................... 286

APPENDIX C. RESEARCHING NUTRITION ......................................... 289

Overview........................................................................................................... 289 Food and Nutrition: General Principles........................................................... 290 Finding Studies on Pancreatic Cancer ............................................................. 294 Federal Resources on Nutrition........................................................................ 298 Additional Web Resources................................................................................ 299 Vocabulary Builder........................................................................................... 300

APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 303

Overview........................................................................................................... 303

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Contents

Preparation ....................................................................................................... 303 Finding a Local Medical Library ...................................................................... 304 Medical Libraries Open to the Public............................................................... 304

APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 311

Overview........................................................................................................... 311 Your Rights as a Patient................................................................................... 311 Patient Responsibilities .................................................................................... 315 Choosing an Insurance Plan............................................................................. 316 Medicare and Medicaid .................................................................................... 318 Financial Assistance for Cancer Care............................................................... 321 NORD’s Medication Assistance Programs ..................................................... 324 Additional Resources ........................................................................................ 325

ONLINE GLOSSARIES.................................................... 327 Online Dictionary Directories.......................................................................... 328

PANCREATIC CANCER GLOSSARY .......................... 329 General Dictionaries and Glossaries ................................................................ 353

INDEX................................................................................... 355

Introduction

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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3

Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 Adapted from the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2

2

Pancreatic Cancer

Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Pancreatic Cancer has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to pancreatic cancer, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on pancreatic cancer. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on pancreatic cancer should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate

Introduction

3

options is always up to the patient in consultation with their physician and healthcare providers.

Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching pancreatic cancer (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to pancreatic cancer. It also gives you sources of information that can help you find a doctor in your local area specializing in treating pancreatic cancer. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with pancreatic cancer. Part II moves on to advanced research dedicated to pancreatic cancer. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on pancreatic cancer. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with pancreatic cancer or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with pancreatic cancer. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with pancreatic cancer.

Scope While this sourcebook covers pancreatic cancer, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that pancreatic cancer is often considered a synonym or a condition closely related to the following: ·

Cancer Pancreas

·

Pancreatic Cancer

4

Pancreatic Cancer

For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to pancreatic cancer. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.

Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with pancreatic cancer will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with pancreatic cancer is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion.

Introduction

5

While we focus on the more scientific aspects of pancreatic cancer, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors

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PART I: THE ESSENTIALS

ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on pancreatic cancer. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of pancreatic cancer to you or even given you a pamphlet or brochure describing pancreatic cancer. Now you are searching for more indepth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.

Guidelines

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CHAPTER 1. THE ESSENTIALS ON PANCREATIC CANCER: GUIDELINES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines on pancreatic cancer. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on pancreatic cancer can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

The National Institutes of Health (NIH)4 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on pancreatic cancer. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.

4

Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.

10 Pancreatic Cancer

There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with pancreatic cancer and associated conditions: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html

·

National Cancer Institute (NCI); guidelines available at http://cancernet.nci.nih.gov/pdq/pdq_treatment.shtml

Among the above, the National Cancer Institute (NCI) is particularly noteworthy. The NCI coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients.5 Specifically, the Institute: ·

Supports and coordinates research projects conducted by universities, hospitals, research foundations, and businesses throughout this country and abroad through research grants and cooperative agreements.

·

Conducts research in its own laboratories and clinics.

·

Supports education and training in fundamental sciences and clinical disciplines for participation in basic and clinical research programs and treatment programs relating to cancer through career awards, training grants, and fellowships.

·

Supports research projects in cancer control.

·

Supports a national network of cancer centers.

·

Collaborates with voluntary organizations and other national and foreign institutions engaged in cancer research and training activities.

·

Encourages and coordinates cancer research by industrial concerns where such concerns evidence a particular capability for programmatic research.

·

Collects and disseminates information on cancer.

This paragraph has been adapted from the NCI: http://www.nci.nih.gov/. “Adapted” signifies that a passage has been reproduced exactly or slightly edited for this book. 5

Guidelines 11

·

Supports construction of laboratories, clinics, and related facilities necessary for cancer research through the award of construction grants.

The NCI, established under the National Cancer Act of 1937, is the Federal Government’s principal agency for cancer research and training. The National Cancer Act of 1971 broadened the scope and responsibilities of the NCI and created the National Cancer Program. Over the years, legislative amendments have maintained the NCI authorities and responsibilities and added new information dissemination mandates as well as a requirement to assess the incorporation of state-of-the-art cancer treatments into clinical practice. Information dissemination is made possible through the NCI Online at www.cancer.gov. Cancer.gov offers to the public and physicians up-to-date information on the latest cancer research, current and upcoming clinical trials, statistics, research programs, and research funding. The following patient guideline was recently published by the NCI on pancreatic cancer.

What Is Pancreatic Cancer?6 Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas. The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas lies behind the stomach and in front of the spine. The pancreas has two main jobs in the body: ·

To produce juices that help digest (break down) food.

·

To produce hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food.

The digestive juices are produced by exocrine pancreas cells and the hormones are produced by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells.

The following guidelines appeared on the NCI website on September 10, 2002. The text was last modified in September 2002. The text has been adapted for this sourcebook. 6


This summary provides information on exocrine pancreatic cancer. Refer to the PDQ summary on Islet Cell Carcinoma (Endocrine Pancreas) Treatment for information on endocrine pancreatic cancer.

Risk Factors Smoking and health history can affect the risk of developing pancreatic cancer. The following are possible risk factors for pancreatic cancer: ·

Smoking.

·

Long-standing diabetes.

·

Chronic pancreatitis.

·

Certain hereditary conditions such as hereditary pancreatitis, multiple endocrine neoplasia type 1 syndrome, hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome), von Hippel-Lindau syndrome, ataxia-telangiectasia, and the familial atypical mole melanoma syndrome. Signs and Symptoms

Possible signs of pancreatic cancer include jaundice, pain, and weight loss. These symptoms can be caused by pancreatic cancer or other conditions. A doctor should be consulted if any of the following problems occur: ·

Jaundice (yellowing of the skin and whites of the eyes).

·

Pain in the upper or middle abdomen and back.

·

Unexplained weight loss.

·

Loss of appetite.

·

Fatigue.

Detection and Diagnosis Pancreatic cancer is difficult to detect (find) and diagnose early. Pancreatic cancer is difficult to detect and diagnose for the following reasons: ·

There aren’t any noticeable signs or symptoms in the early stages of pancreatic cancer.

Guidelines 13

·

The signs of pancreatic cancer, when present, are like the signs of many other illnesses.

·

The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts. Diagnostic Testing

Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer. Pancreatic cancer is usually diagnosed with tests and procedures that produce pictures of the pancreas and the area around it. The process used to find out if cancer cells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose, and stage pancreatic cancer are usually done at the same time. In order to plan the best treatment, it is important to know the stage of the disease and whether or not the pancreatic cancer can be removed by surgery. The following tests and procedures may be used: ·

Chest x-ray: Brief exposure of the chest to radiation to produce an image of the chest and its internal structures.

·

Physical exam: A check of general signs of health, including looking for anything unusual such as lumps or growths.

·

CT scan (CAT scan): A CT scan creates a series of pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CT scan takes detailed pictures of areas inside the body as it scans the body in a spiral path.

·

MRI (magnetic resonance imaging): A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called nuclear magnetic resonance imaging (NMRI).

·

PET scan (positron emission tomography scan): A PET scan creates a picture showing the location of tumor cells in the body. A substance called radionuclide glucose (sugar) is injected into a vein and the PET scanner rotates around the body to create the picture. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.


·

Endoscopic ultrasound (EUS): A test that uses sound waves to create images of body tissues. High-energy sound waves are bounced off internal tissues and organs. The echoes are changed into pictures called sonograms. An endoscopic ultrasound uses an endoscope (a flexible tube inserted into the body).

·

Laparoscopy: A laparoscope (a thin, lighted tube) is inserted through an incision in the abdominal wall to determine if the cancer is within the pancreas only or has spread to nearby tissues and if it can be removed by surgery later. Tissue samples may be removed for biopsy.

·

ERCP (endoscopic retrograde cholangiopancreatography): A procedure to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Pancreatic cancer can cause these ducts to narrow and block or slow the flow of bile, causing jaundice. In ERCP, an endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a stent (a thin tube) may be inserted into the duct to unblock it. The stent may be left in place to keep the duct open. Tissue samples may also be taken with a fine needle or a brush like a pipecleaner.

·

PTC (percutaneous transhepatic cholangiography): A procedure to x-ray the liver and common bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and the ducts are then x-rayed to find the blockages. To relieve jaundice, a stent (a thin tube) is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done.

·

Biopsy: Cells, tissues, or fluid are removed and viewed under a microscope to see if cancer cells are present. There are several ways to do a biopsy for pancreatic cancer. A fine needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy (a surgical incision made in the wall of the abdomen).

Prognosis Certain factors affect treatment options and prognosis (chance of recovery).

Guidelines 15

The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (the size of the tumor and whether the cancer has spread outside the pancreas to nearby tissues or lymph nodes or to other places in the body) and the patient’s general health. Pancreatic cancer can be controlled only if it is found before it has spread, when it can be removed by surgery. If the cancer has spread, palliative treatment can improve the quality of life by controlling the symptoms and complications of this disease. Taking part in one of the clinical trials being done to improve treatment should be considered. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.

Stages of Pancreatic Cancer Tests and procedures to stage pancreatic cancer are usually done at the same time as diagnosis. The following stages are used for pancreatic cancer: Stage I: In stage I, cancer is found in the pancreas only.

Stage II In stage II, cancer has spread to nearby tissue and organs, such as bile ducts or the small intestine. Stage III In stage III, cancer has spread to lymph nodes near the pancreas and may have spread to nearby tissue and organs, such as bile ducts or the small intestine.


Stage IV In stage IV, cancer has spread to other parts of the body. Stage IV is divided into stage IVA and stage IVB, depending on where the cancer has spread. ·

Stage IVA: Cancer has spread to organs and tissues that are near the pancreas (such as the stomach, spleen, or colon), but has not spread to distant organs (such as the lungs). The cancer may have spread to lymph nodes near the pancreas.

·

Stage IVB: Cancer has spread to distant organs (such as the lungs). It may have also spread to organs and tissues near the pancreas or to lymph nodes.

Recurrent Pancreatic Cancer Recurrent pancreatic cancer is cancer that has recurred (come back) after it has been treated. Recurrent pancreatic cancer may come back in the pancreas or in other parts of the body.

Treatment Option Overview Different types of treatment are available for patients with pancreatic cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the “standard” treatment, the new treatment may become the standard treatment. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team. Three types of standard treatment are used: ·

Surgery

·

Radiation therapy

·

Chemotherapy

Guidelines 17

Biological therapy for pancreatic cancer is currently being tested in clinical trials.

Surgery One of the following types of surgery may be used to take out the tumor: ·

Whipple procedure: The head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin.

·

Total pancreatectomy: This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.

·

Distal pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed.

If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms: ·

Surgical biliary bypass: If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area.

·

Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.

·

Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally. Radiation Therapy

Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Both external and internal radiation therapy may be used to treat pancreatic cancer.


Chemotherapy Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Biological Therapy Is Being Tested in Clinical Trials Biological therapy is treatment to stimulate the ability of the immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.7 Treatments for Pain Pain can occur when the tumor presses on nerves or other organs near the pancreas. When pain medicine is not enough, there are treatments that act on nerves in the abdomen to relieve the pain. The doctor may inject medicine into the area around affected nerves or may cut the nerves to block the feeling of pain. Radiation therapy with or without chemotherapy can also help relieve pain by shrinking the tumor.

Patient Nutritional Needs Patients with pancreatic cancer have special nutritional needs. Surgery to remove the pancreas may interfere with the production of pancreatic enzymes that help to digest food. As a result, patients may have problems digesting food and absorbing nutrients into the body. To prevent malnutrition, the doctor may prescribe medicines that replace these enzymes.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site. 7

Guidelines 19

Treatment Options by Stage Stage I Pancreatic Cancer Treatment of stage I pancreatic cancer may include the following: ·

Surgery alone.

·

Surgery with chemotherapy and radiation therapy.

·

A clinical trial of surgery followed by radiation therapy with chemotherapy. Chemotherapy is given before, during, and after the radiation therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site. Stage II Pancreatic Cancer Treatment of stage II pancreatic cancer may include the following: ·

Surgery with or without chemotherapy and radiation therapy.

·

Radiation therapy with chemotherapy.

·

Palliative surgery to bypass blocked areas in ducts or the small intestine.

·


·

A clinical trial of radiation therapy combined with chemotherapy and/or radiosensitizers (drugs that make cancer cells more sensitive to radiation so more tumor cells are killed), followed by surgery.

·

A clinical trial of chemotherapy.

·

A clinical trial of radiation therapy given during surgery or internal radiation therapy. Stage III Pancreatic Cancer

Treatment of stage III pancreatic cancer may include the following: ·



·


·

Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.

·


·

A clinical trial of radiation therapy combined with chemotherapy and/or radiosensitizers, followed by surgery.

·


·

A clinical trial of radiation therapy given during surgery or internal radiation therapy.

Stage IVA Pancreatic Cancer Treatment of stage IVA pancreatic cancer may include the following: ·


·


·


·


·

A clinical trial of radiation therapy combined with chemotherapy and/or radiosensitizers, followed by surgery.

·


·

A clinical trial of radiation therapy given during surgery or internal radiation therapy.

Stage IVB Pancreatic Cancer Treatment of stage IVB pancreatic cancer may include the following: ·

Chemotherapy.

·

Palliative treatments for pain, such as nerve blocks, and other supportive care.

Guidelines 21

·


·

Clinical trials of chemotherapy or biological therapy.

Recurrent Pancreatic Cancer Treatment of recurrent pancreatic cancer may include the following: ·

Chemotherapy.

·

Palliative surgery to bypass blocked areas in ducts or the small intestine.

·

Palliative radiation therapy.

·

Other palliative medical care to reduce symptoms, such as nerve blocks to relieve pain.

·

Clinical trials of chemotherapy or biological therapy.

To Learn More Call For more information, U.S. residents may call the National Cancer Institute’s (NCI’s) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-4226237), Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-ofhearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Web Sites and Organizations The NCI’s Cancer.gov Web site (http://cancer.gov) provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.


Publications The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator (https://cissecure.nci.nih.gov/ncipubs). These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-8004-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp The NCI’s LiveHelp service, a program available on several of the Institute’s Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from Monday - Friday 9:00 AM - 10:00 PM Eastern Time. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write For more information from the NCI, please write to this address: National Cancer Institute Office of Communications 31 Center Drive, MSC 2580 Bethesda, MD 20892-2580

About PDQ PDQ Is a Comprehensive Cancer Database Available on Cancer.gov PDQ is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov (http://cancer.gov), the NCI’s Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government’s focal point for biomedical research.

Guidelines 23

PDQ Contains Cancer Information Summaries The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-tounderstand, non-technical language. Both versions provide current and accurate cancer information. The PDQ cancer information summaries are developed by cancer experts and reviewed regularly. Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary (“Date Last Modified”) indicates the time of the most recent change.

PDQ Contains Information on Clinical Trials Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Listings of clinical trials are included in PDQ and are available online at Cancer.gov (http://cancer.gov/clinical_trials). Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

More Guideline Sources The guideline above on pancreatic cancer is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you


find additional guidelines on topics related to pancreatic cancer. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with pancreatic cancer. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.

The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on pancreatic cancer and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·

Pancreas Disease. [Enfermedad del Pancreas] Source: Camp Hill, PA: Chek-Med Systems, Inc. 1996. 2 p.

Guidelines 25

Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011. (800) 451-5797. Fax (717) 761-0216. Price: $22 per pack of 50 pamphlets for order of 3-10 packs; 3 packet minimum. Discounts available for larger quantities and complete kits of gastroenterology pamphlets. Summary: This patient brochure, available in English and Spanish, provides information about various diseases of the pancreas. The characteristics of each of the five diseases of the pancreas are described: diabetes mellitus, acute pancreatitis, chronic pancreatitis, pancreatic deficiency, and pancreatic tumor. It is not known why insulin-producing cells in the pancreas die off, causing diabetes. Acute pancreatitis in which the pancreas becomes rapidly and severely inflamed is caused by heavy alcohol consumption, gallbladder disease, drugs, high blood fats, heredity, and other factors. It can be treated with hospitalization, bed rest, intravenous feeding, and use of certain medications which stop the pancreas from producing enzymes. Chronic pancreatitis occurs mostly in alcoholics. Pancreatic cancer is difficult to treat and requires early investigation. It is concluded that there are now effective ways to diagnose pancreatic conditions and, in most cases, good treatment programs can be outlined by the physician.

The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “pancreatic cancer” or synonyms. The following was recently posted: ·

Surgical treatment of pancreatic cancer. Source: Society for Surgery of the Alimentary Tract, Inc..; 1998 June 3 (revised 2000 Jan); 3 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1399&sSearch_string=pancreatic+cancer

Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at


http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·

Pancreatic Cancer (PDQ®): Treatment Summary: Up-to-date patient information about pancreatic cancer from the National Cancer Institute's (NCI) PDQ® database. Source: National Cancer Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=1972

The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to pancreatic cancer. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.

Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

·

drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html

·

Family Village: http://www.familyvillage.wisc.edu/specific.htm

·

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

·

Med Help International: http://www.medhelp.org/HealthTopics/A.html

·

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

Guidelines 27

·

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

·

WebMDÒHealth: http://my.webmd.com/health_topics

Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdomen: The part of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Ataxia: Loss of muscle coordination. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Bile: A fluid made by the liver and stored in the gallbladder. Bile is excreted into the small intestine where it helps digest fat. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH]

Biopsy: The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire tumor or lesion is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fineneedle aspiration. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from


the body. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Cholangiography: Roentgenography of the biliary ducts after administration or injection of a contrast medium, orally, intravenously or percutaneously. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] ERCP: Endoscopic retrograde cholangiopancreatography (en-do-SKAH-pik RET-ro-grade ko-LAN-jee-o-PAN-kree-a-TAW-gra-fee). A procedure to xray the bile and pancreatic ducts. In this procedure, a thin, lighted tube (endoscope) is passed through the mouth and down into the first part of the small intestine (duodenum). A smaller tube (catheter) is then inserted through the endoscope into the bile and pancreatic ducts. A dye is injected through the catheter into the ducts, and an x-ray is taken. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH] Exocrine: 1. secreting outwardly, via a duct;. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gastric: Having to do with the stomach. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucose: Sugar. [NIH] Heredity: 1. the genetic transmission of a particular quality or trait from

Guidelines 29

parent to offspring. 2. the genetic constitution of an individual. [EU] Hormones: Chemicals produced by glands in the body and circulated in the bloodstream. Hormones control the actions of certain cells or organs. [NIH] Immunotherapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also called biological therapy or biological response modifier (BRM) therapy. [NIH] Incision: A cut made in the body during surgery. [NIH] Insulin: A hormone made by the islet cells of the pancreas. Insulin controls the amount of sugar in the blood by moving it into the cells, where it can be used by the body for energy. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intravenous: IV. Into a vein. [NIH] Jaundice: A condition in which the skin and the whites of the eyes become yellow, urine darkens, and stool becomes clay colored. Jaundice occurs when the liver is not working properly or when a bile duct is blocked. [NIH] Laparoscopy: The insertion of a thin, lighted tube (called a laparoscope) through the abdominal wall to inspect the inside of the abdomen and remove tissue samples. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] MRI: Magnetic resonance imaging (mag-NET-ik REZ-o- nans IM-a-jing). A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Oncology: The study of cancer. [NIH] Palliative: 1. affording relief, but not cure. 2. an alleviating medicine. [EU] Pancreas: A glandular organ located in the abdomen. It makes pancreatic juices, which contain enzymes that aid in digestion, and it produces several hormones, including insulin. The pancreas is surrounded by the stomach,


intestines, and other organs. [NIH] Pancreatectomy: Surgery to remove the pancreas. In a total pancreatectomy, a portion of the stomach, the duodenum, common bile duct, gallbladder, spleen, and nearby lymph nodes also are removed. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] PTC: Percutaneous transhepatic cholangiography (per-kyoo-TAN-ee-us trans-heh-PAT-ik ko-LAN-jee-AH-gra-fee). A procedure to x-ray the bile ducts. In this procedure, a dye is injected through a thin needle inserted through the skin into the liver or the gallbladder, and an x-ray picture is taken. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiosensitizers: Drugs that make tumor cells more sensitive to radiation. [NIH]

Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Sonogram: A computer picture of areas inside the body created by bouncing sound waves off organs and other tissues. Also called ultrasonogram or ultrasound. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH]

Guidelines 31

Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Stomach: An organ that is part of the digestive system. It helps in the digestion of food by mixing it with digestive juices and churning it into a thin liquid. [NIH] Systemic: Affecting the entire body. [NIH] Telangiectasia: The permanent enlargement of blood vessels, causing redness in the skin or mucous membranes. [NIH] Tomography: A series of detailed pictures of areas inside the body; the pictures are created by a computer linked to an x-ray machine. [NIH]

Seeking Guidance 33

CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with pancreatic cancer. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with pancreatic cancer. The chapter ends with a discussion on how to find a doctor that is right for you.

Associations and Pancreatic Cancer As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8


influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·

Canadian Cancer Society Address: Canadian Cancer Society 10 Alcorn Avenue, Suite 200, Toronto, Ontario, M4V 3B1, Canada Telephone: (416) 961-7223 Toll-free: (888) 939-3333 Fax: (416) 961-4189 Email: [email protected] Web Site: http://www.cancer.ca/ Background: The Canadian Cancer Society (CCS) is a national, nonprofit, community-based organization that is dedicated to eradicating cancer and improving the quality of life of people living with cancer. Established in 1937, the Society currently has 350,000 volunteers, over 600 community locations, 10 provincial divisions, and one national office. The Canadian Cancer Society works to achieve its mission by promoting and supporting cancer research, educating the public, engaging in public policy advocacy efforts, and providing patient and family services. The Society is committed to funding medical research, awarding fellowships to support advanced clinical training in oncology, and funding behavioral research to help determine the best ways to promote lifestyle changes that may reduce the risk of cancer. The Society's public education programs work to promote the prevention and early detection of cancer by providing information and skill development through programs, advocacy, and collaboration. In addition, the Canadian Cancer Society works with coalitions of health, medical, research, and professional organizations to lobby Parliament and provincial legislatures concerning public policies that will promote health and prevent disease. The Society's patient services program is committed to meeting the social, emotional, informational, and spiritual needs of people with cancer and their families. Program services include the Society's Cancer Information Service, which provides affected individuals and family members with current information about all aspects of cancer;

Seeking Guidance 35

networking programs that enable individuals with cancer to communicate with trained volunteers who have also been affected by cancer; transportation to treatment centers and other practical assistance; and educational publications for affected individuals and family members. ·

CancerOnline Address: Telephone: (416) 961-7223 Toll-free: (888) 939-3333 Email: [email protected] Web Site: http://www.canceronline.org Background: CancerOnline is a nonprofit site on the Internet dedicated to providing individuals with cancer easy access to clinical information and offering extensive practical support and encouragement. CancerOnline collaborates with many different cancer care centers and organizations and provides original material contributed by cancer patients, caregivers, and cancer care specialists in private practice and a variety of cancer centers. CancerOnline's content is overseen by three advisory panels made up of oncologists, radiologists, and clinical care providers who want to help cancer patients become students of their disease; other cancer care specialists and providers of psychosocial support who want to encourage patients to participate actively in their treatment; and patients, survivors, and caregivers who want to help patients live with vitality and hope even in the face of a life-challenging illness. CancerOnline offers several major areas within its site including 'About CancerOnline,' 'Support and Encouragement,' 'Getting Information,' 'Participating in This Community,' and 'Special Features.' The site offers several sources of clinical information that can be accessed through a network of subject areas; practical advice before, during, and after treatment; stories from individuals who have triumphed over cancer; opportunities for affected individuals and families to contribute personal stories, creative expressions, commentaries, and questions; hints on how to obtain additional information on and off the Internet; dynamic linkage to additional web sites that provide information and support to those with particular types of cancer; and more. CancerOnline provides information and support to individuals with any type of cancer including Bladder Cancer, Breast Cancer, Colon and Rectal Cancer, Liver Cancer, Lymphoma, Ovarian Cancer, Prostate Cancer, Stomach Cancer, Uterine Cancer, Pediatric Cancers, Brain Tumors, Head and Neck Cancer, Leukemia, Lung Cancer, Melanoma, Pancreatic Cancer, Skin Cancer, Thyroid Cancer, and Rare Adult Cancers.


·

International Cancer Alliance for Research and Education Address: International Cancer Alliance for Research and Education 4853 Cordell Avenue, Suite 11, Bethesda, MD 20814 Telephone: (301) 654-7933 Toll-free: (800) 422-7361 Fax: (301) 654-8684 Email: [email protected] Web Site: http://icare.org Background: The International Cancer Alliance for Research and Education (ICARE) is a nonprofit organization that provides focused information to individuals affected by cancer and their physicians on an ongoing, person-to-person basis. Cancer is a general term referring to a group of diseases characterized by uncontrolled cellular growth that may invade surrounding tissues and spread (metastasize) to other bodily tissues or organs. The different cancers may be classified based upon the organ and cell type involved, the nature of the malignancy, and the disease's clinical course. ICARE has developed several patient-centered programs through a process of collection, evaluation, and dissemination of information, bringing affected individuals into contact with physicians and scientists from around the world. The Alliance is operated by a network of scientists, clinicians, staff members, and lay volunteers, many of whom are affected by cancer themselves. The Alliance maintains the ICARE Registry, a confidential membership listing that permits ongoing dialogue between ICARE and its network members. Registry members receive a 'cancer therapy review' including a description of the specific form of cancer in question, information concerning detection and staging procedures, an overview of current treatments, a bibliography for more in-depth research, and listings of diagnostic tests, ongoing clinical trials, and second opinion centers. Registry members also receive medical, research, clinical trial, and Food and Drug Administration (FDA) updates relating to the specific form of cancer or cancer in general; regular newsletters; and access to all ICARE programs. Such programs include ICARE patient education partner centers, which provide affected individuals with access to an electronic library of cancer information and online hook-ups at the community level; private electronic support groups for individuals dealing with common types of cancer or common issues; a clinical trial matching program; and other services. ICARE provides information concerning its mission, objectives, services, and programs on its web site on the Internet.

Seeking Guidance 37

·

OncoLink: The University of Pennsylvania Cancer Center Resource Address: The University of Pennsylvania Cancer Center Resource Web Site on the Internet, Telephone: (416) 961-7223 Toll-free: (888) 939-3333 Email: [email protected] Web Site: http://www.oncolin.upenn.edu Background: OncoLink is a multimedia oncology information resource on the World Wide Web on the Internet. OncoLink's mission 'is consistent with that of the University of Pennsylvania Medical Center and the University of Pennsylvania Cancer Center, which have sanctioned the site's use and development. OncoLink is accessible worldwide to anyone with Internet access, and there is no charge for its use. Oncolink has been established with the following objectives: (1) dissemination of information relevant to the field of oncology; (2) education of health care personnel; (3) education of affected individuals, families, and other interested parties; and (4) rapid collection of information pertinent to the specialty. OncoLink's home page includes the following headings: Disease Oriented Headings (i.e., specific types of cancer); Medical Specialty Oriented Menus (i.e., medical specialities that deal with cancer, chemotherapy information, etc.); Psychosocial Support and Personal Experiences; Cancer Causes, Screening, and Prevention; Clinical Trials; Global Resources for Cancer Information; Cancer FAQs (frequently asked questions); Medical Supportive Care for the Cancer Patient; Conferences and Meetings; and Financial Issues for Cancer Patients.

Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.

The National Cancer Institute (NCI) The National Cancer Institute (NCI) has complied a list of national organizations that offer services to people with cancer and their families. To view the list, see the NCI fact sheet online at the following Web address: http://cis.nci.nih.gov/fact/8_1.htm. The name of each organization is


accompanied by its contact information and a brief explanation of its services.

The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about pancreatic cancer. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “pancreatic cancer” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.

The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “pancreatic cancer”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “pancreatic cancer” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with pancreatic cancer. You should check back periodically with this database since it is updated every 3 months.

Seeking Guidance 39

The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “pancreatic cancer” (or a synonym) in the search box.

Cancer Support Groups10 People diagnosed with cancer and their families face many challenges that may leave them feeling overwhelmed, afraid, and alone. It can be difficult to cope with these challenges or to talk to even the most supportive family members and friends. Often, support groups can help people affected by cancer feel less alone and can improve their ability to deal with the uncertainties and challenges that cancer brings. Support groups give people who are affected by similar diseases an opportunity to meet and discuss ways to cope with the illness. How Can Support Groups Help? People who have been diagnosed with cancer sometimes find they need assistance coping with the emotional as well as the practical aspects of their disease. In fact, attention to the emotional burden of cancer is sometimes part of a patient’s treatment plan. Cancer support groups are designed to provide a confidential atmosphere where cancer patients or cancer survivors can discuss the challenges that accompany the illness with others who may have experienced the same challenges. For example, people gather to discuss the emotional needs created by cancer, to exchange information about their disease—including practical problems such as managing side effects or returning to work after treatment—and to share their feelings. Support groups have helped thousands of people cope with these and similar situations.

10

This section has been adapted from the NCI: http://cis.nci.nih.gov/fact/8_8.htm.


Can Family Members and Friends Participate in Support Groups? Family and friends are affected when cancer touches someone they love, and they may need help in dealing with stresses such as family disruptions, financial worries, and changing roles within relationships. To help meet these needs, some support groups are designed just for family members of people diagnosed with cancer; other groups encourage families and friends to participate along with the cancer patient or cancer survivor. How Can People Find Support Groups? Many organizations offer support groups for people diagnosed with cancer and their family members or friends. The NCI fact sheet National Organizations That Offer Services to People with Cancer and Their Families lists many cancer-concerned organizations that can provide information about support groups. This fact sheet is available at http://cis.nci.nih.gov/fact/8_1.htm on the Internet, or can be ordered from the Cancer Information Service at 1–800–4–CANCER (1–800–422–6237). Some of these organizations provide information on their Web sites about contacting support groups. Doctors, nurses, or hospital social workers who work with cancer patients may also have information about support groups, such as their location, size, type, and how often they meet. Most hospitals have social services departments that provide information about cancer support programs. Additionally, many newspapers carry a special health supplement containing information about where to find support groups.

What Types of Support Groups Are Available? Several kinds of support groups are available to meet the individual needs of people at all stages of cancer treatment, from diagnosis through follow-up care. Some groups are general cancer support groups, while more specialized groups may be for teens or young adults, for family members, or for people affected by a particular disease. Support groups may be led by a professional, such as a psychiatrist, psychologist, or social worker, or by cancer patients or survivors. In addition, support groups can vary in approach, size, and how often they meet. Many groups are free, but some require a fee (people can contact their health insurance company to find out whether their plan will cover the cost). It is important for people to find an atmosphere that is comfortable and meets their individual needs.

Seeking Guidance 41

Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.

The Cancer Information Service11 The Cancer Information Service (CIS) is a program of the National Cancer Institute (NCI), the Nation’s lead agency for cancer research. As a resource for information and education about cancer, the CIS is a leader in helping people become active participants in their own health care by providing the latest information on cancer in understandable language. Through its network of regional offices, the CIS serves the United States, Puerto Rico, the U.S. Virgin Islands, and the Pacific Islands. For 25 years, the Cancer Information Service has provided the latest and most accurate cancer information to patients and families, the public, and health professionals by: ·

Interacting with people one-on-one through its Information Service,

·

Working with organizations through its Partnership Program,

·

Participating in research efforts to find the best ways to help people adopt healthier behaviors,

·

Providing access to NCI information over the Internet. How Does the CIS Assist the Public?

Through the CIS toll-free telephone service (1–800–4–CANCER), callers speak with knowledgeable, caring staff who are experienced at explaining medical information in easy-to-understand terms. CIS information specialists answer calls in English and Spanish. They also provide cancer information to 11

This section has been adapted from the NCI: http://cis.nci.nih.gov/fact/2_5.htm.


deaf and hard of hearing callers through the toll-free TTY number (1–800– 332–8615). CIS staff have access to comprehensive, accurate information from the NCI on a range of cancer topics, including the most recent advances in cancer treatment. They take as much time as each caller needs, provide thorough and personalized attention, and keep all calls confidential. The CIS also provides live, online assistance to users of NCI Web sites through LiveHelp, an instant messaging service that is available from 9:00 a.m. to 7:30 p.m. Eastern time, Monday through Friday. Through LiveHelp, information specialists provide answers to questions about cancer and help in navigating Cancer.gov, the NCI’s Web site. Through the telephone numbers or LiveHelp service, CIS users receive: ·

Answers to their questions about cancer, including ways to prevent cancer, symptoms and risks, diagnosis, current treatments, and research studies;

·

Written materials from the NCI;

·

Referrals to clinical trials and cancer-related services, such as treatment centers, mammography facilities, or other cancer organizations;

·

Assistance in quitting smoking from information specialists trained in smoking cessation counseling. What Kind of Assistance Does the CIS Partnership Program Offer?

Through its Partnership Program, the CIS collaborates with established national, state, and regional organizations to reach minority and medically underserved audiences with cancer information. Partnership Program staff provide assistance to organizations developing programs that focus on breast and cervical cancer, clinical trials, tobacco control, and cancer awareness for special populations. To reach those in need, the CIS: ·

Helps bring cancer information to people who do not traditionally seek health information or who may have difficulties doing so because of educational, financial, cultural, or language barriers;

·

Provides expertise to organizations to help strengthen their ability to inform people they serve about cancer; and

·

Links organizations with similar goals and helps them plan and evaluate programs, develop coalitions, conduct training on cancer-related topics, and use NCI resources.

