Pancreatic Cancer

As the world mourns the visionary computer technology and Apple, Inc. co-founder Steve Jobs, should look more closely, has publicly battled the disease.
Jobs had a rare form of pancreatic cancer is called a neuroendocrine tumor. Patrick Swayze, Joan Crawford, Margaret Mead and Luciano Pavarotti died of all the most common form of pancreatic cancer, called adenocarcinoma. Supreme Court Justice Ruth Bader Ginsburg had surgery for pancreatic cancer in February 2009 and 18 days later, back on the bench.

"At this time, pancreatic cancer is getting publicity, but it is a neglected disease," said Michaela Banck, a medical oncologist at the Mayo Clinic, which treats patients with neuroendocrine tumors. "It does not draw attention like colon cancer and breast cancer. Groups of activists to raise small amounts of money, since it is a rare disease. It is a complicated disease. We have enough money to move as quickly as we would like.

"Who gets cancer of the pancreas
Pancreatic cancer is the fourth most common cause of cancer death in the United States, after lung cancer, colon and breast. Risk lasting about 1 71 this year, about 44 030 people were diagnosed with pancreatic cancer, and the disease kills about 37 660 people, according to the American Cancer Society.

About 95 percent of people with pancreatic cancer die, experts say. It is so deadly, because in the early stages where the tumor would be treated, there are usually no symptoms. It tends to be detected at an advanced stage, when the abdominal pain or jaundice can cause. Currently, there is no general screening tools.
Rates for pancreatic cancer have declined slightly in men and women in the 15 to 25 years.
As people age, the risk of developing pancreatic cancer increases. Most patients are over 45 years of age, and almost 90% over 55 years of age. The average age at diagnosis is 72
Males are slightly more likely to develop pancreatic cancer than in women, which may be partly due to the increase in smoking among men. Previously, when men smoked than women in general, and the gender gap was wide.

There is also a known association with race: African Americans are more likely to develop pancreatic cancer than whites. Doctors do not know why, but speculate that higher for men to smoke and have diabetes, and women are obese, may contribute to this association.

What are the types of pancreatic cancer?
The pancreas is an elongated, located deep in the abdomen, and is an integral part of both the stomach and endocrine system. It secretes hormones to regulate the body as well as digestive enzymes to break down food.

There are two types of pancreatic cancer: cancer of the exocrine and endocrine tumors.
Exocrine pancreatic tumors are the majority, and the most common type is called adenocarcinoma, which starts the cells of the gland, usually the ducts of the pancreas. Swayze died of pancreatic cancer like that. These tumors tend to be more aggressive neuroendocrine tumors, which was about the occupation, but if caught in time can be effectively treated with surgery.
The neuroendocrine tumors of the pancreas represent only 1% of all cancers of the pancreas. They can be benign or malignant, but the distinction is often blurred and sometimes seemingly only when the cancer has spread beyond the pancreas.

The survival rate at five years for neuroendocrine tumors can range from 50% to 80%, compared to less than 5% for adenocarcinoma.
More advanced tumors have a higher risk of relapse, and may spread to the liver, Libutti said.
Treatment
Pancreatic cancer is usually controlled only by the removal by surgery, and only if it is before it has spread, according to the National Cancer Institute. Palliative care can help a patient's quality of life if the disease has spread.
Two new drugs approved this year, may help patients with neuroendocrine tumors of the pancreas. It is believed to suppress the circulation and the metabolism of cancer cells. He has made good progress since a year ago, the level of treatment was chemotherapy, Banck said.

Everolimus, marketed by Novartis as Afinitor, has received U.S. Food and Drug Administration approval for the treatment of pancreatic neuroendocrine tumors and prevention of transplant rejection. Possible side effects are severe, but: lung or breathing problems, infections and renal failure, which can lead to death.
Sunitinib malate, marketed by Pfizer as Sutent, is prescribed for the treatment of neuroendocrine tumors of the pancreas and kidney cancer and GIST, a rare type of bowel cancer, esophagus or stomach. As with everolimus, there are risks to consider:
it can cause liver problems and death.

Given that employment has undergone surgery to remove his tumor in 2004 and died in 2011, his seven-year survival after treatment is consistent with the average survival for these types of tumors, Libutti said.
If pancreatic cancer is detected early, which can increase the chances of survival, but also depends on the aggressiveness of the tumors are especially in a patient. If surgery leaves microscopic aggressive tumor cells, which can cause cancer recurrence.
Jobs has also undergone a liver transplant in Tennessee in 2009, what is "cutting edge stuff," because when neuroendocrine tumors spread, said Dr. Maged Rizk, director of the chronic abdominal pain in Cleveland Clinic, who specializes in gastroenterology and hepatology.
Steve Jobs has money to buy her a liver transplant more quickly?
But because it is so rare, there is much evidence of the transplant as a cure, the procedure may prolong life, but the immunosuppression drugs may allow the rest of the tumor to grow faster, the doctors say. And the study found that the majority of patients undergoing liver transplantation for this type of cancer was a recurrence of the disease.

But many pancreatic cancers are detected at later stages, because when the tumor is small, there are often no symptoms. Growing up, can block the channels adenocarcinoma of the liver and cause severe back pain. Neuroendocrine tumors may produce insulin, so a patient's first symptoms may be hypoglycemia. But most tumors do not produce hormones, Libutti said.

There are two rare genetic syndromes - multiple endocrine neoplasia type 1 (MEN1) and von Hippel-Lindau syndrome (VHL) - to increase the risk for endocrine tumors of the pancreas. Aside from that, it is unclear whether having a family member to pancreatic cancer increases the risk of a person.
Pancreatic cancer has hit hard the family of former President Jimmy Carter. He lost his father and all his siblings, his brother Billy and his sister Ruth Carter Stapleton and Gloria Carter Spann.
Future treatments
Researchers are working on a better understanding of how pancreatic tumors grow and spread, said Dr. Steven Libutti, pancreatic cancer specialist and director of cancer care-Einstein Montefiore in the Bronx.

"There are a number of factors, which, having been studied in clinical trials, which focus on pathways that can bypass the normal processes of cancer of the pancreas," Libutti said.
One is an antibody that blocks a specific protein called PD-1 on the surface of pancreatic cancer, which means that chemotherapy would be more efficient because there would be an immune response against the tumor. This is done by the National Cancer Institute.
Libutti laboratory works on targeted therapies for metastatic neuroendocrine tumors nanoparticles. The idea is that small particles are coated with a material that is closing in tumor cells and deliver drugs to kill them without harming healthy tissue, thus reducing toxicity to the body in general. This research is still in animal models.

"Hopefully in the not too distant future, we are ready to move to clinical trials," he said.
Another line of research focuses on finding biomarkers for pancreatic cancer so that a simple blood or urine test could be developed. Unlike screening for other conditions such as cancer of the colon, breast and prostate, there is no way routine to see if a patient has a tumor in the pancreas.
The future of medicine to help people involved in genetics of pancreatic cancer, said Banck. This would require a person to match a specific type of cancer using genomic information with care.
"What will make a real difference in the future is a revolution in the era of the genome," he said.