Pancreas

The pancreas is a gland, about six inches long, located in the abdomen that is surrounded by the stomach, small intestine, liver, spleen and gallbladder.

The pancreas is both an exocrine gland and endocrine gland:

Exocrine cells of the pancreas produce enzymes that help with digestion. The endocrine cells of the pancreas produce hormones, which are substances that control or regulate many specific functions in the body. The two main pancreatic hormones are insulin and glucagon. Insulin lowers blood sugar levels and glucagon raises blood sugar levels. Together, these two main hormones work to maintain the proper level of sugar in the blood.

Exocrine Tumors: Pancreatic cancer begins when abnormal cells within the pancreas grow uncontrollably and form a tumor. More than 95% of pancreatic cancers are classified as exocrine tumors and more than 90% of these tumors are adenocarcinomas, where the cancer begins in the cells lining the pancreatic duct.

Rare forms of pancreatic cancers include:

• Acinar Cell Carcinoma, which overproduces enzymes to digest fats
• Intraductal Papillary-Mucinous Neoplasm, which is a cystic tumor usually located in the main pancreatic duct or in side branches of the duct
• Mucinous Cystadenocarcinoma, which is a cystic tumor usually located in the tail of the pancreas that is filled with a thick fluid called mucin

Endocrine Tumors: Pancreatic neuroendocrine tumors (PNETs) account for less that 5% of all pancreatic cancers. They arise from the hormone producing cells in the pancreas called islet cells. PNETs are functional, meaning they produce hormones, or nonfunctional, producing no hormones. Most PNETs are nonfunctional and cancerous.

Treatments for Pancreatic cancer include:

• Surgery
• Chemotherapy
• Radiation Therapy (for exocrine tumors)
• Immunotherapy
• Targeted Therapy
• Clinical Trials.

Stage IA: Tumor is limited to the pancreas and measures less that 2 cm

Stage IB: Tumor is limited to the pancreas and is larger that 2 cm

• Treatment for Stage IA and IB is Surgical resection

Stage IIA: Tumor has extended beyond the pancreas but does not involve local arteries or lymph nodes

Stage 11B: Tumor has may have extended beyond the pancreas and local lymph nodes and without artery involvement

• Treatment for Stage IIA and IIB is surgical resection

Stage III: Tumor involves major arteries (the celiac axis and/or superior mesenteric artery with or without lymph node involvement

Stage IV: Tumor has metastasized to another part of the body, including the liver, abdominal wall, lungs, and/or lymph nodes

The primary treatment for Stage III and Stage IV Pancreatic Cancer is chemotherapy:

• Gemcitabine (Gemzar) is the drug used most often is often combined with other drugs like paclitaxel (Abraxane), erlotinib (Tarceva), or capecitabine (Xeloda)
• Another treatment combination of four chemo drugs that is used to treat advanced pancreatic cancer is called FOLFIRINOX consisting of 5-FU, leucovorin, irinotecan (Camptosar), and oxaliplatin (Eloxatin)

Targeted Therapies for Pancreatic Cancers:

• Treatment for Stage III and Stage IV endocarcinomas includes the targeted therapy drug erlotinib (Tarceva®), in combination with the chemotherapy drug gemcitabine (Gemzar®)
• Treatment for Stage III and Stage IV advanced pancreatic neuroendocrine tumors includes the targeted therapy drugs sunitinib (Sutent®) and everolimus (Afinitor®)

Surgical Procedures for Pancreatic cancer include:

• Whipple procedure is most common in cancers of the head of the pancreas, and is a procedure where the pancreas head, and sometimes the entire organ, is removed along with a portion of the stomach, duodenum, and lymph nodes
• Distal pancreatectomy, is a procedure where the pancreas tail and spleen are removed, along with the spleen. This procedure is usually used to treat islet cell or neuroendocrine tumors
• Total pancreatectomy, a surgery where the entire pancreas and spleen are removed

Clinical Trials:

National Cancer Institute (NCI) Trials
The NCI, part of the National Institutes of Health, is the federal agency that provides funding for most U.S. cancer clinical trials. This site provides information on both open and closed cancer clinical trials that are funded by the government, as well as many sponsored by pharmaceutical companies, medical centers, and some international organizations.
http://www.cancer.gov/clinicaltrials/featured/types/pancreatic-cancer

Pancreatic Cancer Network: National free patient advocacy and research network
http://www.pancan.org/section-facing-pancreatic-cancer/learn-about-pan-cancer/clinical-trials/