Seeking Guidance 43

How Do CIS Research Efforts Assist the Public? The CIS plays an important role in research by studying the most effective ways to communicate with people about healthy lifestyles; health risks; and options for preventing, diagnosing, and treating cancer. The ability to conduct health communications research is a unique aspect of the CIS. Results from these research studies can be applied to improving the way the CIS communicates about cancer and can help other programs communicate more effectively. How Do People Reach the Cancer Information Service? ·

To speak with a CIS information specialist call 1–800–4–CANCER (1–800– 422–6237), 9:00 a.m. to 4:30 p.m. local time, Monday through Friday. Deaf or hard of hearing callers with TTY equipment may call 1–800–332–8615.

·

To obtain online assistance visit the NCI’s Cancer Information Web site at http://cancer.gov/cancer_information and click on the LiveHelp link between 9:00 a.m. and 7:30 p.m. Eastern time, Monday through Friday.

·

For information 24 hours a day, 7 days a week call 1–800–4–CANCER and select option 4 to hear recorded information at any time.

·

Visit NCI’s Web site at http://cancer.gov on the Internet.

·

Visit the CIS Web site at http://cancer.gov/cis on the Internet.

Finding Cancer Resources in Your Community12 If you have cancer or are undergoing cancer treatment, there are places in your community to turn to for help. There are many local organizations throughout the country that offer a variety of practical and support services to people with cancer. However, people often don’t know about these services or are unable to find them. National cancer organizations can assist you in finding these resources, and there are a number of things you can do for yourself. Whether you are looking for a support group, counseling, advice, financial assistance, transportation to and from treatment, or information about cancer, most neighborhood organizations, local health care providers, or area hospitals are a good place to start. Often, the hardest part of looking for help is knowing the right questions to ask. 12

Adapted from the NCI: http://cis.nci.nih.gov/fact/8_9.htm.


What Kind of Help Can I Get? Until now, you probably never thought about the many issues and difficulties that arise with a diagnosis of cancer. There are support services to help you deal with almost any type of problem that might occur. The first step in finding the help you need is knowing what types of services are available. The following pages describe some of these services and how to find them. ·

Information on Cancer. Most national cancer organizations provide a range of information services, including materials on different types of cancer, treatments, and treatment-related issues.

·

Counseling. While some people are reluctant to seek counseling, studies show that having someone to talk to reduces stress and helps people both mentally and physically. Counseling can also provide emotional support to cancer patients and help them better understand their illness. Different types of counseling include individual, group, family, self-help (sometimes called peer counseling), bereavement, patient-to-patient, and sexuality.

·

Medical Treatment Decisions. Often, people with cancer need to make complicated medical decisions. Many organizations provide hospital and physician referrals for second opinions and information on clinical trials (research studies with people), which may expand treatment options.

·

Prevention and Early Detection. While cancer prevention may never be 100 percent effective, many things (such as quitting smoking and eating healthy foods) can greatly reduce a person’s risk for developing cancer. Prevention services usually focus on smoking cessation and nutrition. Early detection services, which are designed to detect cancer when a person has no symptoms of disease, can include referrals for screening mammograms, Pap tests, or prostate exams.

·

Home Health Care. Home health care assists patients who no longer need to stay in a hospital or nursing home, but still require professional medical help. Skilled nursing care, physical therapy, social work services, and nutrition counseling are all available at home.

·

Hospice Care. Hospice is care focused on the special needs of terminally ill cancer patients. Sometimes called palliative care, it centers around providing comfort, controlling physical symptoms, and giving emotional support to patients who can no longer benefit from curative treatment. Hospice programs provide services in various settings, including the patient’s home, hospice centers, hospitals, or skilled nursing facilities. Your doctor or social worker can provide a referral for these services.

Seeking Guidance 45

·

Rehabilitation. Rehabilitation services help people adjust to the effects of cancer and its treatment. Physical rehabilitation focuses on recovery from the physical effects of surgery or the side effects associated with chemotherapy. Occupational or vocational therapy helps people readjust to everyday routines, get back to work, or find employment.

·

Advocacy. Advocacy is a general term that refers to promoting or protecting the rights and interests of a certain group, such as cancer patients. Advocacy groups may offer services to assist with legal, ethical, medical, employment, legislative, or insurance issues, among others. For instance, if you feel your insurance company has not handled your claim fairly, you may want to advocate for a review of its decision.

·

Financial. Having cancer can be a tremendous financial burden to cancer patients and their families. There are programs sponsored by the government and nonprofit organizations to help cancer patients with problems related to medical billing, insurance coverage, and reimbursement issues. There are also sources for financial assistance, and ways to get help collecting entitlements from Medicaid, Medicare, and the Social Security Administration.

·

Housing/Lodging. Some organizations provide lodging for the family of a patient undergoing treatment, especially if it is a child who is ill and the parents are required to accompany the child to treatment.

·

Children’s Services. A number of organizations provide services for children with cancer, including summer camps, make-a-wish programs, and help for parents seeking child care. How to Find These Services

Often, the services that people with cancer are looking for are right in their own neighborhood or city. The following is a list of places where you can begin your search for help. ·

The hospital, clinic, or medical center where you see your doctor, received your diagnosis, or where you undergo treatment should be able to give you information. Your doctor or nurse may be able to tell you about your specific medical condition, pain management, rehabilitation services, home nursing, or hospice care.

·

Most hospitals also have a social work, home care, or discharge planning department. This department may be able to help you find a support group, a nonprofit agency that helps people who have cancer, or the government agencies that oversee Social Security, Medicare, and


Medicaid. While you are undergoing treatment, be sure to ask the hospital about transportation, practical assistance, or even temporary child care. Talk to a hospital financial counselor in the business office about developing a monthly payment plan if you need help with hospital expenses. ·

The public library is an excellent source of information, as are patient libraries at many cancer centers. A librarian can help you find books and articles through a literature search.

·

A local church, synagogue, YMCA or YWCA, or fraternal order may provide financial assistance, or may have volunteers who can help with transportation and home care. Catholic Charities, the United Way, or the American Red Cross may also operate local offices. Some of these organizations may provide home care, and the United Way’s information and referral service can refer you to an agency that provides financial help. To find the United Way serving your community, visit their online directory at http://www.unitedway.org on the Internet or look in the White Pages of your local telephone book.

·

Local or county government agencies may offer low-cost transportation (sometimes called para-transit) to individuals unable to use public transportation. Most states also have an Area Agency on Aging that offers low-cost services to people over 60. Your hospital or community social worker can direct you to government agencies for entitlements, including Social Security, state disability, Medicaid, income maintenance, and food stamps. (Keep in mind that most applications to entitlement programs take some time to process.) The Federal government also runs the Hill-Burton program (1–800–638–0742), which funds certain medical facilities and hospitals to provide cancer patients with free or low-cost care if they are in financial need. Getting the Most From a Service: What To Ask

No matter what type of help you are looking for, the only way to find resources to fit your needs is to ask the right questions. When you are calling an organization for information, it is important to think about what questions you are going to ask before you call. Many people find it helpful to write out their questions in advance, and to take notes during the call. Another good tip is to ask the name of the person with whom you are speaking in case you have follow-up questions. Below are some of the questions you may want to consider if you are calling or visiting a new agency and want to learn about how they can help:

Seeking Guidance 47

·

How do I apply [for this service]?

·

Are there eligibility requirements? What are they?

·

Is there an application process? How long will it take? What information will I need to complete the application process? Will I need anything else to get the service?

·

Do you have any other suggestions or ideas about where I can find help?

The most important thing to remember is that you will rarely receive help unless you ask for it. In fact, asking can be the hardest part of getting help. Don’t be afraid or ashamed to ask for assistance. Cancer is a very difficult disease, but there are people and services that can ease your burdens and help you focus on your treatment and recovery.

Finding Doctors Who Specialize in Cancer Care13 One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with pancreatic cancer must go through the process of selecting a physician. A common way to find a doctor who specializes in cancer care is to ask for a referral from your primary care physician. Sometimes, you may know a specialist yourself, or through the experience of a family member, coworker, or friend. The following resources may also be able to provide you with names of doctors who specialize in treating specific diseases or conditions. However, these resources may not have information about the quality of care that the doctors provide. ·

Your local hospital or its patient referral service may be able to provide you with a list of specialists who practice at that hospital.

·

Your nearest National Cancer Institute (NCI)-designated cancer center can provide information about doctors who practice at that center. The NCI fact sheet The National Cancer Institute Cancer Centers Program describes and gives contact information, including Web sites, for NCIdesignated cancer treatment centers around the country. Many of the cancer centers’ Web sites have searchable directories of physicians who practice at each facility. The NCI’s fact sheet is available at http://cis.nci.nih.gov/fact/1_2.htm on the Internet, or by calling the Cancer Information Service (CIS) at 1–800–4–CANCER (1–800–422–6237).

13

Adapted from the NCI: http://cis.nci.nih.gov/fact/7_47.htm.


·

The American Board of Medical Specialties (ABMS) publishes a list of board-certified physicians. The Official ABMS Directory of Board Certified Medical Specialists lists doctors’ names along with their specialty and their educational background. This resource is available in most public libraries. The ABMS also has a Web site that can be used to verify whether a specific physician is board-certified. This free service is located at http://www.abms.org/newsearch.asp on the Internet. Verification of a physician’s board certification can also be obtained by calling the ABMS at 1–866–275–2267 (1–866–ASK–ABMS).

·

The American Medical Association (AMA) provides an online service called AMA Physician Select that offers basic professional information on virtually every licensed physician in the United States and its possessions. The database can be searched by doctor’s name or by medical specialty. The AMA Physician Select service is located at http://www.ama-assn.org/aps/amahg.htm on the Internet.

·

The American Society of Clinical Oncologists (ASCO) provides an online list of doctors who are members of ASCO. The member database has the names and affiliations of over 15,000 oncologists worldwide. It can be searched by doctor’s name, institution’s name, location, and/or type of board certification. This service is located at http://www.asco.org/people/db/html/m_db.htm on the Internet.

·

The American College of Surgeons (ACOS) Fellowship Database is an online list of surgeons who are Fellows of the ACOS. The list can be searched by doctor’s name, geographic location, or medical specialty. This service is located at http://web.facs.org/acsdir/default.htm on the Internet. The ACOS can be contacted at 633 North Saint Clair Street, Chicago, IL 60611–3211; or by telephone at 312–202–5000.

·

Local medical societies may maintain lists of doctors in each specialty.

·

Public and medical libraries may have print directories of doctors’ names, listed geographically by specialty.

·

Your local Yellow Pages may have doctors listed by specialty under “Physicians.”

The Agency for Healthcare Research and Quality (AHRQ) offers Your Guide to Choosing Quality Health Care, which has information for consumers on choosing a health plan, a doctor, a hospital, or a long-term care provider. The Guide includes suggestions and checklists that you can use to determine which doctor or hospital is best for you. This resource is available at http://www.ahrq.gov/consumer/qntool.htm on the Internet. You can also

Seeking Guidance 49

order the Guide by calling the AHRQ Publications Clearinghouse at 1–800– 358–9295. If you are a member of a health insurance plan, your choice may be limited to doctors who participate in your plan. Your insurance company can provide you with a list of participating primary care doctors and specialists. It is important to ask your insurance company if the doctor you choose is accepting new patients through your health plan. You also have the option of seeing a doctor outside your health plan and paying the costs yourself. If you have a choice of health insurance plans, you may first wish to consider which doctor or doctors you would like to use, then choose a plan that includes your chosen physician(s). The National Comprehensive Cancer Network (NCCN) Physician Directory lists specialists who practice in the NCCN’s 19 member institutions across the U.S. To access the directory, go to http://www.nccn.org/ and click on “Physician Directory“. To use this service, you will be required to scroll to the bottom of the page and select “I agree.” Enter your search criteria and select “Find” at the bottom of the page. To obtain more information on a physician or institution, contact the institution’s Physician Referral Department or the NCCN Patient Information and Referral Service at 1-888909-NCCN or [email protected]. If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.

Selecting Your Doctor14 There are many factors to consider when choosing a doctor. To make the most informed decision, you may wish to speak with several doctors before choosing one. When you meet with each doctor, you might want to consider the following: ·

Does the doctor have the education and training to meet my needs?

·

Does the doctor use the hospital that I have chosen?

14 This

section has been adapted from the AHRQ: http://www.ahrq.gov/consumer/qntascii/qntdr.htm


·

Does the doctor listen to me and treat me with respect?

·

Does the doctor explain things clearly and encourage me to ask questions?

·

What are the doctor’s office hours?

·

Who covers for the doctor when he or she is unavailable? Will that person have access to my medical records?

·

How long does it take to get an appointment with the doctor?

If you are choosing a surgeon, you may wish to ask additional questions about the surgeon’s background and experience with specific procedures. These questions may include: ·

Is the surgeon board-certified?15

·

Has the surgeon been evaluated by a national professional association of surgeons, such as the American College of Surgeons (ACOS)?

·

At which treatment facility or facilities does the surgeon practice?

·

How often does the surgeon perform the type of surgery I need?

·

How many of these procedures has the surgeon performed? What was the success rate?

It is important for you to feel comfortable with the specialist that you choose, because you will be working closely with that person to make decisions about your cancer treatment. Trust your own observations and feelings when deciding on a doctor for your medical care. Other health professionals and support services may also be important during cancer treatment. The National Cancer Institute fact sheet Your Health Care Team: Your Doctor Is Only the Beginning has information about these providers and services, and how to locate them. This fact sheet is located at http://cis.nci.nih.gov/fact/8_10.htm on the Internet, or can be obtained by calling the CIS at 1–800–4–CANCER (1–800–422–6237).

While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 15

Seeking Guidance 51

Working with Your Doctor16 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·

You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.

·

It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.

·

Bring a “health history” list with you (and keep it up to date).

·

Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.

·

Tell your doctor about any natural or alternative medicines you are taking.

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Bring other medical information, such as x-ray films, test results, and medical records.

·

Ask questions. If you don’t, your doctor will assume that you understood everything that was said.

·

Write down your questions before your visit. List the most important ones first to make sure that they are addressed.

·

Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.

·

Ask your doctor to draw pictures if you think that this would help you understand.

·

Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.

·

Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.

·

Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.

This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.

16


·

After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.

By following these steps, you will enhance the relationship you will have with your physician.

Finding a Cancer Treatment Facility17 Choosing a treatment facility is another important consideration for getting the best medical care possible. Although you may not be able to choose which hospital treats you in an emergency, you can choose a facility for scheduled and ongoing care. If you have already found a doctor for your cancer treatment, you may need to choose a facility based on where your doctor practices. Your doctor may be able to recommend a facility that provides quality care to meet your needs. You may wish to ask the following questions when considering a treatment facility: ·

Has the facility had experience and success in treating my condition?

·

Has the facility been rated by state, consumer, or other groups for its quality of care?

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How does the facility check and work to improve its quality of care?

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Has the facility been approved by a nationally recognized accrediting body, such as the American College of Surgeons (ACOS) and/or the Joint Commission on Accredited Healthcare Organizations (JCAHO)?

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Does the facility explain patients’ rights and responsibilities? Are copies of this information available to patients?

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Does the treatment facility offer support services, such as social workers and resources to help me find financial assistance if I need it?

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Is the facility conveniently located?

If you are a member of a health insurance plan, your choice of treatment facilities may be limited to those that participate in your plan. Your Adapted from the NCI: http://cis.nci.nih.gov/fact/7_47.htm. At this Web site, information on how to find treatment facilities is also available for patients living outside the U.S. 17

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insurance company can provide you with a list of approved facilities. Although the costs of cancer treatment can be very high, you have the option of paying out-of-pocket if you want to use a treatment facility that is not covered by your insurance plan. If you are considering paying for treatment yourself, you may wish to discuss the potential costs with your doctor beforehand. You may also want to speak with the person who does the billing for the treatment facility. In some instances, nurses and social workers can provide you with more information about coverage, eligibility, and insurance issues. The following resources may help you find a hospital or treatment facility for your care: ·

The NCI fact sheet The National Cancer Institute Cancer Centers Program describes and gives contact information for NCI-designated cancer treatment centers around the country.

·

The ACOS accredits cancer programs at hospitals and other treatment facilities. More than 1,400 programs in the United States have been designated by the ACOS as Approved Cancer Programs. The ACOS Web site offers a searchable database of these programs at http://web.facs.org/cpm/default.htm on the Internet. The ACOS can be contacted at 633 North Saint Clair Street, Chicago, IL 60611–3211; or by telephone at 312–202–5000.

·

The JCAHO is an independent, not-for-profit organization that evaluates and accredits health care organizations and programs in the United States. It also offers information for the general public about choosing a treatment facility. The JCAHO Web site is located at http://www.jcaho.org on the Internet. The JCAHO is located at One Renaissance Boulevard, Oakbrook Terrace, IL 60181–4294. The telephone number is 630–792–5800.

·

The JCAHO offers an online Quality Check service that patients can use to determine whether a specific facility has been accredited by the JCAHO and view the organization’s performance reports. This service is located at http://www.jcaho.org/qualitycheck/directry/directry.asp on the Internet.

·

The AHRQ publication Your Guide To Choosing Quality Health Care has suggestions and checklists for choosing the treatment facility that is right for you.


Additional Cancer Support Information In addition to the references above, the NCI has set up guidance Web sites that offers information on issues relating to cancer. These include: ·

Facing Forward - A Guide for Cancer Survivors: http://www.cancer.gov/cancer_information/doc_img.aspx?viewid=cc93a 843-6fc0-409e-8798-5c65afc172fe

·

Taking Time: Support for People With Cancer and the People Who Care About Them: http://www.cancer.gov/cancer_information/doc_img.aspx?viewid=21a4 6445-a5c8-4fee-95a3-d9d0d665077a

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When Cancer Recurs: Meeting the Challenge: http://www.cancer.gov/cancer_information/doc_img.aspx?viewid=9e13 d0d2-b7de-4bd6-87da-5750300a0dab

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Your Health Care Team: Your Doctor Is Only the Beginning: http://cis.nci.nih.gov/fact/8_10.htm

Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Charities: Social welfare organizations with programs designed to assist individuals in times of need. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Lymphoma: Cancer that arises in cells of the lymphatic system. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mammogram: An x-ray of the breast. [NIH] Mammography: The use of x-rays to create a picture of the breast. [NIH]

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Metastasize: To spread from one part of the body to another. When cancer cells metastasize and form secondary tumors, the cells in the metastatic tumor are like those in the original (primary) tumor. [NIH] Oncologist: A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. [NIH] Pap test: The collection of cells from the cervix for examination under a microscope. It is used to detect changes that may be cancer or may lead to cancer, and can show noncancerous conditions, such as infection or inflammation. Also called a Pap smear. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH]

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CHAPTER 3. CLINICAL TRIALS AND PANCREATIC CANCER Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning pancreatic cancer.

What Is a Clinical Trial?18 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for pancreatic cancer is to try it on patients in a clinical trial.

The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.

18


What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·

Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.

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Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on pancreatic cancer.

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Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for pancreatic cancer compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?

Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on pancreatic cancer carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on pancreatic cancer. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham

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treatment.” This treatment, like a placebo, has no effect on pancreatic cancer and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how pancreatic cancer develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for pancreatic cancer. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo


surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.

Recent Trials on Pancreatic Cancer The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to pancreatic cancer.19 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·

A multicenter phase 2 study of CI-1040 in patients with advanced nonsmall-cell lung cancer, breast cancer, colon cancer, or pancreatic cancer Condition(s): Colorectal Neoplasms; Breast Neoplasms; Carcinoma, NonSmall-Cell Lung; Pancreatic Neoplasms Study Status: This study is currently recruiting patients. Sponsor(s): Pfizer Purpose - Excerpt: CI-1040 is an experimental drug that is being tested in patients who have advanced colorectal and lung cancer who failed no more than one prior chemotherapy regimen, breast cancer who have failed no more than 2 prior regimens and in patients with pancreatic cancer who have received no prior chemotherapy. CI-1040 is taken orally twice daily with meals. Patients are required to have blood tests periocally while receiving treatment and will be monitored closely throughout the trial for possible side effects and for response. Phase(s): Phase II

19

These are listed at www.ClinicalTrials.gov.

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Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00034827;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

A Study to Test the Effectiveness of Virulizin(r) Given in Combination with Standard Chemotherapy for Pancreatic Cancer Condition(s): Pancreatic Cancer Study Status: This study is currently recruiting patients. Sponsor(s): Lorus Therapeutics Purpose - Excerpt: Virulizin is an immunotherapy drug preparation that is thought to stimulate the patient's immmune system, which in turn may slow the growth of tumors. It is presented in vials as a sterile preparation for IM injection. The purpose of the trial is to investigate if Virulizin in combination with gemcitabine provides better efficacy than gemcitabine alone (with placebo) against pancreatic cancer.Virulizin(r) efficacy will continue to be assessed if chemotherapy is changed to 5-Fluorouracil. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00040092;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Acupuncture and Acupressure in Treating Patients With Moderate or Severe Pain Related to Stage III or Stage IV Pancreatic Cancer Condition(s): pain; recurrent pancreatic cancer; stage IVA pancreatic cancer; stage III pancreatic cancer; stage IVB pancreatic cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Memorial Sloan-Kettering Cancer Center Purpose - Excerpt: RATIONALE: Acupuncture and acupressure may help relieve moderate or severe pain associated with stage III or stage IV pancreatic cancer. PURPOSE: Phase II trial to study the effectiveness of acupuncture and accupressure in treating patients who have moderate or severe pain associated with stage III or stage IV pancreatic cancer. Phase(s): Phase II


Study Type: Supportive Care Contact(s): New York; Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, United States; Recruiting; Barrie R. Cassileth 212639-8629. Study chairs or principal investigators: Barrie R. Cassileth, Study Chair; Memorial Sloan-Kettering Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00040833;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Antineoplaston Therapy in Treating Patients With Stage IV Pancreatic Cancer Condition(s): recurrent pancreatic cancer; stage IVB pancreatic cancer; adenocarcinoma of the pancreas; stage IVA pancreatic cancer Study Status: This study is currently recruiting patients. Sponsor(s): Burzynski Research Institute Purpose - Excerpt: RATIONALE: Antineoplastons are naturally occurring substances found in urine. Antineoplastons may inhibit the growth of cancer cells. PURPOSE: Phase II trial to study the effectiveness of antineoplaston therapy in treating patients who have stage IV pancreatic cancer. Phase(s): Phase II Study Type: Treatment Contact(s): Texas; Burzynski Research Institute, Houston, Texas, 77055, United States; Recruiting; Stanislaw R. Burzynski 713-335-5697. Study chairs or principal investigators: Stanislaw R. Burzynski, Study Chair; Burzynski Research Institute Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003531;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Bevacizumab and Gemcitabine in Treating Patients With Advanced Pancreatic Cancer Condition(s): recurrent pancreatic cancer; stage IVA pancreatic cancer; stage III pancreatic cancer; stage IVB pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Chicago Cancer Research Center

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Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies such as bevacizumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Combining chemotherapy with monoclonal antibodies may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of combining gemcitabine with bevacizumab in treating patients who have advanced pancreatic cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00028834;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Capecitabine Combined with Cisplatin in Treating Patients With Locally Advanced or Metastatic Solid Tumors Condition(s): lung cancer; pancreatic cancer; gastric cancer; lip and oral cavity cancer; esophageal cancer; head and neck cancer; adult primary liver cancer; oropharyngeal cancer; breast cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Kaplan Cancer Center Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one chemotherapy drug may kill more tumor cells. PURPOSE: Phase I trial to study the effectiveness of capecitabine combined with cisplatin in treating patients who have locally advanced or metastatic solid tumors. Phase(s): Phase I Study Type: Treatment Contact(s): New York; NYU School of Medicine's Kaplan Comprehensive Cancer Center, New York, New York, 10016, United States; Recruiting; Franco M. Muggia 212-263-6485. Study chairs or principal investigators: Franco M. Muggia, Study Chair; Kaplan Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00010023;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843


·

CI-1040 in Treating Patients With Advanced Breast, Colon, Pancreatic, or Non-Small Cell Lung Cancer Condition(s): lung cancer; pancreatic cancer; colorectal cancer; colon cancer; breast cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); UAB Comprehensive Cancer Center Purpose - Excerpt: RATIONALE: CI-1040 may stop the growth of tumors by blocking the enzymes necessary for cancer cell growth and by stopping blood flow to the tumor. PURPOSE: Phase II trial to study the effectiveness of CI-1040 in treating patients who have metastatic or unresectable breast, colon, pancreatic, or non-small cell lung cancer. Phase(s): Phase II Study Type: Treatment Contact(s): Alabama; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, 35294-3300, United States; Recruiting; John Rinehart 205-934-2248. Study chairs or principal investigators: John Rinehart, Study Chair; UAB Comprehensive Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00033384;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Combination Chemotherapy and Radiation Therapy in Treating Patients With Pancreatic Cancer Condition(s): stage II pancreatic cancer; stage III pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Cancer and Leukemia Group B Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining chemotherapy with radiation therapy may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy and radiation therapy in treating patients who have locally advanced pancreatic cancer. Phase(s): Phase II Study Type: Treatment

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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00026130;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Combination Chemotherapy Followed by Chemotherapy and Radiation Therapy and/or Surgery in Treating Patients Who Have Pancreatic Cancer Condition(s): stage III pancreatic cancer; stage I pancreatic cancer; stage II pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Kaplan Cancer Center Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug with radiation therapy and/or surgery may kill more tumor cells. PURPOSE: Phase I/II trial to study the effectiveness of combination chemotherapy, consisting of gemcitabine and cisplatin, followed by chemotherapy and radiation therapy and/or surgery in treating patients who have pancreatic cancer. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): New York; NYU School of Medicine's Kaplan Comprehensive Cancer Center, New York, New York, 10016, United States; Recruiting; Howard S. Hochster 212-652-1912. Study chairs or principal investigators: Howard S. Hochster, Study Chair; Kaplan Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003332;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Combination Chemotherapy Plus Filgrastim in Treating Patients With Advanced Solid Tumors Condition(s): lung cancer; pancreatic cancer; gastric cancer; salivary gland cancer; lip and oral cavity cancer; adult soft tissue sarcoma; esophageal cancer; head and neck cancer; bone cancer; ovarian sarcoma; melanoma; ovarian epithelial cancer; bladder cancer; prostate cancer; Kaposi's sarcoma; oropharyngeal cancer; breast cancer; uterine sarcoma Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Norris Cotton Cancer Center


Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Colony-stimulating factors such as filgrastim may increase the number of immune cells found in bone marrow or peripheral blood and may help a person's immune system recover from the side effects of chemotherapy. PURPOSE: Phase I trial to study the effectiveness of combination chemotherapy plus filgrastim in treating patients who have advanced solid tumors. Phase(s): Phase I Study Type: Treatment Contact(s): New Hampshire; Norris Cotton Cancer Center, Lebanon, New Hampshire, 03756-0002, United States; Recruiting; James R. Rigas 603-650-6344. Study chairs or principal investigators: Konstantin H. Dragnev, Study Chair; Norris Cotton Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00014456;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Combination Chemotherapy Plus Radiation Therapy in Treating Patients With Advanced Pancreatic Cancer Condition(s): stage IVA pancreatic cancer; stage III pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); North Central Cancer Treatment Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining radiation therapy with chemotherapy may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy plus radiation therapy in treating patients who have locally advanced pancreatic cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00026403;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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·

Combination Chemotherapy Plus Radiation Therapy in Treating Patients With Locally Advanced Unresectable Pancreatic Cancer Condition(s): stage III pancreatic cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Comprehensive Cancer Center of Wake Forest University Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining radiation therapy with chemotherapy may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy and radiation therapy in treating patients who have locally advanced, unresectable pancreatic cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00025168;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Combination Chemotherapy Plus Radiation Therapy With or Without R115777 in Treating Patients With Locally Advanced Pancreatic Cancer Condition(s): stage II pancreatic cancer; stage III pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Radiation Therapy Oncology Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining chemotherapy plus radiation therapy with R115777 may be an effective treatment for pancreatic cancer. PURPOSE: Randomized phase II trial to compare the effectiveness of gemcitabine, paclitaxel, and radiation therapy with or without R115777 in treating patients who have locally advanced pancreatic cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below


Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00026104;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Cyclophosphamide Plus Vaccine Therapy in Treating Patients With Advanced Cancer Condition(s): lung cancer; brain tumor; melanoma; pancreatic cancer; breast cancer; renal cell cancer; colon cancer; colorectal cancer; kidney tumor Study Status: This study is currently recruiting patients. Sponsor(s): St. Vincent Medical Center - Los Angeles Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Vaccines made from a patient's tumor tissue may make the body build an immune response to kill tumor cells. Chemotherapy combined with vaccine therapy may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of cyclophosphamide plus tumor cell vaccine in treating patients who have metastatic cancer or cancer at high risk of recurrence. Phase(s): Phase II Study Type: Treatment Contact(s): California; St. Vincent Medical Center - Los Angeles, Los Angeles, California, 90057, United States; Recruiting; Charles L. Wiseman 213-484-7575. Study chairs or principal investigators: Charles L. Wiseman, Study Chair; St. Vincent Medical Center - Los Angeles Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002475;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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DHA-Paclitaxel in Treating Patients With Metastatic Pancreatic Cancer Condition(s): recurrent pancreatic cancer; stage IVA pancreatic cancer; stage IVB pancreatic cancer Study Status: This study is currently recruiting patients. Sponsor(s): Theradex Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. PURPOSE: Phase II trial to study the effectiveness of DHA-paclitaxel in treating patients who have metastatic pancreatic cancer. Phase(s): Phase II

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Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00024375;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Endoscopic Placement of Metal Stents in Treating Patients With Cancer- Related Duodenal Obstruction Condition(s): pancreatic cancer; gastric cancer; colorectal cancer; colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Robert H. Lurie Cancer Center Purpose - Excerpt: RATIONALE: The use of endoscopy to place metal stents in the duodenum is less invasive than surgery for treating cancerrelated duodenal obstruction and may have fewer side effects and improve recovery. PURPOSE: Phase I/II trial to study the effectiveness of endoscopic placement of metal stents in treating patients who have cancer-related obstruction of the duodenum. Phase(s): Phase I; Phase II Study Type: Supportive Care Contact(s): Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, 60611-3013, United States; Recruiting; Willis Parsons, III 312-695-4028. Study chairs or principal investigators: Willis Parsons, III, Study Chair; Robert H. Lurie Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004910;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Erlotinib Combined With Gemcitabine in Treating Patients With Newly Diagnosed Locally Advanced or Metastatic Pancreatic Cancer or Other Solid Tumors Condition(s): recurrent pancreatic cancer; stage II pancreatic cancer; stage IVA pancreatic cancer; unspecified adult solid tumor, protocol specific; stage III pancreatic cancer; stage IVB pancreatic cancer Study Status: This study is currently recruiting patients. Sponsor(s): OSI Pharmaceuticals


Purpose - Excerpt: RATIONALE: Erlotinib may interfere with the growth of tumor cells and slow the growth of the tumor. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining erlotinib with gemcitabine may kill more tumor cells. PURPOSE: Phase I trial to study the effectiveness of combining erlotinib with gemcitabine in treating patients who have newly diagnosed locally advanced or metastatic pancreatic cancer or other solid tumors. Phase(s): Phase I Study Type: Treatment Contact(s): Arizona; Arizona Cancer Center, Tucson, Arizona, 85724, United States; Recruiting; Tomislav Dragovich 520-626-7725; Texas; Cancer Therapy & Research Center, San Antonio, Texas, 78229, United States; Recruiting; Amita Patnaik 210-949-5069. Study chairs or principal investigators: Pedro Santabarbara, Study Chair; OSI Pharmaceuticals Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00033241;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Erlotinib in Treating Patients With Solid Tumors and Liver or Kidney Dysfunction Condition(s): lung cancer; pancreatic cancer; lip and oral cavity cancer; esophageal cancer; head and neck cancer; colorectal cancer; ovarian epithelial cancer; bladder cancer; colon cancer; prostate cancer; brain tumor; oropharyngeal cancer; rectal cancer; breast cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Cancer and Leukemia Group B Purpose - Excerpt: RATIONALE: Biological therapies such as erlotinib may interfere with the growth of tumor cells and slow the growth of the tumor. PURPOSE: Phase I trial to study the effectiveness of erlotinib in treating patients who have solid tumors and liver or kidney dysfunction. Phase(s): Phase I Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00030498;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Flavopiridol Plus Radiation Therapy Followed By Gemcitabine in Treating Patients With Pancreatic Cancer Condition(s): recurrent pancreatic cancer; stage II pancreatic cancer; stage IVA pancreatic cancer; stage III pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Memorial Sloan-Kettering Cancer Center Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Flavopiridol may make the tumor cells more sensitive to radiation therapy. PURPOSE: Phase I trial to study the effectiveness of combining flavopiridol with radiation therapy followed by gemcitabine in treating patients who have locally advanced, unresectable pancreatic cancer. Phase(s): Phase I Study Type: Treatment Contact(s): New York; Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, United States; Recruiting; Gary K. Schwartz 212639-8324. Study chairs or principal investigators: Gary K. Schwartz, Study Chair; Memorial Sloan-Kettering Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00047307;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Fluorouracil Plus Radiation Therapy Following Surgery in Treating Patients With Pancreatic Cancer Condition(s): stage I pancreatic cancer; stage II pancreatic cancer; stage IVA pancreatic cancer; stage III pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): GERCOR Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining chemotherapy with radiation therapy may kill more tumor cells left after surgery. PURPOSE: Phase II trial to study the effectiveness of combining fluorouracil and radiation therapy in treating patients who have undergone surgery for pancreatic cancer.


Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00010062;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Fluorouracil With or Without Cisplatin in Treating Patients With Advanced or Metastatic Cancer of the Pancreas Condition(s): stage III pancreatic cancer; stage IVB pancreatic cancer; adenocarcinoma of the pancreas; stage IVA pancreatic cancer Study Status: This study is currently recruiting patients. Sponsor(s): EORTC Chronotherapy Study Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug and giving drugs in different ways may kill more tumor cells. It is not yet known whether fluorouracil plus cisplatin are more effective than fluorouracil alone in treating patients with metastatic cancer of the pancreas. PURPOSE: Randomized phase III trial to compare the effectiveness of fluorouracil with or without cisplatin in treating patients with advanced or metastatic cancer of the pancreas. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003029;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Fluorouracil, Gemcitabine, and Radiation Therapy in Treating Patients With Cancer of the Pancreas Condition(s): stage III pancreatic cancer; stage I pancreatic cancer; stage II pancreatic cancer; adenocarcinoma of the pancreas; stage IVA pancreatic cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Eastern Cooperative Oncology Group; Southwest Oncology Group; Radiation Therapy Oncology Group

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Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining radiation therapy with chemotherapy may kill more tumor cells. It is not yet known which treatment regimen is most effective for pancreatic cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of fluorouracil and gemcitabine plus radiation therapy in treating patients with cancer of the pancreas who have undergone surgery. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003216;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Gemcitabine Alone or in Combination With Other Chemotherapy Drugs in Treating Patients With Metastatic Cancer of the Pancreas Condition(s): stage IVB pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Cancer and Leukemia Group B Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known if gemcitabine is more effective when given alone or in combination with another chemotherapy drug in treating cancer of the pancreas. PURPOSE: Randomized phase II trial to compare the effectiveness of gemcitabine given alone or in combination with other chemotherapy drugs in treating patients who have metastatic cancer of the pancreas. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00012220;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843


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Gemcitabine and Monoclonal Antibody Therapy in Treating Patients With Metastatic Cancer of the Pancreas Condition(s): recurrent pancreatic cancer; stage IVA pancreatic cancer; stage IVB pancreatic cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Brown University Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies such as trastuzumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Combining monoclonal antibody therapy with chemotherapy may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of gemcitabine and trastuzumab in treating patients who have metastatic cancer of the pancreas that overexpresses HER2/neu. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003797;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Gemcitabine and Radiation Therapy in Treating Patients With Cancer of the Pancreas Condition(s): stage I pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Comprehensive Cancer Center of Wake Forest University Purpose - Excerpt: RATIONALE: Radiation therapy uses high-energy xrays to damage tumor cells. Gemcitabine may make tumor cells more sensitive to radiation therapy. Combining chemotherapy with radiation therapy after surgery may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of combining gemcitabine with radiation therapy in treating patients who have undergone surgery to remove cancer of the pancreas. Phase(s): Phase II Study Type: Treatment

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Contact(s): North Carolina; Comprehensive Cancer Center at Wake Forest University, Winston-Salem, North Carolina, 27157-1082, United States; Recruiting; Arthur William Blackstock 336-716-4668. Study chairs or principal investigators: Arthur William Blackstock, Study Chair; Comprehensive Cancer Center of Wake Forest University Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00010166;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Gemcitabine Compared With Pancreatic Enzyme Therapy in Treating Patients Who Have Stage II, Stage III, or Stage IV Pancreatic Cancer Condition(s): stage II pancreatic cancer; stage III pancreatic cancer; stage IV pancreatic cancer; nutrition; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): Herbert Irving Comprehensive Cancer Center Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Pancreatic enzymes may help kill cancer cells. It is not yet known if gemcitabine is more effective than pancreatic enzyme therapy for pancreatic cancer. PURPOSE: Phase III trial to compare the effectiveness of gemcitabine with that of pancreatic enzyme therapy in treating patients who have stage II, stage III, or stage IV pancreatic cancer. Phase(s): Phase III Study Type: Supportive Care, Treatment Contact(s): New York; Herbert Irving Comprehensive Cancer Center, New York, New York, 10032, United States; Recruiting; Karen H. Antman 212-305-8602. Study chairs or principal investigators: John Chabot, Study Chair; Herbert Irving Comprehensive Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003851;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Gemcitabine With or Without Capecitabine in Treating Patients With Advanced Pancreatic Cancer Condition(s): recurrent pancreatic cancer; stage IVA pancreatic cancer; stage III pancreatic cancer; stage IVB pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients.


Sponsor(s): Swiss Institute for Applied Cancer Research; Central European Cooperative Oncology Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known if gemcitabine is more effective with or without capecitabine in treating pancreatic cancer. PURPOSE: Randomized phase III trial to determine the effectiveness of gemcitabine with or without capecitabine in treating patients who have advanced pancreatic cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00030732;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Gemcitabine With or Without Capecitabine in Treating Patients With Locally Advanced or Metastatic Pancreatic Cancer Condition(s): stage IVA pancreatic cancer; duct cell adenocarcinoma of the pancreas; stage III pancreatic cancer; stage IVB pancreatic cancer Study Status: This study is currently recruiting patients. Sponsor(s): Cancer Research UK, Trials Office Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known if gemcitabine is more effective with or without capecitabine in treating pancreatic cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of gemcitabine with or without capecitabine in treating patients who have locally advanced or metastatic pancreatic cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00032175;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Gemcitabine With or Without Erlotinib in Treating Patients With Unresectable Locally Advanced or Metastatic Pancreatic Cancer Condition(s): stage IVA pancreatic cancer; stage III pancreatic cancer; stage IVB pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): NCIC-Clinical Trials Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Biological therapies such as erlotinib use different ways to stimulate the immune system and stop cancer cells from growing. Combining chemotherapy and biological therapy may kill more tumor cells. It is not yet known if gemcitabine is more effective with or without erlotinib in treating pancreatic cancer. PURPOSE: Randomized phase III trial to determine the effectiveness of gemcitabine with and without erlotinib in treating patients who have unresectable locally advanced or metastatic pancreatic cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00026338;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Gemcitabine With or Without Exatecan Mesylate in Treating Patients With Locally Advanced or Metastatic Pancreatic Cancer Condition(s): stage IVA pancreatic cancer; stage III pancreatic cancer; stage IVB pancreatic cancer Study Status: This study is currently recruiting patients. Sponsor(s): Daiichi Pharmaceuticals Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known if gemcitabine is more effective with or without exatecan mesylate in treating pancreatic cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of gemcitabine alone to that of gemcitabine and exatecan mesylate in treating patients who have locally advanced or metastatic pancreatic cancer. Phase(s): Phase III Study Type: Treatment


Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023972;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Gemcitabine With or Without Virulizin in Treating Patients With Stage II, Stage III, or Stage IV Pancreatic Cancer Condition(s): recurrent pancreatic cancer; stage II pancreatic cancer; stage IVA pancreatic cancer; stage III pancreatic cancer; stage IVB pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): Lorus Therapeutics, Incorporated Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Biological therapies use different ways to stimulate the immune system and stop cancer cells from growing. It is not yet known whether chemotherapy is more effective with or without biological therapies in treating pancreatic cancer. PURPOSE: Phase III trial to compare the effectiveness of gemcitabine with or without Virulizin in treating patients who have stage II, stage III, or stage IV pancreatic cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00045409;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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LMB-9 Immunotoxin in Treating Patients With Advanced Colon, Breast, Non-small Cell Lung, Bladder, Pancreatic, or Ovarian Cancer Condition(s): lung cancer; pancreatic cancer; colorectal cancer; ovarian sarcoma; ovarian epithelial cancer; bladder cancer; colon cancer; breast cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Maryland Greenebaum Cancer Center Purpose - Excerpt: RATIONALE: The LMB-9 immunotoxin can locate tumor cells and kill them without harming normal cells. PURPOSE: Phase I trial to study the effectiveness of LMB-9 immunotoxin in treating

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patients who have advanced colon, breast, non-small cell lung, bladder, pancreatic, or ovarian cancer. Phase(s): Phase I Study Type: Treatment Contact(s): Maryland; Marlene & Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland, 21201, United States; Recruiting; Petr F. Hausner 410-328-2567; Warren Grant Magnuson Clinical Center - NCI Clinical Studies Support, Bethesda, Maryland, 20892-1182, United States; Recruiting; Patient Recruitment 1-888-NCI1937. Study chairs or principal investigators: Judith E. Karp, Study Chair; University of Maryland Greenebaum Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005858;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

LMB-9 Immunotoxin in Treating Patients With Advanced Pancreatic, Esophageal, Stomach, Colon, or Rectal Cancer Condition(s): pancreatic cancer; gastric cancer; esophageal cancer; colorectal cancer; colon cancer; rectal cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Freiburg Purpose - Excerpt: RATIONALE: LMB-9 immunotoxin can locate tumor cells and kill them without harming normal cells. This may be an effective treatment for advanced pancreatic, esophageal, stomach, colon or rectal cancer. PURPOSE: Phase I trial to study the effectiveness of LMB-9 immunotoxin in treating patients who have advanced pancreatic, esophageal, stomach, colon, or rectal cancer. Phase(s): Phase I Study Type: Treatment Contact(s): Germany; University of Freiburg Medical Center, Freiburg, D79106, Germany; Recruiting; Peter Hafkmeyer 011-49-761-2703401. Study chairs or principal investigators: Peter Hafkmeyer, Study Chair; University of Freiburg Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00010270;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843


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Octreotide as Palliative Therapy for Cancer-Related Bowel Obstruction That Cannot Be Removed by Surgery Condition(s): pancreatic cancer; gastric cancer; colorectal cancer; ovarian epithelial cancer; colon cancer; rectal cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Robert H. Lurie Cancer Center Purpose - Excerpt: RATIONALE: Palliative therapy with octreotide may help patients who have bowel obstruction that cannot be removed by surgery to live longer and more comfortably. PURPOSE: Phase II trial to study the effectiveness of octreotide as palliative therapy in treating patients who have cancer-related bowel obstruction that cannot be removed by surgery. Phase(s): Phase II Study Type: Supportive Care Contact(s): Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, 60611-3013, United States; Recruiting; J. Cameron Muir 312-908-5250. Study chairs or principal investigators: J. Cameron Muir, Study Chair; Robert H. Lurie Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004895;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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OSI-774 (Tarceva) Plus Gemcitabine in Patients with Locally Advanced, Unresectable or Metastatic Pancreatic Cancer. Condition(s): Pancreatic Cancer Study Status: This study is currently recruiting patients. Sponsor(s): OSI Pharmaceuticals; National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) Purpose - Excerpt: The purpose of this study is to determine if OSI-774 will improve overall survival when combined with a standard dose of the chemotherapy drug gemcitabine, to individuals with pancreatic cancer. OSI-774 is a new type of drug under evaluation, called an epidermal growth factor receptor (EGFR) inhibitor. OSI-774 is an investigational drug that has not yet been approved by the U.S. Food and Drug Administration (FDA). Gemcitabine has been approved by the FDA and is the standard therapy for most pancreatic cancers. Phase(s): Phase III

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Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00040183;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Paclitaxel and Bryostatin-1 in Treating Patients With Locally Advanced Unresectable or Metastatic Pancreatic Cancer Condition(s): recurrent pancreatic cancer; stage II pancreatic cancer; stage III pancreatic cancer; stage IV pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Albert Einstein Cancer Research Center Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Bryostatin-1 may help paclitaxel kill more cancer cells by making tumor cells more sensitive to the drug. PURPOSE: Phase II trial to study the effectiveness of combining paclitaxel and bryostatin-1 in treating patients who have locally advanced unresectable or metastatic pancreatic cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00031694;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Radiation Therapy Plus Chemotherapy in Treating Patients With Pancreatic Cancer Condition(s): stage III pancreatic cancer; stage I pancreatic cancer; stage II pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): Center for Molecular Medicine Purpose - Excerpt: RATIONALE: Radiation therapy uses high-energy xrays to damage tumor cells. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy combined with chemotherapy may kill more tumor


cells. PURPOSE: Phase II trial to study the effectiveness of brachytherapy followed by external-beam radiation therapy plus chemotherapy in treating patients who have pancreatic cancer that cannot be removed surgically. Phase(s): Phase II Study Type: Treatment Contact(s): Georgia; Piedmont Hospital, Inc., Atlanta, Georgia, 30309, United States; Recruiting; Gary B. Stillwagon 404-305-4580; New York; Center for Molecular Medicine, Garden City, New York, 11530, United States; Recruiting; Stanley E. Order 516-222-5190. Study chairs or principal investigators: Stanley E. Order, Study Chair; Center for Molecular Medicine Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002689;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Safety Study of 90Y-hMN14 to Treat Pancreatic Cancer Condition(s): Pancreatic Neoplasms Study Status: This study is currently recruiting patients. Sponsor(s): Immunomedics, Inc. Purpose - Excerpt: The purpose of this trial is to determine the safety of 90Y-hMN14 at different dose levels in the treatment of pancreatic cancer. Phase(s): Phase I; Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00041639;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Study of Combined RHUMAB VEGF and Capecitabine-based Chemoradiation for Patients with Locally Advanced Pancreatic Cancer Condition(s): Pancreatic Cancer Study Status: This study is currently recruiting patients. Sponsor(s): M.D. Anderson Cancer Center Purpose - Excerpt: The goal of this clinical research study is to find the highest safe dose of the drug Bevacizumab that can be given in combination with chemoradiation for the treatment of pancreatic cancer.

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The effect that this combination treatment has on the tumor will also be studied. Phase(s): Phase I Study Type: Interventional Contact(s): Texas; University of Texas MDAnderson Cancer Center, Houston, Texas, 77030, United States; Recruiting; Christopher Crane, MD 713-792-0782 [email protected]; Stephanie Price, RN 713-792-4594 [email protected]; Christopher Crane, MD, Principal Investigator Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00047710;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Surgery Followed by Radiation Therapy and Chemotherapy in Treating Patients With Cancer of the Pancreas Condition(s): stage III pancreatic cancer; stage I pancreatic cancer; stage II pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Mayo Clinic Cancer Center Purpose - Excerpt: RATIONALE: Surgery to remove the pancreas, some of the small intestine, and lymph nodes may be more effective treatment for cancer of the pancreas than surgery to remove the pancreas and some of the small intestine alone. Radiation therapy uses high-energy x-rays to damage tumor cells. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining surgery, radiation therapy, and chemotherapy may be an effective treatment for cancer of the pancreas. PURPOSE: Randomized phase III trial to compare the effectiveness of surgery to remove the pancreas and a portion of the small intestine with or without removing lymph nodes, followed by radiation therapy and chemotherapy, in treating patients with cancer of the pancreas. Phase(s): Phase III Study Type: Treatment Contact(s): Minnesota; Mayo Clinic Cancer Center, Rochester, Minnesota, 55905, United States; Recruiting; Randall K. Pearson 507-284-2478. Study chairs or principal investigators: Randall K. Pearson, Study Chair; Mayo Clinic Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003049;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843


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Triacetyluridine and Fluorouracil Compared With Gemcitabine in Treating Patients With Unresectable, Locally Advanced, or Metastatic Pancreatic Cancer Condition(s): recurrent pancreatic cancer; stage II pancreatic cancer; drug toxicity; stage IVA pancreatic cancer; stage III pancreatic cancer; stage IVB pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): Wellstat Therapeutics Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving the drugs in different combinations may kill more tumor cells. Chemoprotective drugs such as triacetyluridine may protect normal cells from the side effects of chemotherapy. It is not yet known which chemotherapy regimen is more effective in treating pancreatic cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of fluorouracil plus triacetyluridine with that of gemcitabine in treating patients who have locally advanced or metastatic pancreatic cancer that cannot be treated with surgery. Phase(s): Phase III Study Type: Supportive Care, Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00024427;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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UCN-01 and Fluorouracil in Treating Patients With Metastatic Pancreatic Cancer Condition(s): recurrent pancreatic cancer; stage IVB pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Memorial Sloan-Kettering Cancer Center Purpose - Excerpt: RATIONALE: UCN-01 may stop the growth of tumor cells by blocking the enzymes necessary for tumor cell growth. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining UCN-01 with chemotherapy may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of combining UCN-01 with fluorouracil in

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treating patients who have metastatic pancreatic cancer that has not responded to treatment with gemcitabine. Phase(s): Phase II Study Type: Treatment Contact(s): New York; Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, United States; Recruiting; Gary K. Schwartz 212639-8324. Study chairs or principal investigators: Gary K. Schwartz, Study Chair; Memorial Sloan-Kettering Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00045747;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

UCN-01 and Gemcitabine in Treating Patients With Unresectable or Metastatic Pancreatic Cancer Condition(s): recurrent pancreatic cancer; stage II pancreatic cancer; stage IVA pancreatic cancer; stage III pancreatic cancer; stage IVB pancreatic cancer; adenocarcinoma of the pancreas Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); M.D. Anderson Cancer Center Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. UCN-01 may help gemcitabine kill more cancer cells by making tumor cells more sensitive to the drug. PURPOSE: Phase I trial to study the effectiveness of combining UCN-01 with gemcitabine in treating patients who have unresectable or metastatic pancreatic cancer. Phase(s): Phase I Study Type: Treatment Contact(s): Texas; University of Texas - MD Anderson Cancer Center, Houston, Texas, 77030-4009, United States; Recruiting; Linus Ho 713-7922174. Study chairs or principal investigators: Linus Ho, Study Chair; M.D. Anderson Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00039403;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843


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UCN-01 and Irinotecan in Treating Patients With Advanced Solid Tumors Condition(s): lung cancer; pancreatic cancer; gastric cancer; esophageal cancer; colorectal cancer; adult primary liver cancer; ovarian epithelial cancer; colon cancer; rectal cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Sidney Kimmel Cancer Center Purpose - Excerpt: RATIONALE: UCN-01 may stop the growth of tumor cells by blocking the enzymes necessary for tumor cell growth. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining UCN-01 with chemotherapy may kill more tumor cells. PURPOSE: Phase I trial to study the effectiveness of combining UCN-01 with irinotecan in treating patients who have advanced solid tumors. Phase(s): Phase I Study Type: Treatment Contact(s): Maryland; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, 21231-2410, United States; Recruiting; Ross C. Donehower 410-955-8838. Study chairs or principal investigators: Ross C. Donehower, Study Chair; Sidney Kimmel Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00047242;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Vaccine Therapy in Gastrointestinal Tract

Treating

Patients

With

Cancer

of

the

Condition(s): pancreatic cancer; gastric cancer; esophageal cancer; colorectal cancer; colon cancer; rectal cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Texas Purpose - Excerpt: RATIONALE: Vaccines may make the body build an immune response to kill tumor cells. PURPOSE: Randomized phase II trial to compare the effectiveness of two different vaccines in treating patients who have cancer of the gastrointestinal tract. Phase(s): Phase II Study Type: Treatment

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Contact(s): Texas; University of Texas Medical Branch, Galveston, Texas, 77555-0209, United States; Recruiting; Robert P. Whitehead 409-772-1164. Study chairs or principal investigators: Robert P. Whitehead, Study Chair; University of Texas Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00012246;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Vaccine Therapy With or Without Sargramostim in Treating Patients With Advanced or Metastatic Cancer Condition(s): lung cancer; pancreatic cancer; gastric cancer; salivary gland cancer; head and neck cancer; colorectal cancer; adult primary liver cancer; testicular cancer; ovarian epithelial cancer; colon cancer; thyroid cancer; rectal cancer; breast cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Fox Chase Cancer Center Purpose - Excerpt: RATIONALE: Vaccines may make the body build an immune response to kill tumor cells. Colony-stimulating factors such as sargramostim may increase the number of immune cells found in bone marrow or peripheral blood. Combining vaccine therapy with sargramostim may make tumor cells more sensitive to the vaccine and may kill more tumor cells. PURPOSE: Phase I trial to study the effectiveness of vaccine therapy with or without sargramostim in treating patients who have advanced or metastatic cancer. Phase(s): Phase I Study Type: Treatment Contact(s): Pennsylvania; Fox Chase Cancer Center, Philadelphia, Pennsylvania, 19111, United States; Recruiting; Margaret von Mehren 215-728-3545. Study chairs or principal investigators: Margaret von Mehren, Study Chair; Fox Chase Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00028496;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

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Gemcitabine With or Without Dalteparin in Treating Patients With Unresectable or Metastatic Pancreatic Cancer Condition(s): recurrent pancreatic cancer; thromboembolism; stage IVA pancreatic cancer; stage III pancreatic cancer; stage IVB pancreatic cancer; quality of life; adenocarcinoma of the pancreas


Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Cancer Institute (NCI); University of Rochester Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Anticoagulants such as dalteparin may help prevent blood clots in patients being treated with gemcitabine for unresectable or metastatic pancreatic cancer. PURPOSE: Randomized phase III trial to determine the effectiveness of gemcitabine with or without dalteparin in treating patients who have unresectable or metastatic pancreatic cancer. Phase(s): Phase III Study Type: Supportive Care, Treatment Contact(s): Kishan J. Pandya 716-275-9319. Study chairs or principal investigators: Kishan J. Pandya, Study Chair; University of Rochester Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00031837;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Intraperitoneal and Intravenous Gemcitabine, Radiotherapy and Surgery for Advanced Cancer of the Pancreas Condition(s): Pancreatic Cancer Study Status: This study is completed. Sponsor(s): National Cancer Institute (NCI) Purpose - Excerpt: This study will determine the safety and effectiveness of treating advanced cancer of the pancreas with the anticancer drug gemcitabine given directly into the abdomen (intraperitoneally) and then through a vein (intravenously) along with radiation therapy. Patients 18 years of age or older with pancreatic cancer that has not spread beyond the abdomen may be eligible for this study. Candidates will have a physical examination, chest X-ray, blood tests, electrocardiogram, computed tomography (CT) scan of the chest, abdomen and pelvis, and will fill out a quality of life questionnaire. Participants will have a laparoscopy. Done under general anesthesia, this procedure involves inserting a laparoscope-a thin, flexible tube with a light and special fibers at the end-into the abdomen through a small incision. Through this device, the surgeon can see the tumor and remove a piece of it for microscopic examination. During the laparoscopy, a special tube called a Tenckhoff catheter will be placed in the abdomen, and one end will come out through the skin after the incision is closed. Chemotherapy will be delivered directly into the abdomen through this catheter. Patients will then undergo the following procedures: Intraperitoneal gemcitabine.

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Patients will be given gemcitabine, mixed with a warm fluid, directly into the abdomen through the Tenckhoff catheter. After 6 hours, any fluid that has not been absorbed will be removed and another dose will be administered. This treatment will be repeated every 6 hours for 24 hours. During the treatment, samples of blood and of fluid from the abdomen will be taken to measure levels of the drug. Patients will remain in the hospital 48 to 72 hours. Chemotherapy and radiation therapy. About 1 to 3 weeks after the intraperitoneal gemcitabine treatment, patients will have 2 days of intravenous gemcitabine (in 30- to 60-minute infusions) followed by 5 days of radiation therapy. This 7-day treatment cycle will be repeated weekly for 6 weeks. Surgery. About 6 weeks after completing the intraperitoneal and intravenous gemcitabine therapy, patients will have their tumors evaluated to determine the response to treatment. Those whose tumors remained stable or shrunk will undergo surgery to remove them. Patients whose tumors did not respond will be taken off the study. Repeat intraperitoneal gemcitabine. Patients whose tumors outside the pancreas (as well as tumors within the pancreas, if possible) are successfully removed will receive 2 more cycles of intraperitoneal gemcitabine 1 to 3 weeks after the surgery. All other patients will be taken off the study. Maintenance chemotherapy. About 3 weeks after the repeat peritoneal gemcitabine, patients will receive intravenous gemcitabine over 30 minutes every week for 3 weeks followed by 1 week of rest. Another anticancer drug called 5-fluorouracil (5-FU) will be given continuously through the IV catheter via a portable pump carried like a "fanny pack" or over the shoulder. Treatment may continue for up to 6 months. Tumor response will be evaluated very 3 months during treatment, then every 3 months for the first year after treatment, every 4 months during the second year, and then every 6 months for a total of 5 years of follow-up. Phase(s): Phase II Study Type: Interventional Contact(s): Maryland; National Cancer Institute (NCI), 9000 Rockville Pike Bethesda, Maryland, 20892, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00006288;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843 ·

Irinotecan and Docetaxel With or Without Cetuximab in Treating Patients With Metastatic Pancreatic Cancer Condition(s): stage IVA pancreatic cancer; stage IVB pancreatic cancer; adenocarcinoma of the pancreas


Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Cancer Institute (NCI); Eastern Cooperative Oncology Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies such as cetuximab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Combining chemotherapy with cetuximab may kill more tumor cells. PURPOSE: Randomized phase II trial to study the effectiveness of combining irinotecan and docetaxel with or without cetuximab in treating patients who have metastatic pancreatic cancer. Phase(s): Phase II Study Type: Treatment Contact(s): Robert L. Comis 215-789-3609. Study chairs or principal investigators: Robert L. Comis, Study Chair; Eastern Cooperative Oncology Group Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00042939;jsessionid=7B189A B9F4166C46A1FF8089EB9FB843

Benefits and Risks20 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·

A new treatment could be more effective than the current treatment for pancreatic cancer. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.

·

If the treatment is effective, then it may improve health or prevent diseases or disorders.

This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 20

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·

Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.

·

People who take part in trials contribute to scientific discoveries that may help other people with pancreatic cancer. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent

Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient. What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.


What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·

Information on all known risks and benefits of the treatments in the study.

·

Know how the researchers plan to carry out the study, for how long, and where.

·

Know what is expected of you.

·

Know any costs involved for you or your insurance provider.

·

Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.

·

Talk openly with doctors and ask any questions.

After you join a clinical trial, you have the right to: ·

Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.

·

Receive any new information about the new treatment.

·

Continue to ask questions and get answers.

·

Maintain your privacy. Your name will not appear in any reports based on the study.

·

Know whether you participated in the treatment group or the control group (once the study has been completed).

What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·

What is the purpose of the clinical trial?

·

What are the standard treatments for pancreatic cancer? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?

·

What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?

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·

How long will the treatment last? How often will I have to come back for follow-up exams?

·

What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?

·

Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?

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How will my health be monitored?

·

Where will I need to go for the clinical trial? How will I get there?

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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?

·

Will I be able to see my own doctor? Who will be in charge of my care?

·

Will taking part in the study affect my daily life? Do I have time to participate?

·

How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?

Clinical Trials and Insurance Coverage21 As you consider enrolling in a clinical trial, you will face the critical issue of how to cover the costs of care. Even if you have health insurance, your coverage may not include some or all of the patient care costs associated with a clinical trial. This is because some health plans define clinical trials as “experimental” or “investigational” procedures. Because lack of coverage for these costs can keep people from enrolling in trials, the National Cancer Institute is working with major health plans and managed care groups to find solutions. In the meantime, there are strategies that may help you deal with cost and coverage barriers. This section answers frequently asked questions about insurance coverage for clinical trial participation and directs you to additional information resources. The material here is mainly concerned with treatment clinical trials, since other types of trials (prevention, screening, etc.) are newer and generally not covered by health insurance at all. However, this guide may become more Adapted from the NCI: http://www.cancer.gov/clinical_trials/doc_header.aspx?viewid=1d92be79-8748-4bda-80052a56d332463b.

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relevant for prevention and other types of trials as these trials grow more common. If you do not have any health insurance, you may find this section helpful for understanding some of the costs that trials involve.

What Costs Do Trials Involve? Who Is Usually Responsible for Paying Them? There are two types of costs associated with a trial: patient care costs and research costs. Patient care costs fall into two categories: ·

Usual care costs, such as doctor visits, hospital stays, clinical laboratory tests, x-rays, etc., which occur whether you are participating in a trial or receiving standard treatment. These costs have usually been covered by a third-party health plan, such as Medicare or private insurance.

·

Extra care costs associated with clinical trial participation, such as the additional tests that may or may not be fully covered by the clinical trial sponsor and/or research institution.

The sponsor and the participant’s health plan need to resolve coverage of these costs for particular trials. Research costs are those associated with conducting the trial, such as data collection and management, research physician and nurse time, analysis of results, and tests purely performed for research purposes. Such costs are usually covered by the sponsoring organization, such as NCI or a pharmaceutical company.

Criteria Used by Health Plans to Make Reimbursement Decisions about Trials Health insurance companies and managed care companies decide which health care services they will pay for by developing coverage policy regarding the specific services. In general, the most important factor determining whether something is covered is a health plan’s judgment as to whether the service is established or investigational. Health plans usually designate a service as established if there is a certain amount of scientific data to show that it is safe and effective. If the health plan does not think that

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such data exist in sufficient quantity, the plan may label the service as investigational. Health care services delivered within the setting of a clinical trial are very often categorized as investigational and not covered. This is because the health plan thinks that the major reason to perform the clinical trial is that there is not enough data to establish the safety and effectiveness of the service being studied. Thus, for some health plans, any mention of the fact that the patient is involved in a clinical trial results in a denial of payment. Your health plan may define specific criteria that a trial must meet before extending coverage, such as the following:

Sponsorship Some plans may only cover costs of trials sponsored by organizations whose review and oversight of the trial is careful and scientifically rigorous, according to standards set by the health plan.

Trial Phase and Type Some plans may cover patient care costs only for the clinical trials they judge to be “medically necessary” on a case-by-case basis. Trial phase may also affect coverage; for example, while a plan may be willing to cover costs associated with Phase III trials, which include treatments that have already been successful with a certain number of people, the plan may require some documentation of effectiveness before covering a Phase I or II trial. While health plans are interested in efforts to improve prevention and screening, they currently seem less likely to have a review process in place for these trials. Therefore, it may be more difficult to get coverage for the care costs associated with them. Some plans, especially smaller ones, will not cover any costs associated with a clinical trial. Policies vary widely, but in most cases your best bet is to have your doctor initiate discussions with the health plan.


Cost “Neutrality” Some health plans may limit coverage to trials they consider cost-neutral (i.e., not significantly more expensive than the treatments considered standard). Lack of Standard Therapy Some plans limit coverage of trials to situations in which no standard therapy is available. Facility and Personnel Qualifications A health plan may require that the facility and medical staff meet specific qualifications to conduct a trial involving unique services, especially intensive therapy such as a bone marrow transplant (high-dose chemotherapy with bone marrow/ stem cell rescue).

Clinical Trials and Medicare Coverage For up-to-date information about Medicare coverage of clinical trials, go to the Web site for the Centers for Medicaid & Medicare (http://www.hcfa.gov/coverage/8d.htm; formerly the Health Care Financing Administration). As of January 2001, the following information was accurate22:

What Will Medicare Pay? ·

Anything normally covered is still covered when it is part of a clinical trial. This includes test, procedures, and doctor visits that are ordinarily covered.

·

Anything normally covered even if it is a service or item associated with the experimental treatment. For example, Medicare will pay for the

On June 7, 2000, Present Clinton announced that Medicare would revise its payment policy to reimburse the routine patient care costs of clinical trials. The announcement is available for public viewing at the following Web address: http://www.cancer.gov/clinical_trials/doc.aspx?viewid=320DD013-BA7A-4177-A0002011089F34A0.

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intravenous administration of a new chemotherapy drug being tested in a trial, including any therapy to prevent side effects from the new drug. ·

Anything normally covered even if it resulted from your being in the clinical trial. For example, a test or hospitalization resulting from a side effect of the new treatment that Medicare would ordinarily cover. What Costs Are Not Covered?

·

Investigational items or services being tested in a trial. Sponsors of clinical trials often provide the new drug free, but make sure you ask your doctor before you begin.

·

Items or services used solely for the data collection needs of the trial.

·

Anything being provided free by the sponsor of the trial. What Kinds of Clinical Trials Are Covered?

NCI’s Cancer Information Service has provided a fact sheet for Medicare beneficiaries at the following Web site: http://cis.nci.nih.gov/fact/8_14.htm. In general, cancer treatment and diagnosis trials are covered if: ·

They are funded by the National Cancer Institute (NCI), NCI-Designated Cancer Centers, NCI-Sponsored Clinical Trials Cooperative Groups and all other Federal agencies that fund cancer research. Other trials may be eligible for coverage and doctors can ask Medicare to pay the patients’ costs. Ask your doctor about this before you begin.

·

They are designed to treat or diagnose your cancer.

·

The purpose or subject of the trial is within a Medicare benefit category. For example, cancer diagnosis and treatment are Medicare benefits, so these trials are covered. Cancer prevention trials are not currently covered.

Increasing the Likelihood of Insurance Coverage for Trials23 There are several steps you can follow to deal with coverage issues up front when deciding to enter a clinical trial. Along the way, enlist the help of This section has been adapted from the NCI: http://www.cancer.gov/clinical_trials/doc_header.aspx?viewid=1d92be79-8748-4bda-80052a56d332463b&docid=0df4397a-eccb-465f-bd33-a89e7a708c46.

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family members and your doctor or other health professionals. You may find the following checklist useful:

Understand the Costs Associated with the Trial Ask your doctor or the trial’s contact person about the costs that must be covered by you or your health plan. Are these costs significantly higher than those associated with standard care? Also, inquire about the experience of other patients in the trial. Have their plans paid for their care? Have there been any persistent problems with coverage? How often have the trial’s administrators been successful in getting plans to cover patient care costs?

Understand Your Health Plan Be sure you know what’s in your policy; request and carefully review the actual contract language. If there’s a specific exclusion for “experimental treatment,” look closely at the policy to see how the plan defines such treatment and under what conditions it might be covered. If it is not clearly defined, call the plan’s customer service line, consult their Web site, and/or write to them. Ask for specific information about clinical trials coverage.

Work Closely with Your Doctor Talk with your doctor about the paperwork he or she submits to your health plan. If there have been problems with coverage in the past, you might ask your doctor or the hospital to send an information package to the plan that includes studies supporting the procedure’s safety, benefits, and medical appropriateness. This package might include: ·

Publications from peer-reviewed literature about the proposed therapy that demonstrate patient benefits;

·

A letter that uses the insurance contract’s own language to explain why the treatment, screening method, or preventive measure should be covered;

·

Letters from researchers that explain the clinical trial;

·

Support letters from patient advocacy groups.

Be sure to keep your own copy of any materials that the doctor sends to your health plan for future reference.

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Work Closely with Your Company’s Benefits Manager This person may be helpful in enlisting the support of your employer to request coverage by the health plan.

Give Your Health Plan a Deadline Ask the hospital or cancer center to set a target date for the therapy. This will help to ensure that coverage decisions are made promptly. Know Your Rights24 A number of state governments are addressing the question of whether insurance companies ought to cover the costs associated with patients’ participation in clinical trials. Lack of such coverage is a significant barrier to many patients who might otherwise benefit from enrolling in a trial. Lack of coverage also makes it harder for researchers to successfully conduct trials that could improve prevention and treatment options. Information on State initiatives and legislation concerning cancer-related clinical trials is available at http://www.cancer.gov/ClinicalTrials/insurancelaws. By conducting your own research and learning about your rights, you may increase the likelihood that your insurance company will cover the costs of a trial.

If Your Insurance Claim Is Denied after the Trial Has Begun If a claim is denied, read your policy to find out what steps you can follow to make an appeal. In “What Cancer Survivors Need to Know about Health Insurance”, the National Coalition for Cancer Survivorship suggests that you and your doctor demonstrate to the health plan that: ·

The therapy is not just a research study, but also a valid procedure that benefits patients;

·

Your situation is similar to that of other patients who are participating in clinical trials as part of a covered benefit;

·

Possible complications have been anticipated and can be handled effectively.

24

Adapted from Cancer.gov: http://www.cancer.gov/ClinicalTrials/insurancelaws.


You also may wish to contact your state insurance counseling hotline or insurance department for more help, or write your state insurance commissioner describing the problem. Where Else Can I Turn for Assistance? It’s never easy to deal with financial issues when you or a loved one faces cancer. Unfortunately, costs can present a significant barrier to clinical trials participation. The range of insurance issues and health plan contracts makes it impossible to deal with all of them here. You may wish to consult this partial list of publications, organizations, and Web sites for more information: Publications What Cancer Survivors Need to Know about Health Insurance National Coalition of Cancer Survivorship 1010 Wayne Avenue, 5th floor Silver Spring, MD 20910 (301) 650-8868 http://www.cansearch.org/ Cancer Treatments Your Insurance Should Cover The Association of Community Cancer Centers 11600 Nebel Street, Suite 201 Rockville, MD 20852 (301) 984-9496 http://www.accc-cancer.org/main2001.shtml The Managed Care Answer Guide Patient Advocate Foundation 739 Thimble Shoals Boulevard, Suite 704 Newport News, VA 23606 (757) 873-6668 E-mail: [email protected]

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1998 Guide to Health Insurance for People with Medicare, The Medicare Handbook Medicare Helpline: 1-800-444-4606 Health Care Financing Administration: http://www.hcfa.gov/ New Medicare site: http://www.medicare.gov/ Assistance Programs Candlelighters Childhood Cancer Foundation Ombudsman Program 910 Woodmont Avenue, #4607 Bethesda, MD 20814 (301) 657-8401; 1-800-366-2223 (toll-free) E-mail: [email protected] http://www.candlelighters.org The Ombudsman Program helps families of children with cancer and survivors of childhood cancer resolve a range of problems, including insurance coverage difficulties. Local groups appoint a Parent Advocate who works with the treatment center on behalf of families. Medical Care Management Corporation 5272 River Road, Suite 650 Bethesda, MD 20816-1405 (301) 652-1818 email: [email protected] http://www.mcman.com/ Working for a range of clients, including health plans, employers, and patients, MCMC conducts independent, objective reviews of hightechnology medical care cases to assist in decision-making. While it does charge for its services, MCMC also offers a volunteer program for those who cannot afford to pay. More Information Resources OncoLink A service of the University of Pennsylvania Cancer Center. http://www.oncolink.com/ In addition to general cancer information, this web site features a section on financial information for patients. Among the topics: viatical settlements, life insurance, a glossary of financial and medical terms, and news about billing and insurance.


American Association of Health Plans 1129 20th Street, NW, Suite 600 Washington, DC 20036-3421 (202) 778-3200 http://www.aahp.org/ The Web site section “For Consumers” includes a fact sheet on clinical research that describes various health plans’ efforts to support research initiatives and collaborate with academic health centers and universities. Health Insurance Association of America 555 13th Street, NW Washington, DC 20004 (202) 824-1600 ·

Home page: http://www.hiaa.org/

·

Consumer Information: http://www.hiaa.org/consumer/

·

Insurance Counseling Hotlines by State: http://www.hiaa.org/consumer/insurance_counsel.cfm

·

State Insurance Departments: http://www.hiaa.org/consumer/state_insurance.cfm

Government Initiatives to Expand Insurance Coverage for Trials25 The good news is that there has been a recent effort in the U.S. to assure clinical trials coverage, with NCI involved in several new initiatives as described below: NCI-Department of Defense Agreement An innovative 1996 agreement between NCI and the Department of Defense (DoD) has given thousands of DoD cancer patients more options for care and greater access to state-of-the-art treatments. Patients who are beneficiaries of TRICARE/CHAMPUS, the DoD’s health program, are covered for NCIsponsored Phase II and Phase III clinical treatment trials. NCI and DoD are refining a system that allows physicians and patients to determine quickly what current trials meet their needs and where they are taking place. Adapted from the NCI: http://www.cancer.gov/clinical_trials/doc_header.aspx?viewid=1d92be79-8748-4bda-80052a56d332463b&docid=d8092601-daf9-4794-8536-3be2712eb6b9.

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NCI-Department of Veterans Affairs Agreement A 1997 agreement with the Department of Veterans Affairs provides coverage for eligible veterans of the armed services to participate in NCIsponsored prevention, diagnosis, and treatment studies nationwide. For additional information, see the VA/DoD Beneficiaries Digest Page at http://www.va.gov/cancer.htm.

Midwest Health Plans Agreement Some NCI Cooperative Groups have reached agreements with several insurers in Wisconsin and Minnesota to provide more than 200,000 people with coverage. This coverage is allocated for patient care costs if they participate in a cooperative group-sponsored trial.

Pediatric Cancer Care Network This network, a cooperative agreement among the Children’s Cancer Group, the Pediatric Oncology Group, and the Blue Cross Blue Shield System Association (BCBS) nationwide, will ensure that children of BCBS subscribers receive care at designated centers of cancer care excellence and may promote the enrollment of children in Cooperative Group clinical trials.

Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “pancreatic cancer” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is


updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

·

For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

·

For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna

·

A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna

·

The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna

·

The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna

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·

Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna

·

Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna

·

Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Adenocarcinoma: Cancer that begins in cells that line certain internal organs and that have glandular (secretory) properties. [NIH] Anesthesia: Loss of feeling or awareness. Local anesthetics cause loss of feeling in a part of the body. General anesthetics put the person to sleep. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antineoplastons: Substances isolated from normal human blood and urine being tested as a type of treatment for some tumors and AIDS. [NIH] Bevacizumab: A monoclonal antibody that may prevent the growth of blood vessels from surrounding tissue to a solid tumor. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Brachytherapy: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called internal radiation, implant radiation, or interstitial radiation therapy. [NIH]


Capecitabine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Cetuximab: A type of monoclonal antibody being studied as an anticancer drug. Monoclonal antibodies are laboratory-produced substances that can locate and bind to cancer cells. [NIH] Chemoprotective: A quality of some drugs used in cancer treatment. Chemoprotective agents protect healthy tissue from the toxic effects of anticancer drugs. [NIH] Chronotherapy: The adaptation of the administration of drugs to circadian rhythms. The concept is based on the response of biological functions to time-related events, such as the low point in epinephrine levels between 10 p.m. and 4 a.m. or the elevated histamine levels between midnight and 4 a.m. The treatment is aimed at supporting normal rhythms or modifying therapy based on known variations in body rhythms. While chronotherapy is commonly used in cancer chemotherapy, it is not restricted to cancer therapy or to chemotherapy. [NIH] Cisplatin: An anticancer drug that belongs to the family of drugs called platinum compounds. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Cyclophosphamide: An anticancer drug that belongs to the family of drugs called alkylating agents. [NIH] Dalteparin: A drug that helps prevent the formation of blood clots; it belongs to the family of drugs called anticoagulants. [NIH] Docetaxel: An anticancer drug that belongs to the family of drugs called mitotic inhibitors. [NIH] Duodenum: The first part of the small intestine. [NIH] Endoscopy: The use of a thin, lighted tube (called an endoscope) to examine the inside of the body. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Filgrastim: A colony-stimulating factor that stimulates the production of neutrophils (a type of white blood cell). It is a cytokine that belongs to the family of drugs called hematopoietic (blood-forming) agents. Also called granulocyte colony-stimulating factor (G-CSF). [NIH] Flavopiridol: Belongs to the family of anticancer drugs called flavinols. [NIH]

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Fluorouracil: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gemcitabine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Immunotoxin: An antibody linked to a toxic substance. Some immmunotoxins can bind to cancer cells and kill them. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Intraperitoneal: IP. Within the peritoneal cavity (the area that contains the abdominal organs). [NIH] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Irinotecan: An anticancer drug that belongs to a family of anticancer drugs called topoisomerase inhibitors. It is a camptothecin analogue. Also called CPT 11. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Neoplasm: A new growth of benign or malignant tissue. [NIH] Octreotide: A drug similar to the naturally occurring growth hormone inhibitor somatostatin. Octreotide is used to treat diarrhea and flushing associated with certain types of tumors. [NIH] Paclitaxel: An anticancer drug that belongs to the family of drugs called mitotic inhibitors. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] R115777: An anticancer drug that inhibits the transformation of normal cells to cancer cells. It belongs to the family of drugs called enzyme inhibitors. [NIH]

Radiotherapy: The treatment of disease by ionizing radiation. [EU] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recurrence: The return of cancer, at the same site as the original (primary)


tumor or in another location, after the tumor had disappeared. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Sarcoma: A cancer of the bone, cartilage, fat, muscle, blood vessels or other connective or supportive tissue. [NIH] Sargramostim: A colony-stimulating factor that stimulates the production of blood cells, especially platelets, during chemotherapy. It is a cytokine that belongs to the family of drugs called hematopoietic (blood-forming) agents. Also called GM-CSF. [NIH] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH] Sterile: Unable to produce children. [NIH] Testicular: Pertaining to a testis. [EU] Thromboembolism: Obstruction of a blood vessel with thrombotic material carried by the blood stream from the site of origin to plug another vessel. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Trastuzumab: A type of monoclonal antibody used in cancer detection or therapy. Monoclonal antibodies are laboratory-produced substances that can locate and bind to cancer cells. Trastuzumab blocks the effects of the growth factor protein HER2, which transmits growth signals to breast cancer cells. [NIH]

Triacetyluridine: A substance that is being studied for its ability to protect against the gastrointestinal side effects caused by fluorouracil. It is a precursor of uridine, which is a component of RNA. [NIH] Unresectable: Unable to be surgically removed. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vial: A small bottle. [EU]

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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL

ABOUT PART II In Part II, we introduce you to additional resources and advanced research on pancreatic cancer. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on pancreatic cancer. In Part II, as in Part I, our objective is not to interpret the latest advances on pancreatic cancer or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with pancreatic cancer is suggested.

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CHAPTER 4. STUDIES ON PANCREATIC CANCER Overview Every year, academic studies are published on pancreatic cancer or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on pancreatic cancer. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on pancreatic cancer and teach you how to keep current on new studies as they are published or undertaken by the scientific community.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and pancreatic cancer, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the


format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “pancreatic cancer” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·

Understanding Pancreatitis and Pancreatic Cancer Source: Digestive Health and Nutrition. 3(3): 17-20. May-June 2001. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. E-mail: [email protected]. Summary: Acute pancreatitis (inflammation of the pancreas) can happen to anyone, anytime. However, repeated episodes put the patient at risk for chronic pancreatitis and pancreatic cancer, so it is important to learn about the risk factors and symptoms of these diseases. This article reviews the presenting symptoms of pancreatitis, the anatomy and physiology of the healthy pancreas, treatment options, and the risk factors for pancreatic cancer. The most common cause of acute pancreatitis is gallstones that get caught at the opening into the small intestine. Excessive alcohol use is another common cause of the disease. Diagnosis can include blood tests, an abdominal CT (computed tomography) scan, and endoscopic ultrasound. Treatment for acute pancreatitis is usually relatively low tech, featuring hydration (adequate fluids), pain management, and nutrition support (intravenous). During an episode of acute pancreatitis, which can last days or even a week, patients usually do not eat any food at all initially. Clear liquids and then low fat foods are added gradually as symptoms improve. When gallstones cause pancreatitis, surgery to remove them is usually necessary. For those who already have chronic pancreatitis or are at risk for developing it, a healthy lifestyle and positive attitude are essential. Many people with pancreatitis find that a low fat diet helps reduce the severity of acute episodes and also slows the progression of the chronic disease. One sidebar offers a description of hereditary pancreatitis, which is a rare condition. The final section of the article discusses pancreatic cancer, noting that both chronic and hereditary pancreatitis put people at higher risk for developing pancreatic cancer. Appended to the article is a list of websites for readers who want to locate additional information about pancreatitis. 2 figures.

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Diabetes Mellitus as a Risk Factor for Pancreatic Cancer: A MetaAnalysis Source: JAMA. Journal of American Medical Association. 273(20): 16051609. May 24-31, 1995. Summary: This article reviews the evidence for an association of preexisting diabetes with pancreatic cancer. Data sources, which were identified from a MEDLINE search and citations in articles and books, include pertinent studies of diabetes mellitus and pancreatic cancer published between 1975 and 1994. Of the 20 studies included in the metaanalysis, 18 demonstrate a positive association between preexisting diabetes and the occurrence of pancreatic cancer. Although pancreatic cancer and diabetes could result from the same genetic and environmental risk factors, no commonly found risk factor has been identified for both conditions. The article points out that because most cases of pancreatic cancer occurred after the age of 70 years, the large majority of people with diabetes would have had noninsulin-dependent diabetes mellitus (NIDDM, or Type II). The authors conclude that pancreatic cancer occurs with increased frequency among people with long-standing diabetes. In fact, diabetes may become associated with an increasing proportion of pancreatic cancer, if recent trends continue in the declining prevalence of smoking and the increasing prevalence of diabetes. 3 tables. 50 references. (AA-M).

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Diabetes and the Risk of Pancreatic Cancer Source: New England Journal of Medicine. 331(2): 81-84. July 14, 1994. Summary: This article reports on a study to consider the association between diabetes and pancreatic cancer. A total of 720 patients with pancreatic cancer and 720 control patients from 14 medical centers in Italy were enrolled in the study. All subjects were interviewed personally and in detail about their clinical history. The diagnosis of diabetes was based on criteria recommended by the American Diabetes Association. One hundred sixty-four patients with pancreatic cancer (22.8 percent) and 60 controls (8.3 percent) had diabetes. In most of the patients with pancreatic cancer (56.1 percent), diabetes was diagnosed either concomitantly with the cancer (in 40.2 percent) or within 2 years before the diagnosis of cancer (in 15.9 percent). The association between the two conditions was significant. However, when only patients with diabetes of 3 or more years' duration were considered, the association was no longer significant. The researchers conclude that diabetes in patients with pancreatic cancer is frequently of recent onset and is presumably caused by the tumor; diabetes is not a risk factor for pancreatic cancer. 3 tables. 36 references. (AA-M).


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Diabetes and Pancreatic Cancer: The Egg or the Hen? Source: International Journal of Pancreatology. 16(1): 81-98. August 1994. Contact: Available from Humana Press. 999 Riverview Drive, Suite 208, Totowa, NJ 07512. Summary: This journal entry provides abstracts of papers presented at the International Pancreatic Study Group Meeting during the World Congress of Gastroenterology. The theme of these papers is 'Diabetes and Pancreatic Cancer: The Egg or the Hen?'. The papers address topics including an epidemiological assessment of diabetes and pancreatic cancer risk; the relationship between pancreatic cancer and diabetes; alterations of serum pancreatic hormones in pancreatic cancer patients; increased secretion of proinsulin in patients with pancreatic cancer; and an alteration of pancreatic hormones in human and experimental pancreatic cancer. Other topics include abnormal glucose tolerance in patients with early pancreatic carcinoma; effect of subtotal pancreatectomy on glucose metabolism in pancreatic cancer patients; endocrine pattern of pancreatic cancer; and elevated circulating concentrations of islet amyloid polypeptide. 9 figures. 4 tables. 63 references. (AA-M).

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Pancreatic Cancer and Diabetes Source: Diabetes Educator. 20(1): 20, 24, 26. January-February 1994. Contact: Available from American Association of Diabetes Educators. 100 West Monroe, 4th floor, Chicago, IL 60603. (800) 338-3633 or (312) 4242426. Fax (312) 424-2427. Summary: This article reviews current knowledge about the relationship between diabetes and cancer of the pancreas. The author notes that although pre-1970s data led some researchers to believe that diabetes could predispose a person to developing pancreatic cancer, this issue continues to be studied. Recent studies suggest that diabetes is more likely to be a consequence of a pancreatic tumor. Aspects of pancreatic cancer discussed in the article include etiology, risk factors, diagnosis, treatment, nutritional concerns, and implications for the diabetes educator. The author suggests that a challenge for diabetes educators is helping people who have had surgery for pancreatic cancer and who now have resultant impaired glucose tolerance or diabetes. 15 references. (AAM).

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Case-Control Study of Pancreatic Cancer and Cigarettes, Alcohol, Coffee and Diet Source: American Journal of Public Health. 79(8):1016-1019, August 1989. Summary: A pancreatic cancer case-control study was conducted in the Minneapolis-St. Paul area. Case subjects were deceased white males, ages 40 to 84, who died of pancreatic cancer (exocrine only) between January 1, 1980 and June 30, 1983. Population-based control subjects were white males, ages 40 to 84, ascertained at random. Family members were interviewed about the subject's usage of cigarettes, alcohol, coffee, and other dietary factors in the 2 years prior to death (212 cases) or prior to interview (220 controls). Individual dietary information was obtained by a frequency-of-use questionnaire. An increased risk of pancreatic cancer was observed for current cigarette smoking and, to a lesser extent, for duration. A decrease in heavy alcohol and meat consumption and a corresponding increase in vegetables may contribute to a decline in risk. The results support the belief that coffee is not a risk factor for pancreatic cancer. 3 tables, 28 references.

Federally Funded Research on Pancreatic Cancer The U.S. Government supports a variety of research studies relating to pancreatic cancer and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.26 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to pancreatic cancer and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore pancreatic cancer and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could 26 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).


eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for pancreatic cancer: ·

Project Title: Acupuncture Treatment of Pain in Pancreatic Cancer Principal Investigator & Institution: Cassileth, Barrie R.; Adjunct Professor & Consulting Professor; Sloan-Kettering Institute for Cancer Res for Cancer Research New York, Ny 10021 Timing: Fiscal Year 2001; Project Start 8-SEP-2001; Project End 1-AUG2003 Summary: (provided by applicant): BACKGROUND: Pancreatic cancer affects approximately 28,000 Americans a year. Approximately 85-90 percent of these patients are first diagnosed when their disease already is locally advanced or metastatic. AT this point, median survival is three to six months. Treatment of pancreatic cancer is predominantly palliative in nature. Pain control is often the most serious challenge: the pancreas has an extensive blood, lymphatic and nerve supply and is surrounded by numerous other abdominal organs. More than 90 percent of patients with advanced pancreatic cancer experience moderate to severe pain. Several surgical and non-operative procedures are used to palliate pancreatic pain, including blocking afferent pain fibers from the pancreas. Data on the efficacy of these approaches are limited and these interventions tend to be used only in select cases. Oncologic management with gemcitabine chemotherapy or radiotherapy reduces pain in a minority of patients. Most patients require opiates for pain control, and the high doses needed often cause undesirable sedation. Basic and clinical research supports acupuncture for the treatment of pain. A randomized trial found that acupuncture helps relieve non-malignant pancreatic pain, suggesting that an early phase trial of acupuncture for pancreatic cancer pain would be warranted. Objectives: To assess the effects of an acupuncture/acupressure intervention on pain, sedation and opiate medication in patients with pancreatic cancer experiencing moderate to severe pain to: i) determine whether controlled trials are warranted and ii) provide data to aid design of further warranted studies. Methods: Initially, a small number of pancreatic cancer patients reporting either high levels of pain or high levels of sedation will be treated in order to finalize the acupuncture prescription and the data collection procedures. We will then accrue patients in a standard two-stage, Phase II design. Patients will receive four sessions of a standardized acupuncture treatment with intervening acupressure over 10 days. Pain, opiate medication and sedation will be assessed for three days at baseline and post-treatment. Patients will be considered to have responded to

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treatment if they report a pre-specified level of improvement in either pain or sedation. Ten patients will be recruited. If less than two experience responses, the trial will be terminated. Otherwise, an additional 19 patients will be accrued. A Phase III trial will be deemed warranted if there are 6 or more responses in total; this is consistent with a 30 percent response rate. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Amylin and Its Releasing Factor in the Early Diagnosis of Pancreatic Cancer Principal Investigator & Institution: Adrian, Thomas; University of Nebraska Medical Center 42Nd and Dewey Aves Omaha, Ne 68105 Timing: Fiscal Year 2000 Summary: Pancreatic cancer is associated with profound insulin resistance, resulting in diabetes in up to 80% of patients. This metabolic abnormality is tumor dependent and disappears after tumor resection, despite the loss of islets. Amylin is a pancreatic hormone that inhibits muscle glycogen synthesis and reduces food intake. In most pancreatic cancer patients, amylin levels are elevated in the fasting state. Even though diabetes may not be a major problem for the management of patients with pancreatic cancer, measurement of amylin may be a valuable marker for the early diagnosis of the disease, at least in a proportion of patients. Furthermore, the increased amylin levels appear to result from stimulation of peri-tumoral islets by a tumor-derived peptide (amylin releasing peptide of ARP). It is likely that, compared with amylin, circulating ARP levels are elevated in an even higher proportion of pancreatic cancer patients. The major goals of this proposal are as follows: 1. To investigate the specificity of elevated circulating amylin in pancreatic cancer, by investigating patients with pancreatitis, biliary obstruction, newly diagnosed diabetes, pancreatic cancer or other malignancies. 2. To purify and sequence ARP and develop a radioimmunoassay to measure this peptide. 3. To establish whether ARP is a better marker for pancreatic cancer than amylin, by measurement in the above groups of patients. 4. To determine the value of amylin and ARP as early indicators of pancreatic cancer, by measuring the peptides in families with a high risk of developing the disease, and by measuring them in samples from pancreatic cancer patient collected several years prior to their cancer diagnosis. This study may aid in the development of an early screening technique for detecting pancreatic cancer at an early, curable stage. In addition, it will improve our understanding of the role played by the islets in this disease. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket


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Project Title: Cadmium, K-Ras, and Pancreatic Cancer in Egypt Principal Investigator & Institution: Soliman, Amr; Epidemiology; University of Texas Md Anderson Can Ctr Cancer Center Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 0-SEP-2002; Project End 1-AUG2004 Summary: (provided by applicant): Pancreatic cancer is a lethal disease that quickly deprives patients of both quality and quantity of life. It is the fifth leading cause of cancer death in the United States. In 2001, an estimated 29,200 new cases were diagnosed, and 28,900 people died from the disease. The median survival of pancreatic cancer is six months and only 4% of patients are alive five years after diagnosis. Given its incidence and almost entire fatality, substantially increased research efforts are clearly warranted to understand, prevent, and control this disease. Although pancreatic cancer is rare in developing countries, including most of Egypt, the northeast Nile Delta region of Egypt offers a unique setting for studying pancreatic cancer because of: 1) its large number of pancreatic cancer cases; 2) the high serum cadmium levels in residents of the region; and 3) the unique molecular pathologic features of pancreatic cancer tumors of patients from this region [unusually high rate of GGT --> GTT (glycine --> valine) K-ras mutation]. Cadmium has been suspected as a carcinogen for pancreatic cancer and the large number of cases and early-onset disease in addition to the unique K-ras mutations of tumors in this population may be caused by high cadmium exposures. We propose a pilot study to generate a hypothesis that pancreatic cancer, in this population, is caused by high levels of exposure to environmental cadmium. We will recruit 150 pancreatic cancer controls and 150 age-, sex- and residence-matched hospital controls. We will examine lifetime epidemiologic, environmental and cancer family histories to identify novel environmental or lifestyle-related factors that predict risk for pancreatic cancer in this population with high adverse environmental exposures. We will also test serum cadmium levels in cases and controls and K-ras mutation types in tumors of cases to define if the unique mutation types are associated with higher serum cadmium levels or other environmental exposures. This study may define the role of cadmium in the etiology of pancreatic cancer and may set the stage for future studies on gene-environmental interactions in the epidemiology of pancreatic cancer. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Endogenous Opioid Modulation of Human Pancreatic Cancer Principal Investigator & Institution: Zagon, Ian S.; Professor; Neuroscience and Anatomy; Pennsylvania State Univ Hershey Med Ctr 500 University Dr Hershey, Pa 17033 Timing: Fiscal Year 2000; Project Start 3-DEC-1996; Project End 0-NOV2002 Summary: Pancreatic cancer is the 4th leading cause of cancer-related deaths in the U.S. Little is known about the origin, pathogenesis, or treatment of this neoplasia. The opioid growth factor (OGF), [Met5]enkephalin, is a native inhibitory peptide that is particularly targeted to cell proliferative events. The repressive activity of OGF on cell growth is mediated by the zeta opioid receptor. CCF is a negative growth factor in pancreatic cancer both in vitro and in vivo, Blockade of OGF action by the potent opioid antagonist naltrexone increases pancreatic cancer cell proliferation, indicating the tonic activity of OGF. Both OGF and zeta receptor are in pancreatic tumor cells. This grant hypothesizes that a native opioid peptide inhibits the growth of human pancreatic cancer, and does so through a unique opioid receptor. To test this hypothesis, we propose to: (l) Examine the cellular mechanisms of endogenous opioid action on human pancreatic tumor cell function, including DNA synthesis and the cell cycle. (2) Investigate the autocrine production of the opioid peptide related to growth of human pancreatic cancer. (3) Define the regulatory properties of opioid peptide-receptor interaction with respect to human pancreatic cancer cells. (4) Clone and sequence the zeta opioid receptor in human pancreatic neoplasia, and elucidate the function of this receptor using overexpression studies. (5) Learn about the mechanisms of endogenous opioid activity with regard to the incidence and growth of human pancreatic tumors from xenografts in nude mice. These studies will contribute to comprehending the biology of human cancer, and may provide clues to strategies for the treatment of pancreatic neoplasia. Information derived from the proposed investigation would be the first to identify a natural inhibitory substance and its receptor that serve to regulate pancreatic cancer. This research is part of a long-range program in cellular and molecular oncology which seeks to define the fundamental principles underlying pancreatic cancer in humans. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket


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Project Title: Glycoconjugates in Pancreatic Cancer Principal Investigator & Institution: Kim, Young S.; Professor; Northern California Institute Res & Educ for Research and Education San Francisco, Ca 94121 Timing: Fiscal Year 2000; Project Start 6-SEP-1988; Project End 1-DEC2002 Summary: (adapted from the investigator's abstract) This proposal is to extend the investigators' previous studies of the biosynthesis, molecular biology, structure, and immunology of pancreatic cancer mucins. Pancreatic tumors frequently exhibit alterations in mucin gene expression, providing both diagnostic and therapeutic opportunities. Currently, however, knowledge of mucin peptide and carbohydrate structure is incomplete and even less is known about the mechanisms that regulate mucin biosynthesis and release. This information could be applied in several ways including the rational design of novel tumor markers, the enhancement of the effectiveness of mucin-directed antibodies, and the identification of potential targets for therapeutic intervention. In the past funding period they have characterized mucin carbohydrate antigen structure and identified the associated mucin polypeptides. They have also determined that MUC3 is an important component of pancreatic cancer mucin and made significant strides towards obtaining the complete sequence of this large mucin. In other work, the investigators have identified conditions and pharmacological agents capable of modulating mucin gene expression in pancreatic cancer cells and have shown that a human-mouse chimera of Nd2 antibody is an effective agent for the identification of pancreatic tumors. In the upcoming funding period they will continue their efforts in each of these areas. Studies on the biosynthesis of mucins will focus on identifying chemicals or peptides capable of elevating mucin expression and release. Studies on the molecular biology of mucins will focus on: 1) determining the complete cDNA sequence of MUC3 and 2) characterizing the regulation of the MUC3 gene. Studies on the structure of pancreatic cancer mucins will concentrate on: 1) determining the epitope of Nd2 antibody; 2) determining the structures of mucin oligosaccharides; and 3) characterizing pancreatic cancer cell binding to E-, L-, and P-selectins. Studies on the immunology of mucins will focus on: 1) increasing the effectiveness of Nd2 immunoconjugates; 2) producing new antisera against MUC3 mucin and quantitating circulating levels of MUC3 to determine if this mucin has potential as a diagnostic marker, and 3) extending their ongoing clinical evaluations of the anti-tumor activity of Nd2 immunoconjugates. It is hoped that these studies will facilitate the

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development of novel approaches to both the early diagnosis and treatment of pancreatic cancer. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Mthfr Polymorphisms in Pancreatic Cancer in SF Bay Area Principal Investigator & Institution: Holly, Elizabeth A.; Professor; Epidemiology and Biostatistics; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 3-JAN-2001; Project End 1-DEC2002 Summary: The capacity for DNA repair is essential to maintain both genetic integrity and normal cellular function and to control abnormal cell growth. Folate is required for biosynthesis of oligonucleotides needed for DNA repair mechanisms and inadequate folate has been associated with human cancer. The methylenetetrahydrofolate reductase (MTHFR) enzyme is critical in the regulation of folate and methionine metabolism. Because folate is important in DNA synthesis, repair and methylation, it may play a role in cancer prevention and recent evidence suggests that this is the case. The overall goal of this study is to determine whether the prevalence of the C677T and A1298C polymorphisms in the MTHTR gene differs between pancreatic cancer patients and control subjects. DNA will be examined from 334 cases and 966 control participants who had blood drawn in the large population-based casecontrol study that included 550 pancreatic cancer patients and 1600 controls. All genetic testing will be done using the UCSF Comprehensive Cancer Center Genome Core facilities and laboratory personnel. Data analyses for the variables collected in the interviews in the large study and for the MTHFR genetic component also will be completed variables collected in the interviews in the large study and for the MTHFR genetic component also will be completed under the proposed work. The specific aims are to: 1) identify and compare the incidence of MTHFR C677T and A1298C polymorphisms in pancreatic cancer patients and control subjects; 2) evaluate the relationships between MTHFR polymorphisms and other exposures that also may be related to risk for pancreatic cancer such as dietary folate, smoking and alcohol consumption; and 3) perform analyses of other dietary factors and other data collected in the parent study. Data will be analyzed using stratification and multiple logistic regression for all risk factors that could potentially confound or modify the association between the MTHFR polymorphisms and pancreatic cancer such as dietary folate, smoking and alcohol consumption. Data from other risk factors also will be analyzed. While a relationship


between low serum folate and risk for pancreatic has been reported there is no data to describe polymorphisms in MTHFR genes among pancreatic cancer patients and control subjects. These questionnaire- and geneticsbased analyses will provide new and provocative data of public health importance for this devastating disease. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: New Genetic Markers for Pancreatic Cancer Principal Investigator & Institution: Kern, Scott E.; Associate Professor; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2000 Summary: Most human malignancies result from the accumulation of mutations which activate oncogenes and inactivate tumor-suppressor genes. For pancreatic cancer, a limited number of genetic alterations are known, but it is clear that many others remain to be discovered. In the past, technical problems impaired these genetic studies. We recently assembled a novel panel of over 100 human pancreatic cancers, expanded by propagation as xenografts in nude mice. This resource, for the first time, allows such questions to be efficiently answered. Recent developments of sophisticated technologies have also accelerated the genetic dissection of this tumor. Because the biologic characteristics of the tumor are tied to the underlying genetic changes, knowledge of these relationships should enable advances in the understanding and management of pancreatic cancer. We realize that some of the aims of this proposal are not directly translational. However, the RFA states, "Because basic research in pancreatic cancer has lagged behind that of the other major solid tumors, greater leeway is given for basic research studies on pancreatic cancer." Furthermore, our preliminary studies have identified key markers, including the alterations of the p16 gene and of the BRCA2 locus in pancreatic cancer, which already have seen clinical application in inherited forms of pancreatic and breast cancer. In preliminary studies, detailed allelotyping has identified candidate regions for suspected novel tumor-suppressor genes in pancreatic cancer. We confirmed the high rate of K-ras mutations (>90%), established a high race of p53 mutations (70%), identified the common inactivation of the p16 gene (>80%), cloned the tumor-suppressor DPC4 from a novel hotspot of homozygous deletion on 18q, and used the representational difference analysis to provide the fine localization of the BRCA 2 gene through our identification of a small homozygous deletion at the BRCA2 locus in a pancreatic cancer arising in a setting of familial breast cancer. Specifically, this project aims to continue this work to identify new tumor-suppressor genes, identify activated oncogenes, and use these