Center for Information and Study on Clinical Research Participation (CISCRP). CISCRP offers an online clinical trials search engine at SearchClinicalTrials.org. In addition, they provide a toll-free number where patients can receive help locating a clinical trial.
www.SearchClinicalTreials.org

Centerwatch This site helps people connect with clinical trials by offering a list of institutional review board (IRB)-approved clinical trials.
www.centerwatch.com

ClinicalTrials.gov This database of publicly and privately supported clinical trials is maintained by the National Library of Medicine at the NIH.
www.clinicaltrials.gov

Coalition of Cancer Cooperative Groups This organization provides resources and information in order for patients to search for clinical trials.
www.cancertrialshelp.org

EmergingMed Navigator- This organization helps to identify clinical trial options that match a patient’s specific diagnosis, stage and treatment history. Clinical trial specialists can also provide telephone support to help connect eligible patients with IRB-approved study sites that are enrolling new participants.
www.emergingmed.com

WHO International Clinical Trials Registry Platform Search Portal The World Health Organization (WHO) coordinates health matters within the United Nations. This database allows people to search clinical trial registration information from many countries’ registries.
http://www.who.int/ictrp/en/

Care Cares-Cancer education, counseling, and support groups
http://www.cancercare.org/diagnosis/pancreatic_cancer

Pancreatic Cancer Educational Material from Celgene
http://pancreaticcancerdiseaseeducation.com/resources/

Pancreatic Cancer Network-free patient resources
http://www.pancan.org/

Pancreatic Cancer Foundation
http://www.pancreasfoundation.org/

Lustgarten
http://www.lustgarten.org

Modifying Oncolytic Adenoviruses to Target Pancreatic Cancer
March, 2018
https://www.news-medical.net/news/20180309/Modifying-Oncolytic-Adenoviruses-to-Target-Pancreatic-Cancer.aspx

Sequencing Strategies in Pancreatic Cancer
February, 2018
http://www.onclive.com/insights/metastatic-pancreatic-sequencing/sequencing-strategies-in-pancreatic-cancer

Pamrevlumab Granted Fast Track Designation by FDA for Locally Advanced Pancreatic Cancer
March 2, 2018
http://www.targetedonc.com/news/pamrevlumab-granted-fast-track-designation-by-fda-for-locally-advanced-pancreatic-cancer

Protein Identified as Potential Druggable Target for Pancreatic Cancer
March 28, 2017
http://www.sciencenewsline.com/news/2017032815570085.html

A New Form of Irinotican Ups Survival Rate in Pancreatic Cancer
European Society for Medical Oncology ESMO
June 25, 2014
http://www.medscape.com/viewarticle/827432?src=rss

Ruxolitinub Combo Improves Outcomes in Metastic Pancreatic Cancer
OncLive
June, 2014
http://www.onclive.com/conference-coverage/world-GI-2014/Ruxolitinib-Combo-Improves-Outcomes-in-Metastatic-Pancreatic-Cancer

A new study explores the interaction of Pancreatic stroma cells and chemotherapy treatments
Cell Journal
June, 2014
http://medicalxpress.com/print322900115.html

AntiCancer Inc. Announces New Fluorescence Technology Developed for Curative Pancreatic Cancer Surgery
June 25, 2014
http://www.marketwatch.com/story/anticancer-inc-announces-new-fluorescence-technology-developed-for-curative-pancreatic-cancer-surgery-2014-06-24

GVAC Vaccine studied for pancreatic ductal adenocarcinomas
Immunology Research Journal
June 18, 2014
http://articles.baltimoresun.com/2014-06-19/health/bal-scientists-explore-pancreatic-cancer-treatment_1_cancer-cells-own-immune-system-vaccine

Yale Study: Aspirin and Pancreatic Cancer
http://www.registercitizen.com/health/20140626/yale-study-aspirin-may-cut-risk-of-pancreatic-cancer-in-half

Pancreatic Cancer Action Network (PANCAN)
www.pancan.org

The National Pancreatic Foundation
http://www.pancreasfoundation.org/patient-information/pancreatic-cancer/pancreatic-cancer-support-group/

Cancer Connect
www.cancerconnect.org

The Pancreatic Center
http://pancreasmd.org/support_group.html

Daily Strength
http://www.dailystrength.org/c/Pancreatic-Cancer/support-group

Fighting Chance- free counseling service for cancer patients and caregivers
http://fightingchance.org/resourceGuide.shtml