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genetic clues to understand the clinical settings in which pancreatic cancer arises and spreads. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Pancreatic Cancer Genetic Epidemiology Consortium Principal Investigator & Institution: Petersen, Gloria M.; Professor; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002; Project Start 1-AUG-2002; Project End 1-JUL2007 Summary: (provided by applicant): Pancreatic cancer is a devastating, highly lethal, but poorly understood cancer. Family history is an established risk factor for pancreatic cancer, and susceptibility gene discovery in high risk familial pancreatic cancer (FPC) is a valid objective. New technical developments make possible productive family based linkage analysis of cancer. We propose a multicenter, multidisciplinary Pancreatic Cancer Genetic Epidemiology (PACGENE) Consortium to identify susceptibility genes in high risk FPC pedigrees using cuttingedge genetic analysis methods. We hypothesize that (1) there are specific discoverable genotypes that greatly increase the risk of developing adenocarcinoma of the pancreas, and (2) some genotypes may manifest through tobacco exposure. To address these hypotheses, this project has assembled an experienced research team with expertise in genetic epidemiology, gene mapping, pancreatic cancer biology, cancer molecular genetics, and pathology/diagnosis of pancreatic cancer that will study high risk FPC pedigrees using state of the art linkage analysis techniques. The PACGENE Consortium will be composed of six experienced primary data collection centers, a statistical genetics Core, and a pathology/archival genotyping Core. Oversight of the whole will be provided by a Steering Committee with consultation from an External Advisory Committee. Our specific aims are: Aim 1: To identify high risk pedigrees for genetic linkage analysis utilizing established pancreatic cancer family research resources. The six centers will screen 8,900 new cases over 5 years to accrue biospecimens, tumor tissue, and risk factor data (including smoking history) from available relevant family members of 75 FPC pedigrees suitable for genetic linkage studies (those containing 3 or more persons affected with pancreatic cancer and those providing expected lod scores of 0.3 or higher). Aim 2: To genotype informative individuals in high-risk FPC pedigrees with 400 evenly spaced markers (10 centimorgan intervals) throughout the genome. Genotyping with genome-wide microsatellite markers will be done on an estimated 1,500 individuals in the 75 FPC families identified in Aim 1. Aim 3: To map a pancreatic cancer susceptibility gene(s) by genetic linkage analysis of the


high-risk FPC pedigrees. We propose to use conventional parametric linkage strategies, but will also implement the latest methods that incorporate environmental covariates in the analyses. implications Through such efforts, the consortium will facilitate the development of a family-based gene-discovery research resource that will be positioned to characterize genetic risk of pancreatic cancer and to conduct future translational studies, including interventions targeted to high risk groups. The research described in this application is 100% relevant to pancreatic cancer. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Prospective Study of Pancreatic Cancer Pathogenesis Principal Investigator & Institution: Fuchs, Charles S.; Assistant Professor of Medicine; Brigham and Women's Hospital 75 Francis St Boston, Ma 02115 Timing: Fiscal Year 2000; Project Start 1-SEP-2000; Project End 1-AUG2005 Summary: (Adapted from the Applicant's Abstract): Pancreatic cancer is the fourth most common cause of cancer-related mortality for both men and women in the United States. Relatively little is known about the pathogenesis and epidemiology of this malignancy. Our general goals are: first, to examine prospectively hypotheses regarding the etiology of pancreatic cancer, and, second, to establish a unique database consisting of repeated dietary and lifestyle assessments over several decades, archived blood specimens, and archived tumor tissue. This resource will allow for the rapid examination of future hypotheses as they emerge. We will use the resources of three large cohort studies with prospectively collected blood specimens: the Nurses' Health Study (NHS), Health Professionals' Follow-up Study (HPFS), and Physicians' Health Study (PHS). Blood specimens will be analyzed using a matched, nested casecontrol design of projected cases through 2002 to evaluate hypotheses focusing on mechanisms of pancreatic cancer pathogenesis. First, we will examine whether an association between energy intake, obesity, greater adult height, sedentary lifestyle, or diabetes mellitus and pancreatic cancer is mediated through insulin-like growth factors and binding proteins. Second, we will examine whether biochemical indicators of methyl-group availability are associated with pancreatic cancer risk and whether the influence of folate is modified by methylene tetrahydrofolate reductase polymorphisms. Third, we will examine whether polymorphisms of genes responsible for detoxification and activation of aromatic/heterocyclic amines influence the risk of pancreatic cancer, and whether the associations of smoking and red meat intake with pancreatic

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cancer are influenced by these polymorphisms. Finally, we will examine the prevalence and spectrum of K-ras mutations, the prevalence of pl6 loss of heterozygosity and the level of p53, p21 and p27 expression among pancreatic cancers, and assess the influence of dietary and other factors on the prevalence of these molecular changes. These studies will enhance our understanding of pancreatic carcinogenesis and provide a scientific foundation for future preventive efforts. This is the first R01 submitted by the principal investigator following a K award from NCI. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Role of Somatostatin Receptors in Pancreatic Cancer Principal Investigator & Institution: Fisher, William E.; Surgery; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2001; Project Start 1-JUL-2001; Project End 0-JUN2004 Summary: D E S CRIPTION: (provided by Applicant) The incidence of pancreatic adenocarcinoma has increased in recent decades and the prognosis for patients with this disease remains poor. New information about the pathogenesis of pancreatic cancer that has translational potential would be of great medical and economic importance. Cell culture and animal studies suggest that somatostatin can inhibit pancreatic cancer growth if the tumor cells express somatostatin receptors. Despite these promising results, recent clinical trials of somatostatin analogs as adjuvant treatment of pancreatic cancer have failed because most pancreatic cancer cells do not express somatostatin receptors. This application is centered on the hypothesis that functional somatostatin receptors maintain normal homeostasis within pancreatic cells and loss of these receptors is a critical step in pancreatic carcinogenesis. Three specific aims will test this hypothesis by carefully defining both the mechanisms of somatostatin receptor loss and function in several experimental models. The first specific aim will, for the first time, carefully demonstrate the lack of expression of specific somatostatin receptor subtypes at both the mRNA and protein level in clinical samples of human pancreatic cancer and preneoplastic lesions. The molecular mechanisms responsible for somatostatin receptor gene silencing will be discovered. The second aim will correlate the loss of somatostatin receptor expression to tumorigenicity in experimental models of pancreatic carcinogenesis. These experiments will be performed on cultured pancreatic cells and in an animal model. In vitro studies will examine multiple time points during carcinogen exposure for transformation and tumorigenicity while serial sacrifices of exposed animals will capture the progressive development of pancreatic cancer.


The third aim will determine which somatostatin receptor subtypes are important in the inhibition of pancreatic cancer growth. Each somatostatin receptor gene will be individually transfected into a human pancreatic cancer cell line that lacks somatostatin receptors. Effects on growth and responsiveness to somatostatin will be determined using tissue culture and xenografts in nude mice. The molecular mechanisms responsible for the growth inhibitory signal of each receptor subtype in human pancreatic cancer will be determined. The aims outlined in this application will discover a novel aspect of pancreatic carcinogenesis. Gene therapy to restore the responsiveness of pancreatic cancer to somatostatin analogs by somatostatin receptor gene transfer may become possible from the knowledge gained in these experiments. Since somatostatin expression has been demonstrated in other tumor types, the findings may also be relevant to other cancers. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Adenoviral Vector for FHIT Gene Transfer Principal Investigator & Institution: Dumon, Kristoffel R.; Microbiology and Immunology; Thomas Jefferson University 1020 Walnut St Philadelphia, Pa 19107 Timing: Fiscal Year 2000; Project Start 1-JUL-2000 Summary: Pancreatic cancer remains one of the most difficult malignancies to treat. It ranks 4th as a cause of cancer related death in USA and accounted for an estimated 29,000 deaths in 1998. Complete surgical resection offers the only potential for long term survival. Nevertheless, the overall 5 year survival for all stages of surgically respectable disease is only 21 percent. The molecular clues to the origin of this disease are emerging. Activation of oncogenes and inactivation of tumor suppressor genes such as p53, k-ras, p16, p21/WAF and FHIT in pancreatic cancer have been shown to play an important role in tumorigenesis. In our study we will focus on the fragile histidine triade gene (FHIT) located at chromosome 3p14.2 and affected in approximately 66 percent of human pancreatic cancer. The nature of damages to the 3p15.2 locus has recently been further elucidated and underlie FHIT as a tumor suppressor gene. The 1.1-kb FHIT cDNA transcript encodes a protein (Fhit) with in vitro dinucleoside 5`,5"-P1, P3- triphosphate (Ap3A) hydrolase activity. Tumor suppressor activity of Fhit is assumed to be associated with involvement of the Fhit. Ap3A complex in cytokine signaling pathways(s) controlling cell proliferation and Fhit seems to be involved in a p53 independent apoptotic pathways. In order to clarify the function of Fhit as a tumor suppressor in pancreatic cancer and to explore the potential therapeutic role of FHIT gene transfer in pancreatic cancer,

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experimental data are needed. We will study the effects of FHIT gene overexpression mediated by a recombinant adenoviral vector (rAd-FHIT) on cell proliferation, apoptosis and cell-cycle processes in pancreatic cancer cell lines and on tumorigenicity and tumor growth in nude mice. The in vitro model will give us information about the therapeutic efficacy of the Adenoviral gene transfer system by measuring the levels of Fhit cDNA expression by RT-PCR and Fhit protein expression by Western blot and immunochemistry. To evaluate the induction of apoptosis, we will evaluate the level of transfected cells in G0/G1 compared to control cells by FACS analysis. The effect of systemic therapy on in vitro tumor growth inhibition in transduced and nontransduced cells will be evaluated by the MTT test. The in vivo effect on tumor suppression will be evaluated by observing the subcutaneous tumor growth in nude mice injected intratumorally with Ad-FHIT compare to the empty vector. Adenoviruses have been studied extensively and used safely for human vaccine preparations and Rad vectors have shown to be effective gene delivery vehicles, therefore, the results of this study may well result in therapeutic implications for human pancreatic cancer. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Aurora Kinase as a Therapeutic Target in Cancer Principal Investigator & Institution: Von Hoff, Daniel D.; Director; None; University of Arizona Tucson, Az 85721 Timing: Fiscal Year 2002; Project Start 1-MAY-2002; Project End 0-APR2007 Summary: (provided by applicant): Pancreatic cancer is the fourth leading cause of death from cancer in the United States. It has the worst survival of any malignancy followed in the S.E.E.R. database. The discovery of new targets present in pancreatic cancer cells is critically important, both for the prevention and for the treatment of pancreatic cancer. In this proposal, we describe a new target, aurora kinase, a key regulator of chromosome segregation present in pancreatic cancer cells which, with additional work, we feel can be used to develop new therapies for patients with the disease. Aurora kinases are members of the serine/threonine kinase superfamily. They have transforming capacities (are oncogenes) and are present in a variety of human tumors (particularly pancreatic cancer). In preliminary work, we have documented that aurora kinase is upregulated in all pancreatic cancer cell lines but not in normal pancreatic ductal cells. In addition, it is upregulated in pancreatic cancer taken directly from patients and is also amplified in some patients' tumors. This preliminary information makes aurora kinase a very attractive new target in pancreatic cancer. The


specific aims of this proposal are: 1. To further validate aurora kinase as a target in pancreatic cancer. The hypothesis is that aurora kinase is an important target in patients' pancreatic cancer cells. 2. To design agents which interfere with the activity of aurora kinase. The hypothesis is that agents can be found which can selectively inhibit the kinase. Two special techniques will be used to generate lead agents. As will be seen in the proposal, we have a lead from which to begin our design work. 3. To perform in vitro and in vivo testing of agents which interact with aurora kinase to select an agent which would be a candidate for clinical trials in patients with advanced pancreatic cancer. The hypothesis is that we can discover inhibitors of aurora kinase which can inhibit growth (or cause apoptosis) of pancreatic cancer cells both in vitro and in vivo. Aurora kinase has considerable potential to be a very important target in patients' pancreatic cancers, against which new therapeutics can be designed and developed. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Genetic Epidemiology of Pancreas Cancer Principal Investigator & Institution: Hruban, Ralph H.; Associate Professor; Pathology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2000; Project Start 1-JUL-2000; Project End 1-DEC2001 Summary: This pilot study is being performed in conjunction with the planning of a large, multicenter project to investigate the genetics of pancreatic cancer. The results of this study will help the planning of and direct analytic strategies in the larger multicenter study. Pancreatic cancer is the 5th leading cause of cancer death in the United States, but little is understood about its causes. Recent studies have shown that family history of cancer or family history of pancreatic cancer are possible risk factors. These data suggest a hypothesis that genetic factors are involved in pancreatic cancer susceptibility. The primary objective of this study is to determine if there is evidence for a major susceptibility gene in pancreatic cancer. (If major gene models can be delineated, they will be used in gene discovery strategies of the larger study). Segregation analysis using family data on pancreatic cancer probands will be conducted. Previously suggested risk factors, including diabetes, pancreatitis, and tobacco exposure, will be included in the analysis to determine how they modify cancer risk. Secondary objectives of this proposed study are: assessment of how ascertainment bias can affect the results of segregation analysis (an important design issue in genetic analysis of complex diseases); to determine if this bias can be adequately

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corrected; and to develop methods to create a sample representative of the general population from a hospital based tumor registry. Patients with pancreatic cancer have already been identified from the Johns Hopkins Hospital Tumor Registry and Johns Hopkins Bayview Medical Center and contacted by mail. A sample of these respondents that is representative of all Maryland pancreatic cancer cases will be constructed based upon characteristics identified from the Maryland Cancer Registry. Segregation analysis will be performed on the constructed sample population. Additionally, a separate segregation analysis will be performed on the families enrolled in the National Familial Pancreatic Tumor Registry, which has been developed from referrals (primarily selfreferred from the Internet through a Website). This analysis will incorporate novel statistical methods to correct for the highly ascertained nature of the latter population. The two analyses will then be compared to assess the impact of ascertainment bias on segregation analysis and effectiveness of correction methods. This project thus anticipates the new analytic challenges of Internet-based subject accrual, as well as providing a basis for a large-multicenter study to understand the genetic etiology of pancreas cancer. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Peptides and Pancreatic Cancer Principal Investigator & Institution: Smith, Jill P.; Medicine; Pennsylvania State Univ Hershey Med Ctr 500 University Dr Hershey, Pa 17033 Timing: Fiscal Year 2000; Project Start 0-SEP-1999; Project End 9-SEP-2004 Summary: Pancreatic cancer is a fatal disease resulting in nearly 30,000 deaths annually in the United States. From the time of diagnosis, the median survival ranges from 3 to 6 months, giving pancreatic cancer the most dismal prognosis of all malignancies. Some of the reasons for this discouraging outlook include the aggressive nature of pancreatic cancer, its resistance to standard chemotherapy and radiation therapy, and the inability to detect this malignancy in earlier stages. Our research group has been studying the mechanisms concerning the origins and growth regulation of pancreatic cancer with the long-range goals of designing strategies for early diagnosis and novel treatment. In preliminary studies, the candidate has discovered that the gastrointestinal peptides gastrin and CCK regulate growth of human pancreatic cancer through a unique CCK-B/gastrin-like receptor. Other investigations have documented that an endogenous peptide called opioid growth factor serves as a regulatory agent for pancreatic cancer where it represses growth through a nuclearassociated receptor, zeta. This grant hypothesizes that growth of human pancreatic cancer can be inhibited by manipulation of the regulatory


peptides involved in controlling the tumorigenic events. In order to test this hypothesis, the following specific aims are proposed. 1) Study the role of regulatory peptides in growth of human pancreatic cancer, 2) Evaluate human pancreatic tissue and blood specimens to develop tumor markers for the early detection of pancreatic cancer, 3) Design clinical trials to test the efficacy of peptides, antisense oligonucleotides, or antibodies in human subjects with pancreatic cancer, and 4) Provide time to allow the candidate to understand clinical research and serve as a mentor to students and clinician scientists. These studies are part of the applicant's long-range objectives which include the understanding of the role of peptides in pancreatic cancer and to extend her basic science research into therapeutic clinical trials in human subjects. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: The Panins of Pancreatitis,Pancreas Cancer and Controls Principal Investigator & Institution: Goggins, Michael G.; Pathology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 1-JUL-2001; Project End 0-JUN2003 Summary: Pancreatic cancer is the fifth leading cause of cancer death in the USA. Unfortunately, there is currently no effective screening test for asymptomatic disease and the vast majority of patients with pancreatic cancer present with advanced incurable disease. An effective method to detect early pancreatic cancers is urgently needed. This need is perhaps greatest in groups known to have an increased risk of developing pancreatic cancer. For example, patients with sporadic chronic pancreatitis have a lifetime risk of developing pancreatic cancer that approaches 4% and for patients with hereditary pancreatitis, the lifetime risk of pancreatic cancer is very high (approximately 50%). An improved understanding of early neoplasia in patients with chronic pancreatitis should form the foundation on which novel approaches to the early identification of invasive cancer could be developed. Several lines of evidence suggests that the precursor lesions of pancreatic carcinoma are the duct lesions known as pancreatic intraepithelial neoplasias (PanINs). First, PanINs are more common in pancreata with cancer than they were in pancreata without cancer. Second, PanINs found in pancreata with pancreatic cancer harbor many of the same genetic alterations as are found in pancreatic cancer such as activation of K-ras and inactivation of p16, DPC4, p53, and BRCA2. Third, several case studies report patients with PanINs progressing to invasive pancreatic cancer. Despite the risk of pancreatic cancer among patients with chronic pancreatitis, the genetic alterations in the PanINs from patients with chronic pancreatitis have not

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been well-studied. The aim of this study is to compare the frequency, timing and mechanism of several molecular events important for neoplastic progression in PanINs found in the setting of pancreatic cancer with PanINs found in the setting of chronic pancreatitis- associated and with PanINs from other benign pancreatic conditions. Specifically, using genetic, DNA methylation, and immunohistochemical techniques to compare the rates of a) genetic inactivation of DPC4 and b) genetic and epigenetic inactivation of p16 in 40 PanINs that arose in the setting of chronic pancreatitis 40 PanINs that arose in the setting of pancreatic cancer and 40 PanINs that arose in pancreata resected for benign pancreatic conditions without malignant potential. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

E-Journals: PubMed Central27 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).28 Access to this growing archive of e-journals is free and unrestricted.29 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “pancreatic cancer” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for pancreatic cancer in the PubMed Central database: ·

A combinatorial approach for selectively inducing programmed cell death in human pancreatic cancer cells by Zao-zhong Su, Irina V. Lebedeva, Rahul V. Gopalkrishnan, Neil I. Goldstein, C. A. Stein, John C. Reed, Paul Dent, and Paul B. Fisher; 2001 August 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=56961

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A Metastatic Nude-Mouse Model of Human Pancreatic Cancer Constructed Orthotopically with Histologically Intact Patient Specimens by X Fu, F Guadagni, and RM Hoffman; 1992 June 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=49349

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 28 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 29 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 27


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Amplification of AKT2 in Human Pancreatic Cancer Cells and Inhibition of AKT2 Expression and Tumorigenicity by Antisense RNA by JQ Cheng, B Ruggeri, WM Klein, G Sonoda, DA Altomare, DK Watson, and JR Testa; 1996 April 16 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39663

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Cytokine-mediated enhancement of epidermal growth factor receptor expression provides an immunological approach to the therapy of pancreatic cancer by Wolff Schmiegel, Jan Schmielau, Doris HenneBruns, Hartmut Juhl, Christian Roeder, Peter Buggisch, Aydin Onur, Bernd Kremer, Holger Kalthoff, and Elwood V. Jensen; 1997 November 11 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=25059

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Effect of flutamide on survival in patients with pancreatic cancer: results of a prospective, randomised, double blind, placebo controlled trial by Brian A Greenway; 1998 June 27 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28589

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Formation of the Tetraploid Intermediate is Associated with the Development of Cells with More Than Four Centrioles in the ElastaseSimian Virus 40 Tumor Antigen Transgenic Mouse Model of Pancreatic Cancer by DS Levine, CA Sanchez, PS Rabinovitch, and BJ Reid; 1991 August 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=52098

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Regular use of aspirin and pancreatic cancer risk by Ravi J. Menezes, Kenneth R. Huber, Martin C. Mahoney, and Kirsten B. Moysich; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=126211

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Sub-lethal radiation enhances anti-tumor immunotherapy in a transgenic mouse model of pancreatic cancer by Zhu Alexander Cao, Dylan Daniel, and Douglas Hanahan; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=113758

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Tumor Necrosis Factor [alpha] Induces the Expression of Transforming Growth Factor [alpha] and the Epidermal Growth Factor Receptor in Human Pancreatic Cancer Cells by W Schmiegel, C Roeder, J Schmielau, U Rodeck, and H Kalthoff; 1993 February 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=45770

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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.30 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with pancreatic cancer, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “pancreatic cancer” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “pancreatic cancer” (hyperlinks lead to article summaries): ·

5-Lipoxygenase and leukotriene B(4) receptor are expressed in human pancreatic cancers but not in pancreatic ducts in normal tissue. Author(s): Hennig R, Ding XZ, Tong WG, Schneider MB, Standop J, Friess H, Buchler MW, Pour PM, Adrian TE. Source: American Journal of Pathology. 2002 August; 161(2): 421-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12163367&dopt=Abstract

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A comparison of intraoperative celiac plexus block with pharmacological therapy as a treatment for pain of unresectable pancreatic cancer. Author(s): Okuyama M, Shibata T, Morita T, Kitada M, Tukahara Y, Fukushima Y, Ikeda K, Fuzita J, Shimano T. Source: Journal of Hepato-Biliary-Pancreatic Surgery. 2002; 9(3): 372-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12353149&dopt=Abstract

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A critical review of T cell targeting immunotherapy in pancreatic cancer: only a hypothesis or a real hope for the patients? Author(s): Bruserud O, Glenjen N. Source: Expert Opinion on Biological Therapy. 2002 October; 2(7): 693701. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12387668&dopt=Abstract

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A double-blind placebo-controlled, randomised study comparing gemcitabine and marimastat with gemcitabine and placebo as first line therapy in patients with advanced pancreatic cancer. Author(s): Bramhall SR, Schulz J, Nemunaitis J, Brown PD, Baillet M, Buckels JA. Source: British Journal of Cancer. 2002 July 15; 87(2): 161-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12107836&dopt=Abstract

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A new liver metastatic and peritoneal dissemination model established from the same human pancreatic cancer cell line: analysis using cDNA macroarray. Author(s): Nomura H, Nishimori H, Yasoshima T, Hata F, Tanaka H, Nakajima F, Honma T, Araya J, Kamiguchi K, Isomura H, Sato N, Denno R, Hirata K. Source: Clinical & Experimental Metastasis. 2002; 19(5): 391-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12198767&dopt=Abstract

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A nitroimidazole derivative, PR-350, enhances the killing of pancreatic cancer cells exposed to high-dose irradiation under hypoxia. Author(s): Mizumoto K, Qian LW, Zhang L, Nagai E, Kura S, Tanaka M. Source: Journal of Radiation Research. 2002 March; 43(1): 43-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12056329&dopt=Abstract

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A phase I trial of weekly gemcitabine and concurrent radiotherapy in patients with locally advanced pancreatic cancer. Author(s): Ikeda M, Okada S, Tokuuye K, Ueno H, Okusaka T. Source: British Journal of Cancer. 2002 May 20; 86(10): 1551-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12085203&dopt=Abstract

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A phase II study of gemcitabine and tamoxifen in advanced pancreatic cancer. Author(s): Tomao S, Romiti A, Massidda B, Ionta MT, Farris A, Zullo A, Brescia A, Santuari L, Frati L. Source: Anticancer Res. 2002 July-August; 22(4): 2361-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12174927&dopt=Abstract

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A prospective study of medical conditions, anthropometry, physical activity, and pancreatic cancer in male smokers (Finland). Author(s): Stolzenber-Solomon RZ, Pietinen P, Taylor PR, Virtamo J, Albanes D. Source: Cancer Causes & Control : Ccc. 2002 June; 13(5): 417-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12146846&dopt=Abstract

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A protein kinase C inhibitor induces phenotypic reversion of rastransformed pancreatic cancer cells and cooperatively blocks tumor cell proliferation with an anti- ras peptide. Author(s): Way D, Smith S, Sivendran S, Chie L, Kanovsky M, BrandtRauf PW, Chung DL, Michl J, Pincus MR. Source: Cancer Chemotherapy and Pharmacology. 2002 June; 49(6): 42937. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12107546&dopt=Abstract

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A role for survivin in radioresistance of pancreatic cancer cells. Author(s): Asanuma K, Kobayashi D, Furuya D, Tsuji N, Yagihashi A, Watanabe N. Source: Japanese Journal of Cancer Research : Gann. 2002 September; 93(9): 1057-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12359060&dopt=Abstract

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Abnormal differentiation of islet cells in pancreatic cancer. Author(s): Pour PM, Schmied BM, Ulrich AB, Friess H, Andren-Sandberg A, Buchler MW. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap) . [et Al.]. 2001; 1(2): 110-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12120188&dopt=Abstract


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Absence of mutations in the transforming growth factor-beta inducible early gene 1, TIEG1, in pancreatic cancer. Author(s): Antonello D, Moore PS, Zamboni G, Falconi M, Scarpa A. Source: Cancer Letters. 2002 September 26; 183(2): 179-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12065093&dopt=Abstract

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Acinar-to-ductal metaplasia in pancreatic cancer development. Author(s): Schmid RM. Source: The Journal of Clinical Investigation. 2002 June; 109(11): 1403-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12045253&dopt=Abstract

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Acquired resistance of pancreatic cancer cells towards 5-Fluorouracil and gemcitabine is associated with altered expression of apoptosisregulating genes. Author(s): Shi X, Liu S, Kleeff J, Friess H, Buchler MW. Source: Oncology. 2002; 62(4): 354-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12138244&dopt=Abstract

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Activation of peroxisome proliferator-activated receptor gamma inhibits the growth of human pancreatic cancer. Author(s): Sasaki T, Fujimoto Y, Tsuchida A, Kawasaki Y, Kuwada Y, Chayama K. Source: Pathobiology: Journal of Immunopathology, Molecular and Cellular Biology. 2001; 69(5): 258-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12107343&dopt=Abstract

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Adenoviral mediated suicide gene transfer in the treatment of pancreatic cancer. Author(s): Pan X, Li Z, Xu G, Et Al. Source: Chin Med J (Engl). 2002 August; 115(8): 1205-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12215293&dopt=Abstract

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Advanced pancreatic cancer-5 years on. Author(s): Rao S, Cunningham D.

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Source: Annals of Oncology : Official Journal of the European Society for Medical Oncology / Esmo. 2002 August; 13(8): 1165-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12181237&dopt=Abstract ·

Alcohol abuse and the risk of pancreatic cancer. Author(s): Ye W, Lagergren J, Weiderpass E, Nyren O, Adami HO, Ekbom A. Source: Gut. 2002 August; 51(2): 236-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12117886&dopt=Abstract

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Analysis of factors influencing the diagnostic failure of intraoperative fine needle aspiration cytology in pancreatic cancer. Author(s): Molino D, Perrotti P, Antropoli C, Napoli V, Bottino V, Antropoli M, Gargano E. Source: Chir Ital. 2002 May-June; 54(3): 289-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12192921&dopt=Abstract

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Antiproliferative activity induced by the somatostatin analogue, TT232, in human pancreatic cancer cells. Author(s): Lee JU, Hosotani R, Wada M, Doi R, Koshiba T, Fujimoto K, Miyamoto Y, Tsuji S, Nakajima S, Hirohashi M, Uehara T, Arano Y, Fujii N, Imamura M. Source: European Journal of Cancer (Oxford, England : 1990). 2002 July; 38(11): 1526-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12110500&dopt=Abstract

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Antisense oligonucleotides specific to mutated K-ras genes inhibit invasiveness of human pancreatic cancer cell lines. Author(s): Nakada Y, Saito S, Ohzawa K, Morioka CY, Kita K, Minemura M, Takahara T, Watanabe A. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap) . [et Al.]. 2001; 1(4): 314-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12120210&dopt=Abstract

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Antitumor effect of in vivo somatostatin receptor subtype 2 gene transfer in primary and metastatic pancreatic cancer models.


Author(s): Vernejoul F, Faure P, Benali N, Calise D, Tiraby G, Pradayrol L, Susini C, Buscail L. Source: Cancer Research. 2002 November 1; 62(21): 6124-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12414637&dopt=Abstract ·

Antitumor effects induced by dendritic cell-based immunotherapy against established pancreatic cancer in hamsters. Author(s): Akiyama Y, Maruyama K, Nara N, Hojo T, Cheng JY, Mori T, Wiltrout RH, Yamaguchi K. Source: Cancer Letters. 2002 October 8; 184(1): 37-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12104046&dopt=Abstract

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Arsenic trioxide inhibits proliferation and induces apoptosis in pancreatic cancer cells. Author(s): Li X, Ding X, Adrian TE. Source: Anticancer Res. 2002 July-August; 22(4): 2205-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12174905&dopt=Abstract

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Aspirin may lower risk of pancreatic cancer. Author(s): Hitt E. Source: The Lancet Oncology. 2002 September; 3(9): 518. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12217773&dopt=Abstract

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Association between nonsteroidal anti-inflammatory drug use and the incidence of pancreatic cancer. Author(s): Anderson KE, Johnson TW, Lazovich D, Folsom AR. Source: Journal of the National Cancer Institute. 2002 August 7; 94(15): 1168-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12165642&dopt=Abstract

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Bax-induction gene therapy of pancreatic cancer. Author(s): Pirocanac EC, Nassirpour R, Yang M, Wang J, Nardin SR, Gu J, Fang B, Moossa AR, Hoffman RM, Bouvet M.

Studies 139

Source: The Journal of Surgical Research. 2002 August; 106(2): 346-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12175991&dopt=Abstract ·

Bilio-digestive double bypass for nonresectable pancreatic cancer. Author(s): Heinicke JM, Buchler MW, Laffer UT. Source: Digestive Surgery. 2002; 19(3): 165-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12119516&dopt=Abstract

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Chronic pancreatitis and pancreatic cancer. Author(s): Maisonneuve P, Lowenfels AB. Source: Digestive Diseases (Basel, Switzerland). 2002; 20(1): 32-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12145418&dopt=Abstract

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C-Ki-ras mutations in peripheral blood of pancreatic cancer patients: a marker for early tumor metastasis. Author(s): Mohiuddin M, Ahmed MM, Venkatasubbarao K. Source: International Journal of Radiation Oncology, Biology, Physics. 1996 January 1; 34(1): 161-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12118546&dopt=Abstract

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Clinicopathological Significance of Abnormalities in Gadd45 Expression and Its Relationship to p53 in Human Pancreatic Cancer. Author(s): Yamasawa K, Nio Y, Dong M, Yamaguchi K, Itakura M. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2002 August; 8(8): 2563-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12171884&dopt=Abstract

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Common occurrence of multiple K-RAS mutations in pancreatic cancers with associated precursor lesions and in biliary cancers. Author(s): Laghi L, Orbetegli O, Bianchi P, Zerbi A, Di Carlo V, Boland CR, Malesci A. Source: Oncogene. 2002 June 20; 21(27): 4301-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12082617&dopt=Abstract

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CT or MRI for Predicting Vascular Involvement in Pancreatic Cancer? Author(s): Samel ST, Sturm J, Gaa J.


Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap) . [et Al.]. 2002; 2(4): 425-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12138233&dopt=Abstract ·

Cyclooxygenases and lipoxygenases as potential targets for treatment of pancreatic cancer. Author(s): Ding XZ, Tong WG, Adrian TE. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap) . [et Al.]. 2001; 1(4): 291-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12120207&dopt=Abstract

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Cytokine regulation of constitutive production of interleukin-8 and -6 by human pancreatic cancer cell lines and serum cytokine concentrations in patients with pancreatic cancer. Author(s): Wigmore SJ, Fearon KC, Sangster K, Maingay JP, Garden OJ, Ross JA. Source: International Journal of Oncology. 2002 October; 21(4): 881-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12239630&dopt=Abstract

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Detection of genetic alterations in pancreatic cancers by comparative genomic hybridization coupled with tissue microdissection and degenerate oligonucleotide primed polymerase chain reaction. Author(s): Harada T, Okita K, Shiraishi K, Kusano N, Furuya T, Oga A, Kawauchi S, Kondoh S, Sasaki K. Source: Oncology. 2002; 62(3): 251-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12065873&dopt=Abstract

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Dietary sugar, glycemic load, and pancreatic cancer risk in a prospective study. Author(s): Michaud DS, Liu S, Giovannucci E, Willett WC, Colditz GA, Fuchs CS. Source: Journal of the National Cancer Institute. 2002 September 4; 94(17): 1293-300. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12208894&dopt=Abstract

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Differential diagnosis between chronic pancreatitis and pancreatic cancer: value of the detection of KRAS2 mutations in circulating DNA.

Studies 141

Author(s): Maire F, Micard S, Hammel P, Voitot H, Levy P, Cugnenc PH, Ruszniewski P, Puig PL. Source: British Journal of Cancer. 2002 August 27; 87(5): 551-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12189555&dopt=Abstract ·

Differential display of expressed genes in pancreatic cancer cells. Author(s): Gardner-Thorpe J, Ito H, Ashley SW, Whang EE. Source: Biochemical and Biophysical Research Communications. 2002 April 26; 293(1): 391-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12054612&dopt=Abstract

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Discussion on 3-hydroxy-3-methylglutaryl-coenzyme a reductase inhibitors reduce human pancreatic cancer cell invasion and metastasis. Author(s): Kaminski R, Kozar K, Kopec M, Basak G, Skierski JS, Koronkiewicz M, Jakobisiak M, Golab J. Source: Gastroenterology. 2002 November; 123(5): 1747. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12404258&dopt=Abstract

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Does extended lymphadenectomy improve survival of pancreatic cancer patients? Author(s): Popiela T, Kedra B, Sierzega M. Source: Acta Chir Belg. 2002 April; 102(2): 78-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12051095&dopt=Abstract

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Does neoadjuvant chemoradiation downstage locally advanced pancreatic cancer? Author(s): Kim HJ, Czischke K, Brennan MF, Conlon KC. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2002 September-October; 6(5): 763-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12399067&dopt=Abstract

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Dominant negative MEKK1 inhibits survival of pancreatic cancer cells. Author(s): Hirano T, Shino Y, Saito T, Komoda F, Okutomi Y, Takeda A, Ishihara T, Yamaguchi T, Saisho H, Shirasawa H.


Source: Oncogene. 2002 August 29; 21(38): 5923-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12185592&dopt=Abstract ·

Early pancreatic cancer. Author(s): Tsuchiya R, Tajima Y, Matsuzaki S, Onizuka S, Kanematsu T. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap) . [et Al.]. 2001; 1(6): 597-603. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12120242&dopt=Abstract

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Effect of the vascular endothelial growth factor receptor-2 antibody DC101 plus gemcitabine on growth, metastasis and angiogenesis of human pancreatic cancer growing orthotopically in nude mice. Author(s): Bruns CJ, Shrader M, Harbison MT, Portera C, Solorzano CC, Jauch KW, Hicklin DJ, Radinsky R, Ellis LM. Source: International Journal of Cancer. Journal International Du Cancer. 2002 November 10; 102(2): 101-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12385004&dopt=Abstract

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Effects of Celebrex and Zyflo on BOP-induced pancreatic cancer in Syrian hamsters. Author(s): Wenger FA, Kilian M, Achucarro P, Heinicken D, Schimke I, Guski H, Jacobi CA, Muller JM. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap) . [et Al.]. 2002; 2(1): 54-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12120008&dopt=Abstract

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Effects of cisplatin on expression of DNA ligases in MiaPaCa human pancreatic cancer cells. Author(s): Sun D, Urrabaz R, Buzello C, Nguyen M. Source: Biochemical and Biophysical Research Communications. 2002 November 8; 298(4): 537-544. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12408985&dopt=Abstract

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Efficacy of ukrain in the treatment of pancreatic cancer. Author(s): Zemskov V, Prokopchuk O, Susak Y, Zemskov S, Tkachenko O, Hodysh Y, Nowicky W.

Studies 143

Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 2002 June; 387(2): 84-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12111260&dopt=Abstract ·

Eosinophilic gastroenteritis mimicking pancreatic cancer. Author(s): Christopher V, Thompson MH, Hughes S. Source: Postgraduate Medical Journal. 2002 August; 78(922): 498-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12185230&dopt=Abstract

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Epidemiologic and etiologic factors of pancreatic cancer. Author(s): Lowenfels AB, Maisonneuve P. Source: Hematology/Oncology Clinics of North America. 2002 February; 16(1): 1-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12063821&dopt=Abstract

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Epidermal growth factor receptor-targeted therapy for pancreatic cancer. Author(s): Xiong HQ, Abbruzzese JL. Source: Seminars in Oncology. 2002 October; 29(5 Suppl 14): 31-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12422311&dopt=Abstract

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EUS in pancreatic cancer. Author(s): Kochman ML. Source: Gastrointestinal Endoscopy. 2002 October; 56(4 Suppl): S6-S12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12297741&dopt=Abstract

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Evaluation of candidate genes MAP2K4, MADH4, ACVR1B, and BRCA2 in familial pancreatic cancer: deleterious BRCA2 mutations in 17%. Author(s): Murphy KM, Brune KA, Griffin C, Sollenberger JE, Petersen GM, Bansal R, Hruban RH, Kern SE. Source: Cancer Research. 2002 July 1; 62(13): 3789-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12097290&dopt=Abstract


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Evidence for a major gene influencing risk of pancreatic cancer. Author(s): Klein AP, Beaty TH, Bailey-Wilson JE, Brune KA, Hruban RH, Petersen GM. Source: Genetic Epidemiology. 2002 August; 23(2): 133-49. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12214307&dopt=Abstract

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Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis. Author(s): Schafer M, Mullhaupt B, Clavien PA. Source: Annals of Surgery. 2002 August; 236(2): 137-48. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12170018&dopt=Abstract

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Exploiting molecular targets in pancreatic cancer. Author(s): Wolff RA. Source: Hematology/Oncology Clinics of North America. 2002 February; 16(1): 139-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12063824&dopt=Abstract

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Expression of clusterin in human pancreatic cancer. Author(s): Xie MJ, Motoo Y, Su SB, Mouri H, Ohtsubo K, Matsubara F, Sawabu N. Source: Pancreas. 2002 October; 25(3): 234-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12370533&dopt=Abstract

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Expression spectrum and methylation-dependent regulation of melanoma antigen-encoding gene family members in pancreatic cancer cells. Author(s): Bert T, Lubomierski N, Gangsauge S, Munch K, Printz H, Prasnikar N, Robbel C, Simon B. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap) . [et Al.]. 2002; 2(2): 146-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12123095&dopt=Abstract

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Farnesyltransferase inhibitor (L-744,832) restores TGF-beta type II receptor expression and enhances radiation sensitivity in K-ras mutant pancreatic cancer cell line MIA PaCa-2.

Studies 145

Author(s): Alcock RA, Dey S, Chendil D, Inayat MS, Mohiuddin M, Hartman G, Chatfield LK, Gallicchio VS, Ahmed MM. Source: Oncogene. 2002 November 7; 21(51): 7883-7890. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12420225&dopt=Abstract ·

Frequent amplification of 8q24, 11q, 17q, and 20q-specific genes in pancreatic cancer. Author(s): Mahlamaki EH, Barlund M, Tanner M, Gorunova L, Hoglund M, Karhu R, Kallioniemi A. Source: Genes, Chromosomes & Cancer. 2002 December; 35(4): 353-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12378529&dopt=Abstract

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Gadd45a: An Elusive Yet Attractive Candidate Gene in Pancreatic Cancer : Commentary re: K. Yamasawa et al., Clinicopathological Significance of Abnormalities in Gadd45 Expression and Its Relationship to p53 in Human Pancreatic Cancer. Clin. Cancer Res., 8: 2563-2569, 2002. Author(s): Hildesheim J, Fornace AJ Jr. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2002 August; 8(8): 2475-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12171872&dopt=Abstract

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Gemcitabine and oxaliplatin for patients with advanced or metastatic pancreatic cancer: a North Central Cancer Treatment Group (NCCTG) phase I study. Author(s): Alberts SR, Townley PM, Goldberg RM, Cha SS, Moore DF Jr, Krook JE, Pitot HC, Fitch TR, Wiesenfeld M, Mailliard JA, Sargent DJ. Source: Annals of Oncology : Official Journal of the European Society for Medical Oncology / Esmo. 2002 April; 13(4): 553-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12056705&dopt=Abstract

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Gemcitabine and platinum combinations in pancreatic cancer. Author(s): Philip PA. Source: Cancer. 2002 August 15; 95(4 Suppl): 908-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12209670&dopt=Abstract


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Gemcitabine in combination with 5-fluorouracil with or without folinic acid in the treatment of pancreatic cancer. Author(s): Oettle H, Riess H. Source: Cancer. 2002 August 15; 95(4 Suppl): 912-22. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12209671&dopt=Abstract

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Gemcitabine or gemcitabine plus cisplatin for in 42 patients with locally advanced or metastatic pancreatic cancer. Author(s): Wang X, Ni Q, Jin M, Li Z, Wu Y, Zhao Y, Feng F. Source: Zhonghua Zhong Liu Za Zhi. 2002 July; 24(4): 404-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12408777&dopt=Abstract

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Gene therapy for intraperitoneally disseminated pancreatic cancers by Escherichia coli uracil phosphoribosiltransferase (UPRT) gene mediated by restricted replication-competent adenoviral vectors. Author(s): Oonuma M, Sunamura M, Motoi F, Fukuyama S, Shimamura H, Yamauchi J, Shibuya K, Egawa S, Hamada H, Takeda K, Matsuno S. Source: International Journal of Cancer. Journal International Du Cancer. 2002 November 1; 102(1): 51-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12353234&dopt=Abstract

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Gene therapy for pancreatic cancer using an adenovirus vector encoding soluble flt-1 vascular endothelial growth factor receptor. Author(s): Hoshida T, Sunamura M, Duda DG, Egawa S, Miyazaki S, Shineha R, Hamada H, Ohtani H, Satomi S, Matsuno S. Source: Pancreas. 2002 August; 25(2): 111-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12142732&dopt=Abstract

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Gene transduction of NK4, HGF antagonist, inhibits in vitro invasion and in vivo growth of human pancreatic cancer. Author(s): Maehara N, Nagai E, Mizumoto K, Sato N, Matsumoto K, Nakamura T, Narumi K, Nukiwa T, Tanaka M. Source: Clinical & Experimental Metastasis. 2002; 19(5): 417-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12198770&dopt=Abstract

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Gene-environment interactions in pancreatic cancer. Author(s): Malats N.

Studies 147

Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap) . [et Al.]. 2001; 1(5): 472-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12120227&dopt=Abstract ·

Genetic basis of pancreatic cancer. Author(s): Schmid RM. Source: Best Practice & Research. Clinical Gastroenterology. 2002 June; 16(3): 421-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12079267&dopt=Abstract

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German national case collection of familial pancreatic cancer - clinicalgenetic analysis of the first 21 families. Author(s): Rieder H, Sina-Frey M, Ziegler A, Hahn SA, Przypadlo E, Kress R, Gerdes B, Colombo Benkmann M, Eberl T, Grutzmann R, Lorken M, Schmidt J, Bartsch DK. Source: Onkologie. 2002 June; 25(3): 262-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12119461&dopt=Abstract

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Granulocyte-colony stimulating factor enhances chimeric antibody Nd2 dependent cytotoxicity against pancreatic cancer mediated by polymorphonuclear neutrophils. Author(s): Tamamori Y, Sawada T, Nishihara T, Yamashita Y, Ohira M, Ho JJ, Kim YS, Hirakawa-Ys Chung K. Source: International Journal of Oncology. 2002 September; 21(3): 649-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12168113&dopt=Abstract

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Hereditary pancreatic cancer. Author(s): Lynch HT, Brand RE, Deters CA, Shaw TG, Lynch JF. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap) . [et Al.]. 2001; 1(5): 466-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12120226&dopt=Abstract

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High prevalence of diabetes in patients with pancreatic cancer in central Anatolia, Turkey. Author(s): Cetin M, Colak R, Bayram F, Altinbas M, Unal A, Kelestimur F.


Source: Diabetes Research and Clinical Practice. 2002 November; 58(2): 97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12213350&dopt=Abstract ·

High response rates in patients with pancreatic cancer using the novel oral fluoropyrimidine S-1. Author(s): Hayashi K, Imaizumi T, Uchida K, Kuramochi H, Takasaki K. Source: Oncol Rep. 2002 November-December; 9(6): 1355-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12375048&dopt=Abstract

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High-dose intraoperative radiotherapy for unresectable pancreatic cancer. Author(s): Shibamoto Y, Manabe T, Ohshio G, Sasai K, Nishimura Y, Imamura M, Takahashi M, Abe M. Source: International Journal of Radiation Oncology, Biology, Physics. 1996 January 1; 34(1): 57-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12118565&dopt=Abstract

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Hyperstable U1snRNA complementary to the K-ras transcripts induces cell death in pancreatic cancer cells. Author(s): Kato K, Hitomi Y, Imamura K, Esumi H. Source: British Journal of Cancer. 2002 October 7; 87(8): 898-904. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12373606&dopt=Abstract

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Hypoxia enhances the expression of autocrine motility factor and the motility of human pancreatic cancer cells. Author(s): Niizeki H, Kobayashi M, Horiuchi I, Akakura N, Chen J, Wang J, Hamada JI, Seth P, Katoh H, Watanabe H, Raz A, Hosokawa M. Source: British Journal of Cancer. 2002 June 17; 86(12): 1914-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12085186&dopt=Abstract

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IIIc isoform of fibroblast growth factor receptor 1 is overexpressed in human pancreatic cancer and enhances tumorigenicity of hamster ductal cells. Author(s): Kornmann M, Ishiwata T, Matsuda K, Lopez ME, Fukahi K, Asano G, Beger HG, Korc M.

Studies 149

Source: Gastroenterology. 2002 July; 123(1): 301-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12105858&dopt=Abstract ·

Imaging pancreatic cancer: the role of multidetector CT with threedimensional CT angiography. Author(s): Fishman EK, Horton KM. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap) . [et Al.]. 2001; 1(6): 610-24. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12120244&dopt=Abstract

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Immunotherapy for pancreatic cancer: current concepts. Author(s): Kaufman HL, Di Vito J Jr, Horig H. Source: Hematology/Oncology Clinics of North America. 2002 February; 16(1): 159-97, Viii. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12063825&dopt=Abstract

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Increased arylhydrocarbon receptor expression offers a potential therapeutic target for pancreatic cancer. Author(s): Koliopanos A, Kleeff J, Xiao Y, Safe S, Zimmermann A, Buchler MW, Friess H. Source: Oncogene. 2002 September 5; 21(39): 6059-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12203118&dopt=Abstract

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Inducible nitric oxide synthase (iNOS) immunoreactivity and its relationship to cell proliferation, apoptosis, angiogenesis, clinicopathologic characteristics, and patient survival in pancreatic cancer. Author(s): Kong G, Kim EK, Kim WS, Lee YW, Lee JK, Paik SW, Rhee JC, Choi KW, Lee KT. Source: Int J Pancreatol. 2001; 29(3): 133-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12067216&dopt=Abstract

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Induction and expression of betaig-h3 in pancreatic cancer cells. Author(s): Schneider D, Kleeff J, Berberat P, Zhu Z, Korc M, Friess H, Buchler M.


Source: Biochimica Et Biophysica Acta. 2002 October 9; 1588(1): 1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12379307&dopt=Abstract ·

Induction of DNA Ligase I by 1-beta-D-Arabinosylcytosine and Aphidicolin in MiaPaCa Human Pancreatic Cancer Cells. Author(s): Sun D, Urrabaz R, Buzello C, Nguyen M. Source: Experimental Cell Research. 2002 October 15; 280(1): 90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12372342&dopt=Abstract

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Influence of conjugated vs. conventional linoleic acid on liver metastasis and hepatic lipidperoxidation in BOP-induced pancreatic cancer in Syrian hamster. Author(s): Kilian M, Mautsch I, Gregor JI, Stahlknecht P, Jacobi CA, Schimke I, Guski H, Wenger FA. Source: Prostaglandins, Leukotrienes, and Essential Fatty Acids. 2002 October; 67(4): 223-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12401436&dopt=Abstract

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Inherited pancreatic cancer: surveillance and treatment strategies for affected families. Author(s): Rulyak SJ, Brentnall TA. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap) . [et Al.]. 2001; 1(5): 477-85. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12120228&dopt=Abstract

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Intraductal Spread of Pancreatic Cancer. clinicopathologic study of 54 pancreatectomized patients. Author(s): Yamasaki S, Suda K, Nobukawa B, Sonoue H. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap) . [et Al.]. 2002; 2(4): 407-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12138230&dopt=Abstract

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Intraperitoneal injection of adenovirus-mediated NK4 gene suppresses peritoneal dissemination of pancreatic cancer cell line AsPC-1 in nude mice. Author(s): Saimura M, Nagai E, Mizumoto K, Maehara N, Okino H, Katano M, Matsumoto K, Nakamura T, Narumi K, Nukiwa T, Tanaka M.

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Source: Cancer Gene Therapy. 2002 October; 9(10): 799-806. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12224019&dopt=Abstract ·

Irinotecan, cisplatin and mitomycin in inoperable gastro-oesophageal and pancreatic cancers - a new active regimen. Author(s): Slater S, Shamash J, Wilson P, Gallagher CJ, Slevin ML. Source: British Journal of Cancer. 2002 October 7; 87(8): 850-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12373598&dopt=Abstract

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Irinotecan/gemcitabine followed by twice-weekly gemcitabine/radiation in locally advanced pancreatic cancer. Author(s): Blackstock AW, Melin SA, Butler JM, Patton S, Pineau B, Albertson D, Howerton R, Levine E. Source: Oncology (Huntingt). 2002 May; 16(5 Suppl 5): 25-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12109802&dopt=Abstract

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Irsogladine Malate Up-regulates Gap Junctional Intercellular Communication Between Pancreatic Cancer Cells Via PKA Pathway. Author(s): Kawasaki Y, Tsuchida A, Sasaki T, Yamasaki S, Kuwada Y, Murakami M, Chayama K. Source: Pancreas. 2002 November; 25(4): 373-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12409832&dopt=Abstract

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Leukotriene B4 receptor antagonist LY293111 inhibits proliferation and induces apoptosis in human pancreatic cancer cells. Author(s): Tong WG, Ding XZ, Hennig R, Witt RC, Standop J, Pour PM, Adrian TE. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2002 October; 8(10): 3232-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12374694&dopt=Abstract

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Locally advanced pancreatic cancer treated with radiation and 5fluorouracil. Author(s): Mawdsley S, Hall M, Glynne-Jones R.


Source: Clin Oncol (R Coll Radiol). 2002 August; 14(4): 308-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12206644&dopt=Abstract ·

Locoregional Chemotherapy for Patients with Pancreatic Cancer Intraarterial Adjuvant Chemotherapy After Pancreatectomy with Portal Vein Resection. Author(s): Yamaue H, Tani M, Onishi H, Kinoshita H, Nakamori M, Yokoyama S, Iwahashi M, Uchiyama K. Source: Pancreas. 2002 November; 25(4): 366-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12409831&dopt=Abstract

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Low Sensitivity of the ki-ras Polymerase Chain Reaction for Diagnosing Pancreatic Cancer From Pancreatic Juice and Bile: A Multicenter Prospective Trial. Author(s): Trumper L, Menges M, Daus H, Kohler D, Reinhard JO, Sackmann M, Moser C, Sek A, Jacobs G, Zeitz M, Pfreundschuh M. Source: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. 2002 November 1; 20(21): 4331-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12409332&dopt=Abstract

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Low-dose trimetrexate glucuronate and protracted 5-fluorouracil infusion in previously untreated patients with advanced pancreatic cancer. Author(s): Amado RG, Rosen LS, Hecht JR, Lin LS, Rosen PJ. Source: Annals of Oncology: Official Journal of the European Society for Medical Oncology / Esmo. 2002 April; 13(4): 582-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12056709&dopt=Abstract

Vocabulary Builder Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of

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blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Anthropometry: The technique that deals with the measurement of the size, weight, and proportions of the human or other primate body. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Aphidicolin: An antiviral antibiotic produced by Cephalosporium aphidicola and other fungi. It inhibits the growth of eukaryotic cells and certain animal viruses by selectively inhibiting the cellular replication of DNA polymerase II or the viral-induced DNA polymerases. The drug may be useful for controlling excessive cell proliferation in patients with cancer, psoriasis or other dermatitis with little or no adverse effect upon nonmultiplying cells. [NIH] Apoptosis: A normal series of events in a cell that leads to its death. [NIH] Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Aspiration: Removal of fluid from a lump, often a cyst, with a needle and a syringe. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] BRCA2: A gene on chromosome 13 that normally helps to suppress cell growth. A person who inherits an altered version of the BRCA2 gene has a higher risk of getting breast, ovarian, or prostate cancer. [NIH] Cadmium: An element with atomic symbol Cd, atomic number 48, and atomic weight 114. It is a metal and ingestion will lead to cadmium


poisoning. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Centrioles: Self-replicating, short, fibrous, rod-shaped organelles. Each centriole is a short cylinder containing nine pairs of peripheral microtubules, arranged so as to form the wall of the cylinder. [NIH] Chimera: An individual that contains cell populations derived from different zygotes. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Dendritic: 1. branched like a tree. 2. pertaining to or possessing dendrites. [EU]

Detoxification: Treatment designed to free an addict from his drug habit. [EU]

Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Flutamide: An anticancer drug that belongs to the family of drugs called antiandrogens. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or

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psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydration: Combining with water. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Immunochemistry: Field of chemistry that pertains to immunological phenomena and the study of chemical reactions related to antigen stimulation of tissues. It includes physicochemical interactions between antigens and antibodies. [NIH] Immunoconjugates: Combinations of diagnostic or therapeutic substances linked with specific immune substances such as immunoglobulins, monoclonal antibodies or antigens. Often the diagnostic or therapeutic substance is a radionuclide. These conjugates are useful tools for specific targeting of drugs and radioisotopes in the chemotherapy and radioimmunotherapy of certain cancers. [NIH] Immunology: The study of the body's immune system. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU]


Inflammation: A response of redness, swelling, pain, and a feeling of heat in certain areas which is meant to protect tissues affected by injury or disease. [NIH] Inoperable: Not suitable to be operated upon. [EU] Intraepithelial: Within the layer of cells that form the surface or lining of an organ. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5-lipoxygenase, arachidonate 12lipoxygenase, and arachidonate 15-lipoxygenase. EC 1.13.11.12. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] LY293111: A substance that is being studied as a treatment for cancer. It belongs to the family of drugs called leukotriene B4 receptor antagonists. [NIH]

Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer. Also called lymph node dissection. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Marimastat: An anticancer drug that belongs to the family of drugs called angiogenesis inhibitors. Marimastat is a matrix metalloproteinase inhibitor. [NIH]

Metaplasia: A change of cells to a form that does not normally occur in the tissue in which it is found. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH]

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Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Mitomycin: An anticancer drug that belongs to the family of drugs called antitumor antibiotics. [NIH] Motility: The ability to move spontaneously. [EU] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Necrosis: Refers to the death of living tissues. [NIH] Neutrophil: A type of white blood cell. [NIH] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Oxaliplatin: An anticancer drug that belongs to the family of drugs called platinum compounds. [NIH] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pedigree: A record of one's ancestors, offspring, siblings, and their offspring that may be used to determine the pattern of certain genes or disease inheritance within a family. [NIH] Platinum: A metal that is an important component of some anticancer drugs, such as cisplatin and carboplatin. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino


acids contained. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH]

Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]

Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Resected: Surgical removal of part of an organ. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Serine: A non-essential amino acid occurring in natural form as the Lisomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Somatostatin: A polypeptide hormone produced in the hypothalamus, and other tissues and organs. It inhibits the release of human growth hormone, and also modulates important physiological functions of the kidney, pancreas, and gastrointestinal tract. Somatostatin receptors are widely expressed throughout the body. Somatostatin also acts as a neurotransmitter in the central and peripheral nervous systems. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations

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obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Subcutaneous: Beneath the skin. [NIH] Tamoxifen: An anticancer drug that belongs to the family of drugs called antiestrogens. Tamoxifen blocks the effects of the hormone estrogen in the body. It is used to prevent or delay the return of breast cancer or to control its spread. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH]

Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]

Tonic: 1. producing and restoring the normal tone. 2. characterized by continuous tension. 3. a term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU]

Trimetrexate: A nonclassical folic acid inhibitor through its inhibition of the enzyme dihydrofolate reductase. It is being tested for efficacy as an antineoplastic agent and as an antiparasitic agent against Pneumocystis carinii pneumonia in AIDS patients. Myelosuppression is its dose-limiting toxic effect. [NIH] Valine: A branched-chain essential amino acid that has stimulant activity. It promotes muscle growth and tissue repair. It is a precursor in the penicillin biosynthetic pathway. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Xenograft: The cells of one species transplanted to another species. [NIH]

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CHAPTER 5. PATENTS ON PANCREATIC CANCER Overview You can learn about innovations relating to pancreatic cancer by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.31 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with pancreatic cancer within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with pancreatic cancer. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.

31Adapted

from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.


Patents on Pancreatic Cancer By performing a patent search focusing on pancreatic cancer, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on pancreatic cancer: ·

Cadmium is a risk factor for human pancreatic cancer Inventor(s): Schwartz; Gary G. (Winston-Salem, NC) Assignee(s): Wake Forest University (Winston-Salem, NC) Patent Number: 6,383,817 Date filed: December 22, 2000 Abstract: The present invention provides a method of screening for risk of pancreatic cancer in a subject, wherein the presence or absence of increased levels of cadmium in the subject is detected and wherein the presence of increased levels of cadmium in the subject indicates that the subject is at increased risk of pancreatic cancer. Excerpt(s): The present invention concerns methods of screening for risk of, or predisposition to, pancreatic cancer. ... Cancer of the pancreas is an important cause of cancer mortality in developed countries and accounts for more than 28,000 deaths in the U.S. per year. Pancreatic cancer produces few specific symptoms in its early stages and usually is detected at an advanced and incurable stage. This contributes to pancreatic cancer having the worst survival of any major cancer; the average survival after diagnosis is less than 6 months and fewer than 5% of patients survive 5 years (Rosenberg, L. (1997) Pancreatol. 22:81-93; Flanders and Foulkes (1996) J. Med. Genet. 33:889-898). ... The etiology of pancreatic cancer is obscure (see refs Anderson, et al. (1996) In D. Schottenfeld, J. F. Fraumeni, J. F., Jr. Cancer Epidemiology and Prevention, 2.sup.nd Ed., Oxford University Press, New York, pp. 725771; Fontham and Correa (1989) Surg. Clin. North Am. 69:551-567; Fryzek, et al. (1997) GI Cancer 2:99-100 for reviews of the epidemiology). Incidence rates for pancreatic cancer increase exponentially with age beginning at about age 40, are approximately 50% higher among males

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than females, and are higher among blacks than whites. Despite considerable epidemiologic study, the only modifiable risk factor that has been established is cigarette smoking. However, the identity of the carcinogen(s) in cigarette smoke is unknown. Few strong occupational risks have been detected, although moderate risks have been associated with several industries, including metal working occupations and pesticide exposure (Pietri and Clavel (1991) Br. J. Ind. Med. 48:583-587). Mapping of U.S. mortality rates from pancreatic cancer has identified significantly elevated rates in southern Louisiana (Blot, et al. (1978) Cancer 42:373-380), but the cause of that cluster remains largely unexplained. Web site: http://www.delphion.com/details?pn=US06383817__ ·

Methods of identifying and detecting pancreatic cancer Inventor(s): Weinberg; David (Philadelphia, PA), Waldman; Scott A. (Ardmore, PA), Barber; Michael T. (Paoli, PA), Biswas; Sanjoy (Philadelphia, PA) Assignee(s): Thomas Jefferson University (Philadelphia, PA) Patent Number: 6,187,536 Date filed: February 18, 1998 Abstract: Conjugated compounds which comprises an CCK A receptor binding moiety and a radiostable active moiety are disclosed. Pharmaceutical compositions comprising conjugated compound which comprises an CCK A receptor binding moiety and a radiostable active moiety or an CCK A receptor binding moiety and a radioactive active moiety are disclosed. Methods of treating an individual suspected of suffering from pancreatic cancer are disclosed. Methods of radioimaging pancreatic cancer cells are disclosed. In vitro methods, kits and reagents are disclosed for determining whether or not an individual has pancreatic cancer cells, for determining whether tumor cells are pancreatic in origin and for analyzing tissue samples to evaluate the extent of metastasis of pancreatic tumor cells. Excerpt(s): The present invention relates to compounds for and methods of identifying and imaging pancreatic cancer cells and identifying and treating individuals with pancreatic cancer. ... Pancreatic adenocarcinoma is the fifth leading cause of cancer death in the United States. The etiology of this malignancy is large unknown. Advancing age, male gender and smoking are established risk factors, while chronic pancreatitis and diabetes may be as well. The prognosis for patients with pancreatic cancer is poor, with reported 1 year survival rates between 5% and 10%.


... There is considerable evidence to support a central role for cholecystokinin (CCK)* in human pancreatic cancer. The influence of endogenous hormones is well-described for several human malignancies including breast, ovary and prostate. Generally, the hormones implicated are important in both the health and disease of their target organ. CCK is an important mediator in the growth of the normal pancreas. Animal studies in which exogenous CCK was administered or endogenous CCK levels were manipulated documented pancreatic hyperplasia, dysplasia and the production of frank malignancies. Similar studies, following the induction of pancreatic tumors, suggest that CCK administration accelerates the growth of malignant compared to uninvolved tissue. In human cancer cell lines and xenografted human tumors, CCK promotes the growth of pancreatic adenocarcinoma. Web site: http://www.delphion.com/details?pn=US06187536__ ·

Method for treating pancreatic cancer in humans with water-insoluble S-camptothecin of the closed lactone ring form and derivatives thereof Inventor(s): Stehlin; John S. (Houston, TX), Natelson; Ethan A. (Houston, TX), Giovanella; Beppino C. (Houston, TX), Kozielski; Anthony J. (Houston, TX) Assignee(s): The Stehlin Foundation for Cancer Research (Houston, TX) Patent Number: 6,080,751 Date filed: September 13, 1996 Abstract: A method of treating human pancreatic cancer with waterinsoluble 20(S)-camptothecin compounds with the closed-lactone ring intact and/or derivatives thereof is disclosed. The method includes preferably administering the compounds intramuscularly, orally, and transdermally. Excerpt(s): The present invention relates to a method for treating pancreatic cancer in humans. ... An object of the present invention is to provide a novel method for treating pancreatic cancer in humans. ... To achieve the objects and in accordance with the purpose of the present invention, as embodied and broadly described herein, the present invention relates to a method for treating pancreatic cancer in a human which comprises administering an effective amount of a water-insoluble 20(S)-Camptothecin (CPT) with the closed-lactone ring intact or a derivative thereof or a mixture thereof, preferably 9-nitro-20(S)camptothecin. Web site: http://www.delphion.com/details?pn=US06080751__

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Polynucleotides PANC1A and PANC1B associated with pancreatic cancer Inventor(s): Goold; Richard D. (San Francisco, CA), Akerblom; Ingrid E. (Redwood City, CA), Seilhamer; Jeffrey J. (Los Altos Hills, CA) Assignee(s): Incyte Pharmaceuticals, Inc. (Palo Alto, CA) Patent Number: 5,840,870 Date filed: December 29, 1995 Abstract: The present invention provides polynucleotide sequences designated PANC1A and PANC1B which are associated with a genomic sequence related to pancreatic cancer as well as other cancers. The present invention also provides for PANC1A and PANC1B antisense molecules. The invention further provides genetically engineered expression vectors and host cells for the production of purified PANC1A and PANC1B polypeptide; antibodies, antagonists and inhibitors of PANC1A and PANC1B polypeptide; and pharmaceutical compositions and methods of treatment based on the polypeptide, its antibodies, antagonists and inhibitors. The invention specifically provides for use of the polypeptide as a diagnostic composition for the detection of pancreatic cancer in individuals at risk for and subject to pancreatic cancer. The invention also relates to therapeutic methods and compositions based upon the nucleotide sequences for PANC1A and PANC1B. Excerpt(s): The present invention relates to novel polynucleotide sequences, PANC1A and PANC1B, associated with pancreatic cancer and to the use of PANC1A and PANC1B in the diagnosis and treatment of pancreatic cancer. ... Recently, Schutte et al ((1995) Proc Natl Acad Sci 92:5950-5954) used the method of representational difference analysis (RDA) as described by (Lisitsyn et al (1995) Proc Natl Acad Sci 92:151155) to demonstrate a homozygous deletion in pancreatic carcinoma mapping to a 1-cM region at 13ql.3. The deletion was flanked by the markers D135171 and D135260 and lay within the 6-cM region identified as containing the BRCA.sub.2 (600185) locus of heritable breast cancer susceptibility. Schutte supra suggest that the same gene may be involved in multiple tumor types and that its function is that of a tumor suppressor rather than that of a dominant oncogene. Additionally, Muller-Pillasch et al. submitted to EMBL/GenBank and the gene database of Japan (DDBJ DDBI) in 1994 a nucleotide sequence designated NCBI GI 533948 which was found to be differentially expressed in the pancreatic cancer cell line PATU. ... Current methods for the diagnosis of pancreatic cancer include measurement of serum amylase and lipase values, however these values are found to be abnormal in only 10% of all


cases. Blood, urine and feces of individuals subject to carcinoma of the body and tail of the pancreas are often normal. Also, standard gastrointestinal x-rays may suggest the presence of carcinoma of the head of the pancreas, but only 50% of all patients with this type of carcinoma have an abnormal examination (Harrison's Principles of Internal Medicine supra). Web site: http://www.delphion.com/details?pn=US05840870__ ·

Use of L-canavanine as a chemotherapeutic agent for the treatment of pancreatic cancer Inventor(s): Crooks; Peter A. (Lexington, KY), Rosenthal; Gerald A. (Lexington, KY) Assignee(s): The University of Kentucky Research Foundation (Lexington, KY) Patent Number: 5,552,440 Date filed: December 5, 1994 Abstract: A pharmaceutical composition of canavanine, and a method treatment of cancer, particularly pancreatic cancer with L-canavanine is disclosed. Excerpt(s): The invention relates to a pharmaceutical composition comprising canavanine, and a method treatment of cancer, particularly pancreatic cancer, with L-canavanine. ... More than 26,000 people die each year in our country from pancreatic adenocarcinoma (1, see numbered references below). Death is the inevitable consequence to more than 90% of patients with this disease. It is the fourth most common cause of cancer death in men and the fifth most common for women (2). Overall, it is the fourth most common carcinoma after those of the lung, colon and breast (3). The incidence of this disease is linear with age to sixty but its occurrence increases markedly in the seventh or eighth decade of life (4). There are several different histologies associated with cancer of the pancreas including small cell cancer, cystadenocarcinoma, islet cell tumors, lymphoma and carcinoid; however, 75-80% of the cases involve adenocarcinomas of ductal origin (5). The only definitive risk factor in pancreatic cancer is cigarette smoking. A typical smoker accepts up to four times the risk of a nonsmoker (6). ... While new experimental efforts in treating pancreas cancer have been initiated, their limited success emphasizes the need for radically new approaches in the management of this devastating disease. The present invention provides an additional alternative for the treatment of cancers, particularly pancreatic cancer by providing for a pharmaceutical composition

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comprising canavanine, and a method treatment of cancer, particularly pancreatic cancer with canavanine. Web site: http://www.delphion.com/details?pn=US05552440__ ·

Monoclonal antibodies to human pancreatic cancer Inventor(s): Kajiji; Shama (San Diego, CA), Quaranta; Vito (La Jolla, CA) Assignee(s): Scripps Clinic & Research Foundation (La Jolla, CA) Patent Number: 4,962,048 Date filed: April 3, 1989 Abstract: Novel hybridoma cell lines producing monoclonal antibodies which react specifically with human pancreatic cancer cells are described. Methods for producing antigenic preparations to generate the hybridoma cell lines and for selecting, purifying and characterizing the monoclonal antibodies reactive with human cells, including pancreatic cancer cells, are disclosed. Excerpt(s): The present invention relates generally to novel hybridoma cell lines, and more specifically to monoclonal cell lines producing monoclonal antibodies reactive with human pancreatic cancer cells. ... Cancer currently constitutes the second most common cause of death in the United States. Carcinomas of the pancreas are the eighth most prevalent form of cancer and fourth among the most common causes of cancer deaths in this country. The incidence of pancreatic cancer has been increasing steadily in the past twenty years in most industrialized countries, exhibiting the characteristics of a growing epidemiological problem. ... The prognosis for pancreatic carcinoma is, at present, very poor, it displays the lowest five-year survival rate among all cancers. Such prognosis results primarily from delayed diagnosis, due in part to the fact that the early symptoms are shared with other more common abdominal ailments. The diagnosis of pancreatic cancer is often dependent on exploratory surgery, inevitably performed after the disease has advanced considerably. Web site: http://www.delphion.com/details?pn=US04962048__


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Immunotoxin conjugate which comprises arsanilic acid, useful for treating malignant tumors, particularly pancreatic cancer Inventor(s): Runge; Richard G. (6311 S. 149th St., Omaha, NE 68137) Assignee(s): none reported Patent Number: 4,485,093 Date filed: August 13, 1982 Abstract: An immunotoxin conjugate, useful for treating malignant tumors in mammals, which consists of arsanilic acid and tumor specific antibodies covalently bound to a polyglutamic acid linking agent is taught. The conjugate selectively delivers arsanilic acid to a tumor, killing the tumor cells and exhibiting little or no toxicity to normal cells. The conjugate is effective in treating human pancreatic cancer. Excerpt(s): The method and manner of isolating antibodies is well known and is not a part of this invention. Indeed, many antibodies are freely commercially available. However, for the sake of completeness of the present invention description, the antibodies which were employed were obtained by injecting purified porcine gastric mucin into a rabbit. Three injections were provided, one per week for three weeks. Seven weeks after the first injection, the animal was bled to obtain the serum containing the antibody. Further details will be shown in the example. Again, it is not important how one collects the antibody, that being well within the skill of the art. Monoclonal antibodies may also be used. The antibody isolated from the rabbit as mentioned above, is a monospecific anti-A antibody and known to be tumor specific for pancreatic cancers in Syrian hamsters. ... The linked product previously discussed, after separation and concentration, is now available for use in parenteral injection (i.e., intravenous, intraperitoneal, intralesional) treatment of tumors. For purposes of convenience, storage and shipment, it may be lyophilized if desired, and later reconstituted with pH adjusted phosphate buffered saline (PBS). The dose administered of the composition, or linked product, will vary with the particular tumor, its severity and the weight and size of the host animal. However, for the hamster studies discussed in the examples below, the dosage was generally 5 milligrams of linked product. For individual human dosages, it would normally be expected to have a dosage range of from 10 to 50 milligrams per kilogram of body weight which should be well, under the LD.sub.50. The composition may be administered in aqueous solution, or also incorporated into particulate carriers, such as liposomes. With regard to the time of treatment, it has been found that a series of parenteral injections over a several week period provides the most effective treatment, particularly for pancreatic cancers. ... Malignant

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growths were induced in hamsters by treatment with a known carcinogen causing pancreatic cancer, hereinafter referred to as BOP, whose technical name is N-nitrosobis (2)-oxopropyl) amine. Fourteen hamsters were treated with a total of 80 mg/kg of BOP over a four week period. Thirty weeks after their last BOP injection, eight animals were treated i.p. (intraperitoneally) with 5 mg of monospecific anti-A to which arsanilic acid (via PGA) had been conjugated (i.e., 1 mg AA/5 mg antiA). This represents about 1/10 of the LD.sub.50 of unbound arsanilic acid (AA). Four animals were killed four days after injection. The pancreases were removed and thoroughly examined histopathologically (step sections). None of the animals appeared to have systemic toxic effects but because the liver is known to concentrate arsenic following exposure and to develop fatty infiltration and necrosis, it was examined also and found to be histologically unremarkable. Four animals were killed ten days after injection of conjugate. Two age-and sex-matched groups of two animals were treated with 1 mg of AA alone, and 5 mg of anti-A alone. These animals were killed one week after injection and examined in a fashion identical to that of the conjugate-treated animals. Two animals received only BOP. Web site: http://www.delphion.com/details?pn=US04485093__

Patent Applications on Pancreatic Cancer As of December 2000, U.S. patent applications are open to public viewing.32 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to pancreatic cancer: ·

Specific mucin expression as a marker for pancreatic cancer Inventor(s): Batra, Surinder K. ; (Omaha, NE), Brand, Randall E. ; (Omaha, NE), Ringel, Joerg ; (Rostoct, DE), Faulmann, Grit ; (Leipzig, DE), Lohr, Matthias ; (Weinheim, DE), Varshney, Grish C. ; (Lhandigarh, IN) Correspondence: Kathleen D. Rigaut, Ph.D., J.D.; Dann, Dorfman, Herrell and Skillman; Suite 720; 1601 Market Street; Philadelphia; PA; 191032307; US Patent Application Number: 20020150894 Date filed: December 8, 2000

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This has been a common practice outside the United States prior to December 2000.


Abstract: Methods are provided for the diagnosis of pancreatic cancer. Excerpt(s): This invention relates to the fields of molecular biology and oncology. Specifically, the invention provides a molecular marker for use in the diagnosis of pancreatic cancer. ... Over the past decade, a remarkable increase in the knowledge of somatic genetic alterations underlying human pancreatic cancer cells has been recorded. Mutations of the K-ras oncogene (.about.90% of PA cases) and the p53 tumor suppressor gene (50-70%) are the most widely studied genetic tumor markers in pancreatic cancer (4,5). In fact, K-ras mutations have been detected in cytological examinations, from cells present in pancreatic juice and stool samples, as well as in the peripheral blood of patients with pancreatic cancer (6-8). The detection of these mutations have also been associated with chronic pancreatitis (9). ... Additionally, there are various highly sensitive PCR-based screening tests for detection of pancreatic cancer cells in blood samples. All of these RT-PCR techniques are based on the detection of genes which are predicted to be specific for pancreatic cancer cells in blood samples (10,11). However, the clinical value, specificity and sensitivity of these molecular tumor markers used in the diagnosis of pancreatic adenocarcinoma differ among the various published studies and are still under evaluation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Compositions and methods for the therapy and diagnosis of pancreatic cancer Inventor(s): Pyle, Ruth A. ; (Seattle, WA), Xu, Jiangchun ; (Bellevue, WA), Kalos, Michael D. ; (Seattle, WA) Correspondence: Seed Intellectual Property Law Group PLLC; 701 Fifth Ave; Suite 6300; Seattle; WA; 98104-7092; US Patent Application Number: 20020076721 Date filed: August 6, 2001 Abstract: Compositions and methods for the therapy and diagnosis of cancer, particularly pancreatic cancer, are disclosed. Illustrative compositions comprise one or more pancreatic tumor polypeptides, immunogenic portions thereof, polynucleotides that encode such polypeptides, antigen presenting cell that expresses such polypeptides, and T cells that are specific for cells expressing such polypeptides. The disclosed compositions are useful, for example, in the diagnosis, prevention and/or treatment of diseases, particularly pancreatic cancer.

Patents 171

Excerpt(s): Pancreatic cancer is the fifth leading cause of cancer death in the United States. Current therapies for this common and difficult-totreat disease include surgery and/or chemotherapy. Although 5-year survival rates after surgical removal of the pancreas and a large portion of the duodenum have improved, the procedure is only used on 9% of patients. Of these, the highest reported 5-year survival rate is in the range of 20%. Patients with advanced pancreatic cancer are treated primarily by chemotherapy. The objective of such therapy is to prolong patient survival. Surgery and irradiation are used as well to relieve pain and reduce organ blockage. ... In spite of considerable research into therapies for these and other cancers, pancreatic cancer remains difficult to diagnose and treat effectively. Accordingly, there is a need in the art for improved methods for detecting and treating such cancers. The present invention fulfills these needs and further provides other related advantages. ... Within further aspects, the present invention provides methods for stimulating an immune response in a patient, preferably a T cell response in a human patient, comprising administering a pharmaceutical composition described herein. The patient may be afflicted with pancreatic cancer, in which case the methods provide treatment for the disease, or patient considered at risk for such a disease may be treated prophylactically. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Cadmium is a risk factor for human pancreatic cancer Inventor(s): Schwartz, Gary G. ; (Winston-Salem, NC) Correspondence: Kenneth D. Sibley; Myers Bigel Sibley & Sajovec; Post Office Box 37428; Raleigh; NC; 27627; US Patent Application Number: 20020009808 Date filed: December 22, 2000 Abstract: The present invention provides a method of screening for risk of pancreatic cancer in a subject, comprising detecting the presence or absence of increased levels of cadmium in said subject, the presence of increased levels of cadmium in said subject indicating the subject is at increased risk of pancreatic cancer. Excerpt(s): The present invention concerns methods of screening for risk of, or predisposition to, pancreatic cancer. ... Cancer of the pancreas is an important cause of cancer mortality in developed countries and accounts for more than 28,000 deaths in the U.S. per year. Pancreatic cancer produces few specific symptoms in its early stages and usually is detected at an advanced and incurable stage. This contributes to


pancreatic cancer having the worst survival of any major cancer; the average survival after diagnosis is less than 6 months and fewer than 5% of patients survive 5 years (Rosenberg, L. (1997) Pancreatol. 22:81-93; Flanders and Foulkes (1996) J. Med. Genet. 33:889-898). ... The etiology of pancreatic cancer is obscure (see refs Anderson, et al. (1996) In D. Schottenfeld, J. F. Fraumeni, J. F., Jr. Cancer Epidemiology and Prevention, 2.sup.nd Ed., Oxford University Press, New York, pp. 725771; Fontham and Correa (1989) Surg. Clin. North Am. 69:551-567; Fryzek, et al. (1997) GI Cancer 2:99-100 for reviews of the epidemiology). Incidence rates for pancreatic cancer increase exponentially with age beginning at about age 40, are approximately 50% higher among males than females, and are higher among blacks than whites. Despite considerable epidemiologic study, the only modifiable risk factor that has been established is cigarette smoking. However, the identity of the carcinogen(s) in cigarette smoke is unknown. Few strong occupational risks have been detected, although moderate risks have been associated with several industries, including metal working occupations and pesticide exposure (Pietri and Clavel (1991) Br. J. Ind. Med. 48:583-587). Mapping of U.S. mortality rates from pancreatic cancer has identified significantly elevated rates in southern Louisiana (Blot, et al. (1978) Cancer 42:373-380), but the cause of that cluster remains largely unexplained. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with pancreatic cancer, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “pancreatic cancer” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on pancreatic cancer. You can also use this procedure to view pending patent applications concerning pancreatic cancer. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.

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Vocabulary Builder Amylase: An enzyme that helps the body digest starches. [NIH] Aqueous: Having to do with water. [NIH] Camptothecin: An anticancer drug that belongs to the family of drugs called topoisomerase inhibitors. [NIH] Carcinoid: A type of tumor usually found in the gastrointestinal system (most often in the appendix), and sometimes in the lungs or other sites. Carcinoid tumors are usually benign. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH]

Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Hyperplasia: An abnormal increase in the number of cells in an organ or tissue. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Liposome: A spherical particle in an aqueous medium, formed by a lipid bilayer enclosing an aqueous compartment. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Milligram: A measure of weight. A milligram is approximately 450,000times smaller than a pound and 28,000-times smaller than an ounce. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH]


Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Radioactive: Giving off radiation. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Saline: A solution of salt and water. [NIH] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Stool: The waste matter discharged in a bowel movement; feces. [NIH]

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CHAPTER 6. BOOKS ON PANCREATIC CANCER Overview This chapter provides bibliographic book references relating to pancreatic cancer. You have many options to locate books on pancreatic cancer. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on pancreatic cancer include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “pancreatic cancer” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on pancreatic cancer:


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Gastrointestinal Endocrinology Source: Totowa, NJ: Humana Press, Inc. 1999. 592 p. Contact: Available from Humana Press, Inc. Customer Service, 999 Riverview Drive, Suite 208, Totowa, NJ 07512. (973) 256-1699. Fax (973) 256-8341. E-mail: [email protected]. Price: $150.00 plus shipping and handling. ISBN: 0896035069. Summary: Gut peptides are part of a complex biological signaling system and provide the substrate for intercellular communication in the gut as well as between the gut and other organs in the body. Gastrointestinal and pancreatic peptides are better called regulatory peptides because they are also found outside of the gastrointestinal tract and pancreas, are produced in nonendocrine cell types, and participate in the regulation of many processes that ultimately result in physiologic homeostasis and adaptation. In this text, leading clinical and basic science researchers present the latest molecular and cellular findings on key gut peptides, illuminating their physiology and pathophysiology, as well as highlighting the regulatory mechanisms underlying their action in the intestinal tract. The book focuses on gut peptide physiology and receptor pharmacology, gut processing and receptor biology, and on regulatory mechanisms in the gut, including pancreatic feedback mechanisms. Also included are chapters on the trophic effects of gut peptides on gastrointestinal and pancreatic cancer, the regulation of gut peptide gene expression, and gastric secretion, especially in diseased states. Each chapter includes extensive references and a subject index concludes the volume.

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Gastroenterology and Hepatology: The Comprehensive Visual Reference. Volume 8: Pancreas Source: Philadelphia, PA: Current Medicine. 1998. [200 p.]. Contact: Available from Current Medicine. 400 Market Street, Suite 700, Philadelphia, PA 19106. (800) 427-1796 or (215) 574-2266. Fax (215) 5742270. E-mail: [email protected]. Website: current-medicine.com. Price: $125.00 plus shipping and handling. ISBN: 0443078629. Summary: This atlas is one in an 8-volume collection of images that pictorially displays the gastrointestinal tract, liver, biliary tree, and pancreas in health and disease, both in children and adults. This volume includes 10 chapters on the pancreas. Topics covered include neurohormonal control of the pancreas, pathogenesis of pancreatic diseases, acute pancreatitis, chronic pancreatitis, surgery for chronic pancreatitis, developmental anomalies of the pancreas, pancreatic cancer, the rationale and application of radioligand imaging in gastroenterology,

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cystic fibrosis, and hereditary pancreatitis. The format of the atlas is visual images supported by relatively brief text. Tables, charts, diagrams, and photomicrographs are used extensively. A subject index concludes the volume. ·

Medical Advisor Home Edition: The Complete Guide to Alternative and Conventional Treatments Source: Alexandria, VA: Time-Life Books. 1997. 960 p. Contact: Available from Time-Life Books. 400 Keystone Industrial Park, Dunsmore, PA 18512. Price: $20.00. ISBN: 0783552505. Summary: This book offers information about 300 health problems, ranging from relatively benign conditions to the most serious diseases. There are symptoms charts which name several related problems and help readers decide which ailment entry to look up. Ailment entries provide a more complete list of symptoms, plus guidelines to discern whether the condition is potentially serious or requires a doctor's attention. Each entry describes the ailment and how it affects the body. Next, the entry outlines the underlying causes of the ailment and the tests and procedures a doctor may use to confirm the diagnosis. The treatment segment presents conventional and alternative recommendations for curing the problem or alleviating the symptoms. Most ailment entries conclude with advice on preventive measures that can be used to maintain health. Alternative treatments discussed include bodywork, acupuncture and acupressure, herbal therapies, homeopathy, lifestyle changes, and nutrition and diet. The book begins with a section on emergency medicine. Also included is a visual diagnostic guide, an atlas to the body, a medicine chest section (describing herbs, homeopathic remedies, and over the counter drugs), a glossary, a subject index, a bibliography, and a list of health associations and organizations. Topics related to digestive diseases include abdominal pain, AIDS, allergies, anal bleeding, anal fissure, anorexia nervosa, bad breath, bowel movement abnormalities, bulimia, celiac disease, cholesterol problems, colitis, colorectal cancer, constipation, Crohn's disease, diarrhea, diverticulitis, flu, food poisoning, gallstones, gas and gas pains, gastritis, gastroenteritis, heartburn, hiatal hernia, hiccups, incontinence, indigestion, irritable bowel syndrome, lactose intolerance, lupus, obesity, pancreatic cancer, pancreatic problems, stomach cancer, stomach ulcers, swallowing difficulty, trichomoniasis, vomiting, and worms. The book is illustrated with line drawings and full-color photographs.


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Hepatobiliary and Pancreatic Disease: The Team Approach to Management Source: Boston, MA: Little, Brown and Company. 1995. 493 p. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. Price: $99.95. ISBN: 0316709158. Summary: In this book, the editors identify 42 hepatobiliary and pancreatic problems that require a team approach to management. For each of the 42 chapters, a surgeon, gastroenterologist, or radiologist is the lead author, and physicians from different specialties are coauthors. The authors discuss etiology, pathogenesis, and diagnosis, but focus on patient management and results. The chapters cover hepatitis, hepatic failure, cirrhosis, portal hypertension, primary biliary cirrhosis, BuddChiari syndrome, noninflammatory cysts, hepatic abscesses, hydatid disease, hemobilia, hepatic trauma, benign hepatic tumors, hepatocellular carcinoma, hepatic metastases, biliary atresia, biliary cysts, gallbladder stones, choledocholithiasis, hepatolithiasis, acute cholecystitis, acute cholangitis, biliary parasites, sclerosing cholangitis, benign strictures, motility disorders, gallbladder cancer, cholangiocarcinoma, acute pancreatitis, gallstone pancreatitis, pseudocysts, pancreatic abscesses, pancreatic necrosis, pancreatic hemorrhage, pancreas divisum, chronic pancreatitis, pancreatic fistulas, pancreatic trauma, islet cell tumors, cystic neoplasms, ampullary carcinoma, and pancreatic cancer. Each chapter includes numerous black-and-white photographs, and a subject index concludes the volume.

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Digestive Diseases in the United States: Epidemiology and Impact Source: Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1994. 799 p. Contact: Available from National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. (800) 8915389 or (301) 654-3810. E-mail: [email protected]. Price: $15.00. Summary: This monograph is a compendium of descriptive statistics about the scope and impact of digestive diseases in the United States. Each chapter provides national and population data based on the prevalence, incidence, medical care, disability, mortality, and research needs. Twenty chapters cover the following conditions: infectious diarrheas, viral hepatitis, esophageal cancer, gastric cancer, colorectal cancer, liver cancer, pancreatic cancer, hemorrhoids, esophageal diseases, peptic ulcer, gastritis and nonulcer dyspepsia, acute appendicitis,

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abdominal wall hernia, inflammatory bowel diseases, diverticular disease of the colon, constipation, irritable bowel syndrome, chronic liver disease and cirrhosis, gallstones, and pancreatitis. These chapters compare the impact and costs of the disease to other diseases. The book also includes an overview chapter, a chapter about the cost of digestive diseases in the United States, and a listing of all digestive diseases diagnostic codes for the ninth and tenth editions of the International Classification of Diseases. Extensive figures are used throughout the volume. 3 appendices.

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “pancreatic cancer” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:33

Chapters on Pancreatic Cancer Frequently, pancreatic cancer will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with pancreatic cancer, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and pancreatic cancer using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “pancreatic cancer” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on pancreatic cancer: ·

Cancer Prevention and Early Detection in African Americans: Figures, Facts, and Future Directions for Nursing Practice Source: in Cancer Prevention in Diverse Populations: Cultural Implications for the Multidisciplinary Team. Second Edition. FrankStromborg, M.; Olsen, S.J.; eds. Pittsburgh, PA, Oncology Nursing Society, pp. 101-143, 2001. Contact: ONS Publishing Division, 501 Holiday Drive, Pittsburgh, PA 15220-2749. Summary: Cancer Prevention and Early Detection in African Americans: Figures, Facts, and Future Directions for Nursing Practice, a chapter in Cancer Prevention in Diverse Populations: Cultural Implications for the Multidisciplinary Team, reveals a comprehensive review of the cancer risks, statistics, and issues related to assessment, screening, and early detection of cancer in African Americans. Recent reports released reveal that among the five major racial/ethnic groups in the United States, African Americans have the highest overall risk of developing cancer, the highest overall risk of dying from cancer, and the poorest indices of cancer survival. Breast cancer is the most common form of cancer experienced by African American women, followed by cancer of the lung and bronchus, colon and rectal cancer, uterine cancer, ovarian cancer, pancreatic cancer, non-Hodgkin's lymphoma, kidney cancer, and multiple myeloma. Factors most strongly associated with cancer risk are lifestyle choices and personal behavior. Tobacco, diet and nutrition, physical inactivity, obesity, and alcohol consumption can be linked to the development of most new cancers and cause the greatest number of cancer deaths among African American populations. Multiple factors have been shown to influence the smoking patterns of African American adults and youth. However, studies have shown that the following have a pronounced effect on smoking patterns in this community: (1) Peers and family; (2) socioeconomic status; (3) stress related to housing, employment, discrimination, and racism; and (4) advertising and marketing that present a positive image of the tobacco industry and promote the misperception that tobacco use is safe, cool, glamorous, and socially acceptable.

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Cancer: Reducing Your Risks Source: in Access to Health. Sixth Edition. Donatelle, R.J.; Davis, L.G. Needham Heights, MA, Allyn and Bacon, pp. 431-455, 2000. Contact: Allyn and Bacon, 75 Arlington Street, Suite 300, Boston, MA 02116. Internet/Email: www.abacon.com. Summary: Cancer: Reducing Your Risks, a chapter in Access to Health, Sixth Edition, discusses risk factors for and actions an individual can take to reduce his/her risk for various cancers. The chapter presents an overview of the epidemiological aspects of cancer. Causes of cancer discussed include lifestyle factors, biological factors, occupational/environmental factors, social and psychological factors, chemicals in foods, viral factors, and medical factors. The chapter discusses (1) risk factors and protective actions for lung cancer, female breast cancer, colon and rectal cancer, prostate cancer, skin cancer, testicular cancer, endometrial (uterine) cancer, ovarian cancer, pancreatic cancer, and leukemia; and (2) techniques for coping with and treating these cancers.

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Dyspepsia Source: in Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 59-80. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070220557. Summary: The complaint of upper abdominal pain or dyspepsia encompasses a wide variety of clinical presentations and diagnoses, ranging from mild gastrointestinal infections to such life-threatening conditions as perforated duodenal ulcer and pancreatic cancer. This chapter on dyspepsia is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. Topics include the prevalence of dyspepsia; principal diagnosis, including nonulcer dyspepsia, gastroesophageal reflux disease (GERD), duodenal ulcer, gastric ulcer, and gastritis; the typical presentation; key elements of the patient history, including symptoms indicative of serious conditions, the use of nonsteroidal antiinflammatory drugs (NSAIDs), and dsypeptic symptoms; the physical examination; ancillary tests, including those to detect Helicobacter pylori, endoscopy, upper gastrointestinal radiography, and esophageal pH monitoring and manometry; treatment strategies for H. pylori infection, nonulcer dyspepsia, GERD, gastritis,


duodenal ulcers, gastric ulcers, and NSAID gastropathy; patient education; common clinical errors; controversies in this area; and emerging concepts. The chapter includes a chapter outline for quick reference, the text itself, a diagnostic and treatment algorithm, and selected references. This chapter also contains the five color plates that serve the entire text. 6 figures. 6 tables. 32 references. ·

Biliary Obstruction Source: in Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 287-306. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070220557. Summary: Obstruction of the bile ducts is a medical problem that any physician with an active clinical practice will repeatedly encounter. While stones are the most common cause of biliary obstruction, biliary strictures (both benign and malignant) also lead to obstruction. This chapter on biliary obstruction is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. Topics include incidence and background; pathophysiology; principal diagnoses, including choledocholithiasis (biliary tract stones), and bile duct strictures due to pancreatic cancer, cholangiocarcinoma (gallbladder cancer), ampullary and duodenal tumors, primary sclerosing cholangitis, chronic pancreatitis, AIDS cholangiopathy, biliary dyskinesia, and iatrogenic (caused by medical treatment) biliary strictures; typical presentations, including aseptic biliary obstruction, acute cholangitis (inflammation of the gallbladder), liver abscess, and biliary cirrhosis (scarring); key elements to the patient history, including jaundice, dark urine and acholic (without bile) stool, pruritis (itching), fever, constitutional symptoms, and prior history of biliary disease; the physical examination, ancillary tests, and imaging tests; treatment options, including that for resuscitation, antibiotics, and biliary drainage; patient education; common clinical errors; and clinical controversies. The chapter includes an outline for quick reference, the text itself, a diagnostic and treatment algorithm, and selected references. 4 figures. 3 tables. 26 references.

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Pancreatic Tumors Source: in Beckingham, I.J., ed. ABC of Liver, Pancreas and Gallbladder. London, UK: BMJ Publishing Group. 2001. p.41-43.

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Contact: Available from BMJ Publishing Group. BMA Books, BMA House, Tavistock Square, London WCIH 9JR. Fax 44 (0)20 7383 6402. Email: [email protected]. Website: www.bmjbooks.com. Price: Contact publisher for price. ISBN: 0727915312. Summary: Neoplasms (new tissue growth) of the pancreas may originate from both exocrine and endocrine cells, and they vary from benign to highly malignant. Clinically, 90 percent of pancreatic tumors are malignant ductal adenocarcinomas. This chapter on pancreatic tumors, from an atlas of the liver, pancreas and gallbladder, focuses on ductal adenocarcinoma (cancer). Topics include incidence and prognosis, clinical presentation, examination and symptoms, investigation and diagnostic tests, and treatment options, including radiotherapy, chemotherapy, surgery, and symptom control (pain management, primarily). Presentation of pancreatic cancer is usually with painless insidious jaundice. Prognosis is poor, with median survival from diagnosis less than six months. Less than 15 percent of all pancreatic tumors are respectable, and five year survival after resection is 10 to 15 percent. A liberal policy of pain control with paracetamol, nonsteroidal antiinflammatory drugs, and opiate analgesics (painkillers) should be followed. The authors also briefly consider cystic tumors and endocrine tumors. The chapter concludes with summary points of the concepts discussed. 5 figures. 5 tables. 3 references. ·

Gastrointestinal Disease in the Aged Source: in Reichel, W., et al., eds. Care of the Elderly: Clinical Aspects of Aging. 4th ed. Baltimore, MD: Williams and Wilkins. 1995. p. 198-205. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 4478438 or (410) 528-8550. Price: $69.00 (as of 1996). ISBN: 0683072099. Summary: This chapter on gastrointestinal (GI) disease in the aged is from a text on the clinical aspects of aging. This chapter covers problems associated with the esophagus, the stomach, the small bowel and pancreas, and the colon and rectum; liver disease; biliary disease; and pancreatic disease. Specific conditions discussed include appendicitis, heartburn, dysphagia, drug-induced gastritis, gastroparesis, lactose intolerance, inflammatory bowel disease, diverticulosis, colon cancer, constipation, fecal incontinence, irritable bowel syndrome, jaundice, hepatitis, gallstones, pancreatitis, and pancreatic cancer. 1 table. 22 references.


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Recognition and Management of Premalignant Gastrointestinal Lesions Source: in Danzi, J.T.; Scopelliti, J.A., eds. Office Management of Digestive Diseases. Malvern, PA: Lea and Febiger. 1992. p. 188-195. Contact: Available from Lea and Febiger. Box 3024, Malvern, PA 193559725. (215) 251-2230. Price: $39.50. ISBN: 0812114361. Summary: A precancerous lesion or disease is a condition that is associated with the development of a specific cancer that is not likely to be found in a matched population lacking the associated condition. This chapter, from a medical textbook about the office management of common gastrointestinal diseases, discusses the recognition and management of premalignant gastrointestinal lesions. Topics include surveillance, gastrointestinal oncologists and primary physicians, and premalignant gastrointestinal conditions of the esophagus, stomach, small bowel, colon, liver, and pancreas. Specific conditions discussed include achalasia, Barrett's esophagus, chronic gastroesophageal reflux disease, lye stricture, Plummer-Vinson syndrome, tylosis, pernicious anemia, atrophic gastritis, Menetrier's disease, gastric ulceration, gastric polyp, gastric remnant, primary cancers of the small bowel, glutensensitive enteropathy or celiac sprue, Crohn's disease, immunodeficiency syndromes, postureterosigmoidostomy, chronic radiation enteritis-colitis, Bowen's disease, liver cancer, hepatocarcinogen exposure, cholangiocarcinoma, and pancreatic cancer. 36 references.

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Risks of Active and Passive Smoking Source: in Smoking: Risk, Perception, and Policy. Slovic, P., ed., Thousand Oaks, CA, Sage Publications, Inc., pp. 3-28, 2001. Contact: Sage Publications, Inc., 2455 Teller Road, Thousand Oaks, California 91320. Internet/Email: [email protected]. Summary: Risks of Active and Passive Smoking, a chapter in Smoking: Risk, Perception, and Policy, notes that tobacco smoking, particularly cigarette smoking, is a remarkably powerful cause of disease. Topics include (1) the history of studies on the risks of smoking; (2) toxicology of tobacco smoke; (3) health effects of active smoking; (4) effects on reproduction, cardiovascular diseases, chronic obstructive pulmonary disease, respiratory morbidity, lung cancer, laryngeal cancer, oral cancer, esophageal cancer, pancreatic cancer, kidney cancer, bladder cancer, and peptic ulcer disease; (5) effects on children; (6) health effects of passive smoking; and (7) cigar smoking. The toxic components of tobacco smoke have been linked to cancer, heart and lung disease, and adverse effects on reproduction and the fetus. Even nonsmokers inadvertently exposed to

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tobacco smoke are harmed. Exposure to ETS in infants and children has adverse effects on respiratory health. The burden of disease caused by smoking is immense, with 1 in 10 adults worldwide currently dying of a tobacco-related disease. By 2030, tobacco is expected to be the single biggest cause of death worldwide, accounting for about 10 million deaths per year. Smoking is a principal cause of lost life for middle-age persons. The author concludes that strong scientific evidence on smoking as a cause of disease and the enormous adverse impact of tobacco use on global public health provide sufficient rationale for giving high priority and adequate resources to tobacco control programs. ·

Women's Smoking: Health Consequences Source: in Some Like it Light: Women and Smoking in the European Union. Joossens, L.; Sasco, A.J. Brussels, Belgium, European Network for Smoking Prevention, pp. 8-21, 1999. Contact: European Network for Smoking Prevention, 48 rue de Pascale, 1040 Bruxelles, Brussels, Belgium. 32 2 230 65 15. FAX: 32 2 230 75 07. Internet/Email: http://www.ensp.org; [email protected]. Summary: Women's Smoking: Health Consequences, a chapter in Some Like it Light: Women and Smoking in the European Union, summarizes the health consequences of tobacco use in women and provides health promotion recommendations. Lung cancer has been the traditional marker of disease linked to tobacco. About 1.2 million lung cancer deaths occur in the world each year, making it the most frequent cancer mortality worldwide. Of these deaths, 282,000 occur in women and the rate of lung cancer deaths is rising significantly among women. Other cancers linked to tobacco use have also been increasing among women, including (1) bladder, (2) kidney, and (3) pancreatic cancers. Women who smoke have an increased risk of cervical cancer. Tobacco use is linked to heart attack, chronic heart disease, peripheral vascular disease, and cerebrovascular diseases in women as it is in men. Chronic obstructive pulmonary diseases, such as emphysema and chronic bronchitis are linked to tobacco use, especially among women. Smoking has been linked to facial wrinkling and the general health of the skin. Smoking affects the fertility of women, with a longer delay for conception in smokers as compared with nonsmokers. In vitro fertilization is also less successful in smokers. Smoking is also linked to pelvic inflammatory disease, low birthweight, spontaneous abortion, and sudden infant death syndrome. The author concludes with intervention strategies to prevent or reduce smoking during pregnancy. Special emphasis is on younger women, relapse prevention, and lower socioeconomic groups. The chapter also


provides information on the Put Smoking Out of Fashion project in the United Kingdom.

General Home References In addition to references for pancreatic cancer, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Cancer: 50 Essential Things to Do by Greg Anderson, O. Carl Simonton; Paperback - 184 pages; Revised & Updated edition (August 1999), Plume; ISBN: 0452280745; http://www.amazon.com/exec/obidos/ASIN/0452280745/icongroupinterna · Cancer Encyclopedia -- Collections of Anti-Cancer & Anti-Carcinogenic Agents, Chemicals, Drugs and Substances by John C. Bartone; Paperback (January 2002), ABBE Publishers Association of Washington, DC; ISBN: 0788326791; http://www.amazon.com/exec/obidos/ASIN/0788326791/icongroupinterna · Cancer Sourcebook: Basic Consumer Health Information About Major Forms and Stages of Cancer by Edward J. Prucha (Editor); Library Binding - 1100 pages, 3rd edition (August 1, 2000), Omnigraphics, Inc.; ISBN: 0780802276; http://www.amazon.com/exec/obidos/ASIN/0780802276/icongroupinterna · Cancer Supportive Care: A Comprehensive Guide for Patients and Their Families by Ernest H. Rosenbaum, M.D., Isadora Rosenbaum, M.A.; Paperback - 472 pages (November 5, 1998), Somerville House Books Limited; ISBN: 1894042115; http://www.amazon.com/exec/obidos/ASIN/1894042115/icongroupinterna · Cancer Symptom Management: Patient Self-Care Guides (Book with CD-ROM for Windows & Macintosh) by Connie Henke Yarbro (Editor), et al; CD-ROM - 264 pages, 2nd Book & CD-Rom edition (January 15, 2000), Jones & Bartlett Publishing; ISBN: 0763711675; http://www.amazon.com/exec/obidos/ASIN/0763711675/icongroupint erna · Diagnosis Cancer: Your Guide Through the First Few Months by Wendy Schlessel Harpham, Ann Bliss Pilcher (Illustrator); Paperback: 230 pages; Revised & Updated edition (November 1997), .W. Norton & Company;

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ISBN: 0393316912; http://www.amazon.com/exec/obidos/ASIN/0393316912/icongroupinterna · The Human Side of Cancer: Living with Hope, Coping with Uncertainty by Jimmie C. Holland, M.D., Sheldon Lewis; Paperback - 368 pages (October 2, 2001), Quill; ISBN: 006093042X; http://www.amazon.com/exec/obidos/ASIN/006093042X/icongroupinterna

Vocabulary Builder Abortion: 1. the premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. premature stoppage of a natural or a pathological process. [EU] Analgesics: Drugs that reduce pain. These drugs include aspirin, acetaminophen, and ibuprofen. [NIH] Anemia: A condition in which the number of red blood cells is below normal. [NIH] Anorexia: An abnormal loss of the appetite for food. Anorexia can be caused by cancer, AIDS, a mental disorder (i.e., anorexia nervosa), or other diseases. [NIH]

Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bronchus: A large air passage that leads from the trachea (windpipe) to the lung. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]

Cholangitis: Inflammation of a bile duct. [EU] Cholecystitis: Inflammation of the gallbladder. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH]


Cirrhosis: A type of chronic, progressive liver disease. [NIH] Colitis: Inflammation of the colon. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Constitutional: 1. affecting the whole constitution of the body; not local. 2. pertaining to the constitution. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Diverticulosis: A condition marked by small sacs or pouches (diverticula) in the walls of an organ such as the stomach or colon. These sacs can become inflamed and cause a condition called diverticulitis, which may be a risk factor for certain types of cancer. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dyspepsia: Upset stomach. [NIH] Dysphagia: Difficulty in swallowing. [EU] Emphysema: Pulmonary emphysema is a disorder affecting the alveoli (tiny air sacs) of the lungs. The transfer of oxygen and carbon dioxide in the lungs takes place in the walls of the alveoli. In emphysema, the alveoli become abnormally inflated, damaging their walls and making it harder to breathe. People who smoke or have chronic bronchitis have an increased risk of emphysema. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH] Facial: Of or pertaining to the face. [EU] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrosis: The growth of fibrous tissue. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it

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communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Gastritis: Inflammation of the stomach. [EU] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hemobilia: Hemorrhage in or through the biliary tract, due to trauma, inflammation, cholelithiasis, vascular disease, or neoplasms. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hepatitis: Inflammation of the liver. [NIH] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU] Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [NIH] Hypertension: Abnormally high blood pressure. [NIH] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH]


Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Laryngeal: Having to do with the larynx. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]

Myeloma: Cancer that arises in plasma cells, a type of white blood cell. [NIH] NSAIDs: Nonsteroidal anti-inflammatory drugs. A group of drugs that decrease fever, swelling, pain, and redness. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Pelvic: Pertaining to the pelvis. [EU] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Pernicious: Tending to a fatal issue. [EU] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Pulmonary: Relating to the lungs. [NIH] Radiography: The making of film records (radiographs) of internal structures of the body by passage of x-rays or gamma rays through the body to act on specially sensitized film. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU]

Substrate: A substance upon which an enzyme acts. [EU] Toxicology:

The science concerned with the detection, chemical

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composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Trophic: Of or pertaining to nutrition. [EU] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU]

Periodicals and News 193

CHAPTER 7. PERIODICALS AND NEWS ON PANCREATIC CANCER Overview Keeping up on the news relating to pancreatic cancer can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on pancreatic cancer. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover pancreatic cancer beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.

News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on pancreatic cancer is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.


PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “pancreatic cancer” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·

Panacea Pharmaceuticals, Inc. Awarded SBIR Grant From National Cancer Institute to Develop Diagnostic Test for Pancreatic Cancer Summary: Rockville, Md., Oct. 23 /PRNewswire/ -- Panacea Pharmaceuticals, Inc. announced today that it has been awarded a Phase I Small Business Innovation Research (SBIR) grant from the National Cancer Institute (NCI) of the National Institutes of Health (NIH). The grant will provide funding towards the development of a diagnostic test for pancreatic cancer based on the Company's HAAH Oncology Program, which targets the enzyme Human Aspartyl Asparaginyl BetaHydroxylase or HAAH as both a therapeutic target and as a cancer marker. "We are pleased to receive a third SBIR award from the National Institutes of Health, as it points to the importance of our technologies being developed," stated Hossein A. Ghanbari, Ph.D., President and CEO of the Company. "We are particularly excited about the development of tests based on HAAH, which have the potential to be used in the diagnosis and monitoring of solid tumors both during and subsequent to treatment and which may assist the clinician in treatment selection." The grant, entitled, "Development of Immunodiagnostics for Pancreatic Carcinoma," has several goals. These include the validation of HAAH as a soluble marker for pancreatic cancer, the development of sensitive and specific assays for HAAH in body fluid samples, and conducting a retrospective study of HAAH in pancreatic cancer patients. The retrospective study will measure HAAH levels in patients diagnosed with pancreatic cancer and will correlate these levels to tumor stage and patient outcome. Future work will include large-scale clinical studies to define the correlation between HAAH levels in the blood and pancreatic juice for the diagnosis, prognosis, and monitoring of pancreatic cancer. This work


may lead to the establishment of HAAH-specific immunoassays to be used in clinical diagnostic labs for multiple cancers. Current methods for the diagnosis and management of cancer rely heavily on imaging techniques, such as X-ray, CT scanning, and MRI as well as tissue biopsy and histopathologic findings. Current imaging procedures are costly and time consuming while tissue biopsy is quite invasive. Much effort has been put forth to identify specific molecular tumor markers that could be easily detected in bodily fluid samples and to develop sensitive assays to detect them. Unfortunately, to date, most tumor markers that have been identified have lacked in the requisite specificity and sensitivity for diagnosis and are of limited value in the determination of disease prognosis and as a method for continued monitoring of patients subsequent to treatment. The American Cancer Society estimates that 30,000 Americans die each year from pancreatic cancer. Pancreatic cancer is the fourth leading cause of cancer death in the United States for men and women, and has the highest mortality rate. The main reason for the poor prognosis of cancer of the pancreas is that very few of these cancers are found early. Because the pancreas is located deep inside the body, early tumors can't be seen or felt by healthcare providers during routine physical exams, and most patients have no symptoms until the cancer has reached a large size or spread to other organs.

Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to pancreatic cancer. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “pancreatic cancer” (or synonyms). The following was recently listed in this archive for pancreatic cancer: ·

GlycoGenesys drug demonstrates activity in pancreatic cancer trial Source: Reuters Industry Breifing Date: October 30, 2002 http://www.reuters.gov/archive/2002/10/30/business/links/20021030 drgd004.html


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High glycemic load and insulin resistance combine to increase pancreatic cancer risk Source: Reuters Medical News Date: September 10, 2002 http://www.reuters.gov/archive/2002/09/10/professional/links/20020 910epid001.html

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Starchy diet linked to pancreatic cancer--study Source: Reuters Health eLine Date: September 03, 2002 http://www.reuters.gov/archive/2002/09/03/eline/links/20020903elin 032.html

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Aphton seeks fast-track status for pancreatic cancer drug Source: Reuters Industry Breifing Date: August 19, 2002 http://www.reuters.gov/archive/2002/08/19/business/links/20020819 rglt006.html

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Small excess risk of pancreatic cancer seen among alcoholics Source: Reuters Medical News Date: August 13, 2002 http://www.reuters.gov/archive/2002/08/13/professional/links/20020 813epid003.html

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Aspirin use may protect postmenopausal women against pancreatic cancer Source: Reuters Industry Breifing Date: August 08, 2002 http://www.reuters.gov/archive/2002/08/08/business/links/20020808 epid008.html

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Aspirin may protect against pancreatic cancer Source: Reuters Health eLine Date: August 07, 2002 http://www.reuters.gov/archive/2002/08/07/eline/links/20020807elin 024.html

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Gemcitabine plus radiotherapy holds promise for pancreatic cancer Source: Reuters Industry Breifing Date: July 23, 2002 http://www.reuters.gov/archive/2002/07/23/business/links/20020723 clin002.html


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GenVec starts phase IIb program for pancreatic cancer drug Source: Reuters Industry Breifing Date: July 17, 2002 http://www.reuters.gov/archive/2002/07/17/business/links/20020717 drgd003.html

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Positive cytology does not contraindicate resection of pancreatic cancer Source: Reuters Medical News Date: June 06, 2002 http://www.reuters.gov/archive/2002/06/06/professional/links/20020 606clin004.html

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Cell Genesys tests GVAX in second pancreatic cancer trial Source: Reuters Industry Breifing Date: May 29, 2002 http://www.reuters.gov/archive/2002/05/29/business/links/20020529 drgd006.html

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Saturated fat intake increases risk of pancreatic cancer among smokers Source: Reuters Medical News Date: May 17, 2002 http://www.reuters.gov/archive/2002/05/17/professional/links/20020 517epid007.html

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Test could screen diabetics for pancreatic cancer Source: Reuters Health eLine Date: May 15, 2002 http://www.reuters.gov/archive/2002/05/15/eline/links/20020515elin 017.html

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Fujirebio's pancreatic cancer treatment assay receives FDA clearance Source: Reuters Industry Breifing Date: May 14, 2002 http://www.reuters.gov/archive/2002/05/14/business/links/20020514 rglt008.html

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Fatty diet ups pancreatic cancer risk in smokers Source: Reuters Health eLine Date: May 14, 2002 http://www.reuters.gov/archive/2002/05/14/eline/links/20020514elin 012.html

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Critical pancreatic cancer detection period identified in diabetics Source: Reuters Medical News Date: May 14, 2002 http://www.reuters.gov/archive/2002/05/14/professional/links/20020 514clin018.html


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Ulcer surgery linked to risk of pancreatic cancer Source: Reuters Health eLine Date: April 30, 2002 http://www.reuters.gov/archive/2002/04/30/eline/links/20020430elin 008.html

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Human macrophage metalloelastase expression worsens pancreatic cancer prognosis Source: Reuters Medical News Date: April 22, 2002 http://www.reuters.gov/archive/2002/04/22/professional/links/20020 422clin004.html

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Plant compounds may curb pancreatic cancer growth Source: Reuters Health eLine Date: April 16, 2002 http://www.reuters.gov/archive/2002/04/16/eline/links/20020416elin 005.html

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Food polyphenols show action against pancreatic cancer Source: Reuters Industry Breifing Date: April 15, 2002 http://www.reuters.gov/archive/2002/04/15/business/links/20020415 scie001.html

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Photodynamic therapy shows promise as treatment for pancreatic cancer Source: Reuters Industry Breifing Date: April 12, 2002 http://www.reuters.gov/archive/2002/04/12/business/links/20020412 drgd001.html

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Statins might fight spread of pancreatic cancer Source: Reuters Health eLine Date: March 29, 2002 http://www.reuters.gov/archive/2002/03/29/eline/links/20020329elin 004.html

·

Light therapy shows promise for pancreatic cancer Source: Reuters Health eLine Date: March 14, 2002 http://www.reuters.gov/archive/2002/03/14/eline/links/20020314elin 005.html


·

Heredity's role in pancreatic cancer confirmed Source: Reuters Health eLine Date: March 08, 2002 http://www.reuters.gov/archive/2002/03/08/eline/links/20020308elin 024.html

·

Heredity tied to increased pancreatic cancer risk Source: Reuters Medical News Date: March 07, 2002 http://www.reuters.gov/archive/2002/03/07/professional/links/20020 307epid001.html

·

Gemzar/Camptosar therapy points to higher survival in pancreatic cancer patients Source: Reuters Industry Breifing Date: March 06, 2002 http://www.reuters.gov/archive/2002/03/06/business/links/20020306 drgd003.html

·

Scientists zero in on pancreatic cancer gene Source: Reuters Health eLine Date: March 01, 2002 http://www.reuters.gov/archive/2002/03/01/eline/links/20020301elin 030.html

·

Gemcitabine/radioimmunotherapy show promise as pancreatic cancer treatment Source: Reuters Industry Breifing Date: February 08, 2002 http://www.reuters.gov/archive/2002/02/08/business/links/20020208 scie002.html

·

Receptor blocks pancreatic cancer growth in mice Source: Reuters Health eLine Date: January 25, 2002 http://www.reuters.gov/archive/2002/01/25/eline/links/20020125elin 002.html

·

Radiation plus chemotherapy may treat pancreatic cancer Source: Reuters Industry Breifing Date: November 21, 2001 http://www.reuters.gov/archive/2001/11/21/business/links/20011121 drgd001.html


·

Radiation-drug combo may treat pancreatic cancer Source: Reuters Health eLine Date: November 20, 2001 http://www.reuters.gov/archive/2001/11/20/eline/links/20011120elin 012.html

·

Chemo plus surgery ups pancreatic cancer survival Source: Reuters Health eLine Date: November 12, 2001 http://www.reuters.gov/archive/2001/11/12/eline/links/20011112elin 012.html

·

Obesity, inactivity may up pancreatic cancer risk Source: Reuters Health eLine Date: October 10, 2001 http://www.reuters.gov/archive/2001/10/10/eline/links/20011010elin 011.html

·

Physical activity may decrease risk of pancreatic cancer Source: Reuters Medical News Date: October 09, 2001 http://www.reuters.gov/archive/2001/10/09/professional/links/20011 009epid002.html

·

Gene therapy may destroy pancreatic cancer cells Source: Reuters Health eLine Date: October 09, 2001 http://www.reuters.gov/archive/2001/10/09/eline/links/20011009elin 004.html

·

Laparoscopy contributes to staging of potentially unresectable pancreatic cancer Source: Reuters Medical News Date: December 11, 2000 http://www.reuters.gov/archive/2000/12/11/professional/links/20001 211clin011.html

·

RAS peptide vaccine for pancreatic cancer under development Source: Reuters Industry Breifing Date: November 23, 2000 http://www.reuters.gov/archive/2000/11/23/business/links/20001123 drgd002.html


·

Phase II study shows irofulven effective in treating pancreatic cancer Source: Reuters Industry Breifing Date: November 09, 2000 http://www.reuters.gov/archive/2000/11/09/business/links/20001109 drgd007.html

·

Multimodal therapy including hyperthermia useful for unresectable pancreatic cancer Source: Reuters Medical News Date: November 09, 2000 http://www.reuters.gov/archive/2000/11/09/professional/links/20001 109clin004.html

·

Gemcitabine, 5-FU, cisplatin effective for advanced pancreatic cancer Source: Reuters Industry Breifing Date: November 07, 2000 http://www.reuters.gov/archive/2000/11/07/business/links/20001107 drgd005.html

·

MGI Pharma to assess irofulven in treating pancreatic cancer Source: Reuters Industry Breifing Date: October 23, 2000 http://www.reuters.gov/archive/2000/10/23/business/links/20001023 inds004.html

·

Neurotensin receptor a potential therapeutic target for pancreatic cancer Source: Reuters Industry Breifing Date: June 20, 2000 http://www.reuters.gov/archive/2000/06/20/business/links/20000620 scie002.html

·

NIH funds trial of alternative pancreatic cancer therapy Source: Reuters Medical News Date: June 08, 2000 http://www.reuters.gov/archive/2000/06/08/professional/links/20000 608drgd003.html

·

NIH funds study of alternative pancreatic cancer protocol Source: Reuters Health eLine Date: June 07, 2000 http://www.reuters.gov/archive/2000/06/07/eline/links/20000607elin 042.html


·

Abnormal glucose metabolism associated pancreatic cancer mortality Source: Reuters Medical News Date: May 18, 2000 http://www.reuters.gov/archive/2000/05/18/professional/links/20000 518epid001.html

·

High glucose levels linked to pancreatic cancer risk Source: Reuters Health eLine Date: May 16, 2000 http://www.reuters.gov/archive/2000/05/16/eline/links/20000516elin 015.html

·

Laparoscopy reduces unnecessary interventions for patients with pancreatic cancer Source: Reuters Medical News Date: April 18, 2000 http://www.reuters.gov/archive/2000/04/18/professional/links/20000 418clin004.html

·

Organochlorine serum levels linked to K-ras mutations in pancreatic cancer Source: Reuters Medical News Date: December 17, 1999 http://www.reuters.gov/archive/1999/12/17/professional/links/19991 217epid001.html

·

Exposure to pesticides linked to pancreatic cancer Source: Reuters Health eLine Date: December 17, 1999 http://www.reuters.gov/archive/1999/12/17/eline/links/19991217elin 002.html

·

Screening protocol recommended for relatives of patients with pancreatic cancer Source: Reuters Medical News Date: August 17, 1999 http://www.reuters.gov/archive/1999/08/17/professional/links/19990 817clin001.html

The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus


allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.

Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.

Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “pancreatic cancer” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about. Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “pancreatic cancer” (or synonyms). If you know the name of a company that is relevant to pancreatic cancer, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.

BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “pancreatic cancer” (or synonyms).


Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “pancreatic cancer” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on pancreatic cancer: ·

Clues to Pancreatic Cancer Source: Nutrition Action Healthletter. 28(9): 9. November 2001. Contact: Center for Science in the Public Interest. 1875 Connecticut Avenue NW, Suite 300, Washington, DC 20009-5728. Summary: A study originally published in the Journal of the American Medical Association found an increased risk of pancreatic cancer in people who are obese. One possible explanation may be that high blood insulin levels may promote pancreatic cancer. Both obesity and being sedentary raise insulin, while weight loss and exercise lower it. The study showed that among those who are either overweight or obese, even moderate physical activity lowers the risk of pancreatic cancer. Overweight people who walked or hiked at least 4 hours a week had half the risk of pancreatic cancer compared to those who walked fewer than 20 minutes a week. Exercise reduced the risk even in the absence of weight loss.

Academic Periodicals Covering Pancreatic Cancer Academic periodicals can be a highly technical yet valuable source of information on pancreatic cancer. We have compiled the following list of periodicals known to publish articles relating to pancreatic cancer and which are currently indexed within the National Library of Medicine’s PubMed


database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on pancreatic cancer published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit the Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on pancreatic cancer: ·

Acta Anaesthesiologica Scandinavica. (Acta Anaesthesiol Scand) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ac ta+Anaesthesiologica+Scandinavica&dispmax=20&dispstart=0

·

Best Practice & Research. Clinical Gastroenterology. (Best Pract Res Clin Gastroenterol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Be st+Practice+&+Research.+Clinical+Gastroenterology&dispmax=20&disp start=0

·

British Journal of Cancer. (Br J Cancer) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bri tish+Journal+of+Cancer&dispmax=20&dispstart=0

·

Cancer Research. (Cancer Res) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ca ncer+Research&dispmax=20&dispstart=0

·

Clinical & Experimental Metastasis. (Clin Exp Metastasis) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cli nical+&+Experimental+Metastasis&dispmax=20&dispstart=0


·

Diabetes Research and Clinical Practice. (Diabetes Res Clin Pract) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Di abetes+Research+and+Clinical+Practice&dispmax=20&dispstart=0

·

Gastrointestinal Endoscopy. (Gastrointest Endosc) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ga strointestinal+Endoscopy&dispmax=20&dispstart=0

·

Genetic Epidemiology. (Genet Epidemiol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ge netic+Epidemiology&dispmax=20&dispstart=0

·

Journal of Gastroenterology and Hepatology. (J Gastroenterol Hepatol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Gastroenterology+and+Hepatology&dispmax=20&dispstart=0

·

Journal of Gastroenterology. (J Gastroenterol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Gastroenterology&dispmax=20&dispstart=0

·

Journal of Surgical Oncology. (J Surg Oncol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Surgical+Oncology&dispmax=20&dispstart=0

·

Journal of the National Cancer Institute. (J Natl Cancer Inst) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+the+National+Cancer+Institute&dispmax=20&dispstart=0

·

Postgraduate Medical Journal. (Postgrad Med J) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Po stgraduate+Medical+Journal&dispmax=20&dispstart=0

·

Scandinavian Journal of Gastroenterology. (Scand J Gastroenterol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Sc andinavian+Journal+of+Gastroenterology&dispmax=20&dispstart=0

·

Seminars in Oncology. (Semin Oncol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Se minars+in+Oncology&dispmax=20&dispstart=0


Vocabulary Builder Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Panacea: A cure-all. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Radioimmunotherapy: Treatment with a radioactive substance that is linked to an antibody that will attach to the tumor when injected into the body. [NIH] Retrospective: Looking back at events that have already taken place. [NIH]

Physician Guidelines and Databases 209

CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.

NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

·

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

·

National Cancer Institute (NCI); guidelines available at http://cancernet.nci.nih.gov/pdq/pdq_treatment.shtml


In this chapter, we begin by reproducing one such guideline for pancreatic cancer:

What Is Pancreatic Cancer?34 Carcinoma of the pancreas has markedly increased in incidence over the past several decades, and ranks as the fifth leading cause of cancer death in the United States. Despite the high mortality rate associated with pancreatic cancer, its etiology is poorly understood.35 Cancer of the exocrine pancreas is rarely curable and has an overall survival rate of less than 4%.36 The highest cure rate occurs if the tumor is truly localized to the pancreas; however, this stage of disease accounts for fewer than 20% of cases. For those patients with localized disease and small cancers (< 2 centimeters) with no lymph node metastases and no extension beyond the “capsule” of the pancreas, complete surgical resection can yield actuarial 5-year survival rates of 18% to 24%.37 [Level of evidence: 3iA] Improvements in imaging technology, including spiral computed tomographic scans, magnetic resonance imaging scans, positron emission tomographic scans, endoscopic ultrasound examination, and laparoscopic staging can aid in the diagnosis and the identification of patients with disease that is not amenable to resection.38 In a case series of 228 patients, positive peritoneal cytology had a positive predictive value of 94%, specificity of 98%, and sensitivity of 25% for determining unresectability.39 For patients with advanced cancers, the overall survival

The following guidelines appeared on the NCI website on September 10, 2002. The text was last modified in September 2002. The text has been adapted for this sourcebook. Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.) 35 Silverman DT, Schiffman M, Everhart J, et al.: Diabetes mellitus, other medical conditions and familial history of cancer as risk factors for pancreatic cancer. British Journal of Cancer 80(11): 1830-1837, 1999. 36 Greenlee RT, Murray T, Bolden S, et al.: Cancer statistics, 2000. CA: A Cancer Journal for Clinicians 50(1): 7-33, 2000. 37 Yeo CJ, Abrams RA, Grochow LB, et al.: Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Annals of Surgery 225(5): 621-636, 1997. 38 Riker A, Libutti SK, Bartlett DL: Advances in the early detection, diagnosis, and staging of pancreatic cancer. Surgical Oncology 6(3): 157-169, 1998. 39 Merchant NB, Conlon KC, Saigo P, et al.: Positive peritoneal cytology predicts unresectability of pancreatic adenocarcinoma. Journal of the American College of Surgeons 188(4): 421-426, 1999. 34


rate of all stages is less than 1% at 5 years with most patients dying within 1 year.40 There are no tumor-specific markers for pancreatic cancer; markers such as serum CA 19-9 have low specificity. Most patients with pancreatic cancer will have an elevated CA 19-9 at diagnosis. Following or during definitive therapy, the increase of CA 19-9 levels may identify patients with progressive tumor growth.41 [Level of evidence: 3iDii] However, the presence of a normal CA 19-9 does not preclude recurrence. Patients with any stage of pancreatic cancer can appropriately be considered candidates for clinical trials because of the poor response to chemotherapy, radiation therapy, and surgery as conventionally used. However, palliation of symptoms may be achieved with conventional treatment. Symptoms due to pancreatic cancer may depend on the site of the tumor within the pancreas and the degree of involvement. Palliative surgical or radiologic biliary decompression, relief of gastric outlet obstruction, and pain control may improve the quality of life while not affecting overall survival.42 Palliative efforts may also be directed to the potentially disabling psychological events associated with the diagnosis and treatment of pancreatic cancer.43

Lillemoe KD: Current management of pancreatic carcinoma. Annals of Surgery 221(2): 133-148, 1995. Yeo CJ: Pancreatic cancer: 1998 update. Journal of the American College of Surgeons 187(4): 429-442, 1998. Nitecki SS, Sarr MG, Colby TV, et al.: Long-term survival after resection for ductal adenocarcinoma of the pancreas: is it really improving? Annals of Surgery 221(1): 59-66, 1995. Conlon KC, Klimstra DS, Brennan MF: Long-term survival after curative resection for pancreatic ductal adenocarcinoma: clinicopathologic analysis of 5-year survivors. Annals of Surgery 223(3), 273-279, 1996. 41 Willett CG, Daly WJ, Warshaw AL: CA 19-9 is an index of response to neoadjuvant chemoradiation therapy in pancreatic cancer. American Journal of Surgery 172(4): 350-352, 1996. 42 Sohn TA, Lillemoe KD, Cameron JL, et al.: Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s. Journal of the American College of Surgeons 188(6): 658-669, 1999. Baron TH: Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. New England Journal of Medicine 344(22): 1681-1687, 2001. 43 Passik SD, Breitbart WS: Depression in patients with pancreatic carcinoma: diagnostic and treatment issues. Cancer 78(3): 615-626, 1996. 40


Cellular Classification Malignant ·

Duct cell carcinoma (90% of all cases)

·

Acinar cell carcinoma

·

Papillary mucinous carcinoma

·

Signet ring carcinoma

·

Adenosquamous carcinoma

·

Undifferentiated carcinoma

·

Mucinous carcinoma

·

Giant cell carcinoma

·

Mixed type (ductal-endocrine or acinar-endocrine)

·

Small cell carcinoma

·

Cystadenocarcinoma (serous and mucinous types)

·

Unclassified

·

Pancreatoblastoma

·

Papillary-cystic neoplasm (this tumor has lower malignant potential, and may be cured with surgery alone)44

Borderline Malignancies ·

Mucinous cystic tumor with dysplasia

·

Intraductal papillary mucinous tumor with dysplasia

·

Pseudopapillary solid tumor

Stage Information The staging system for pancreatic exocrine cancer continues to evolve. The importance of staging beyond that of “resectable” and “unresectable” is Sanchez JA, Newman KD, Eichelberger MR, et al.: The papillary-cystic neoplasm of the pancreas. Archives of Surgery 125(11): 1502-1505, 1990. Warshaw AL, Compton CC, Lewandrowski K, et al.: Cystic tumors of the pancreas: new clinical, radiologic, and pathologic observations in 67 patients. Annals of Surgery 212(4): 432-443, 1990.

44


uncertain since state-of-the-art treatment has demonstrated little impact on survival. However, in order to communicate a uniform definition of disease, knowledge of the extent of the disease is necessary. Cancers of the pancreas are commonly identified by the site of involvement within the pancreas. Surgical approaches differ for masses in the head, body, tail, or uncinate process of the pancreas. The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification.45

TNM Definitions Primary tumor (T): ·

TX: Primary tumor cannot be assessed

·

T0: No evidence of primary tumor

·

Tis: In situ carcinoma

·

T1: Tumor limited to the pancreas 2 cm or less in greatest dimension

·

T2: Tumor limited to the pancreas more than 2 cm in greatest dimension

·

T3: Tumor extends directly into any of the following: duodenum, bile duct, or peripancreatic tissues

·

T4: Tumor extends directly into any of the following: stomach, spleen, colon, or adjacent large vessels

Regional lymph nodes (N): ·

NX: Regional lymph nodes cannot be assessed

·

N0: No regional lymph node metastasis

·

N1: Regional lymph node metastasis

Distant metastasis (M): ·

MX: Distant metastasis cannot be assessed

·

M0: No distant metastasis

·

M1: Distant metastasis

Exocrine pancreas. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual. Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed., 1997, pp 121-126.

45


AJCC Stage Groupings Stage 0 ·

Tis, N0, M0

Stage I ·

T1, N0, M0

·

T2, N0, M0

Stage II ·

T3, N0, M0

Stage III ·

T1, N1, M0

·

T2, N1, M0

·

T3, N1, M0

Stage IVA ·

T4, Any N, M0

Stage IVB ·

Any T, Any N, M1

Treatment Option Overview46 The survival rate of patients with any stage of pancreatic exocrine cancer is poor. Clinical trials are appropriate alternatives for treatment of patients with any stage of disease and should be considered prior to selecting palliative approaches. To provide optimal palliation, determination of Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)

46


resectability must be made. Staging studies for resectability include helical computed tomographic scan, magnetic resonance imaging scan, and endoscopic ultrasound. The introduction of minimally invasive techniques, such as laparoscopy and laparoscopic ultrasound, may decrease the use of laparotomy.47 Surgical resection remains the primary modality when feasible since, on occasion, resection can lead to long-term survival and provides effective palliation.48 [Level of evidence: 3iA] Frequently, malabsorption due to exocrine insufficiency contributes to malnutrition. Attention to pancreatic enzyme replacement can help alleviate this problem. (Refer to the PDQ summary on Nutrition for more information.) Celiac axis (and intrapleural) nerve blocks can provide highly effective and long-lasting control of pain for some patients. The designations in PDQ that treatments are “standard” or “under clinical evaluation” are not to be used as a basis for reimbursement determinations.

Stage I Pancreatic Cancer Approximately 20% of patients present with pancreatic cancer amenable to local surgical resection, with operative mortality rates of approximately 1% to 16%.49 Using information from the Medicare claims database, a national

John TG, Greig JD, Carter DC, et al.: Carcinoma of the pancreatic head and periampullary region: tumor staging with laparoscopy and laparoscopic ultrasonography. Annals of Surgery 221(2): 156-164, 1995. Minnard EA, Conlon KC, Hoos A, et al.: Laparoscopic ultrasound enhances standard laparoscopy in the staging of pancreatic cancer. Annals of Surgery 228(2): 182-187, 1998. 48 Yeo CJ, Cameron JL, Lillemoe KD, et al.: Pancreaticoduodenectomy for cancer of the head of the pancreas: 201 patients. Annals of Surgery 221(6): 721-733, 1995. Conlon KC, Klimstra DS, Brennan MF: Long-term survival after curative resection for pancreatic ductal adenocarcinoma: clinicopathologic analysis of 5-year survivors. Annals of Surgery 223(3), 273-279, 1996. Yeo CJ, Abrams RA, Grochow LB, et al.: Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Annals of Surgery 225(5): 621-636, 1997. 49 Birkmeyer JD, Finlayson SR, Tosteson AN, et al.: Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery 125(3): 250-256, 1999. Cameron JL, Pitt HA, Yeo CJ, et al.: One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Annals of Surgery 217(5): 430-438, 1993. Spanknebel K, Conlon KC: Advances in the surgical management of pancreatic cancer. Cancer Journal from Scientific American 7(4): 312-323, 2001. Balcom JH 4th, Rattner DW, Warshaw AL, et al.: Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Archives of Surgery 136(4): 391-398, 2001. 47


cohort study of over 7000 patients undergoing pancreaticoduodenectomy between 1992 and 1995 revealed higher in-hospital mortality rates at low volume hospitals (5 per year), (16% vs. 4% respectively, p

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