Pancreatic Cancer

Pancreatic cancer is a rapidly fatal disease, and there is an urgent need for early detection markers and novel therapeutic targets. The current study has used a proteomic approach of two-dimensional (2D) gel electrophoresis and mass spectrometry (MS) to identify differentially expressed ...

Limited information on salvage treatment in patients affected by pancreatic cancer is available. At failure, about half of the patients present good performance status (PS) and are candidate for further treatment. Patients >18 years, PS ⩾50, with metastatic pancreatic adenocarcinoma previously treated with gemcitabine-containing chemotherapy, and progression-free survival (PFS) 2 toxicity was: neutropenia in five patients (12%), thrombocytopenia, liver and vomiting in three (7%), fatigue in two (5%). In total, 10 patients (24%) yielded a partial response, 11 a stable disease. Progression-free survival at 6 months was 14.6%. Median survival was 5.2 months. Survival was significantly longer in patients with previous PFS >6 months and in patients without pancreatic localisation. A clinically relevant improvement of quality of life was observed in numerous domains. Raltitrexed–oxaliplatin regimen may constitute a treatment opportunity in gemcitabine-resistant metastatic pancreatic...

Purpose Pancreatic cancer (PC) is one of the deadliest of all tumors. Previously, we were the first to show that Thymoqui-none (TQ) derived from black seed (Nigella sativa) oil has anti-tumor activity against PC. However, the concentration of TQ required was ...

Venous thromboembolism (VTE) is a significant cause of mortality in patients with lung cancer. Despite the availability of a wide range of anticoagulants to help prevent thrombosis, thromboprophylaxis in ambulatory patients is a challenge due to its associated risk of haemorrhage. As a result, anticoagulation is only recommended in patients with a relatively high risk of VTE. Efforts have been made to develop predictive models for VTE risk assessment in cancer patients, but the availability of a reliable predictive model for ambulate patients with lung cancer is unclear. We have analysed the latest information on this topic, with a focus on the lung cancer-related risk factors for VTE, and risk prediction models developed and validated in this group of patients. The existing risk models, such as the Khorana score, the PROTECHT score and the CONKO score, have shown poor performance in external validations, failing to identify many high-risk individuals. Some of the newly developed an...

Background: In chronic pancreatitis (CP), a debilitating, progressive and incurable disease, patients' wellbeing is considerably impaired, but the different factors affecting quality of life (QoL), have not been identified yet. Methods: 69 patients with CP were evaluated (M/F 55/14; mean age 46.6 8 10.05 years). Different degrees of pancreatic damage were defined using the Cambridge classification; pain intensity and frequency were assessed using pain index. QoL was measured using EORTC QLQ-C30 and the PAN26 questionnaire. Although developed for pancreatic cancer, the C30/PAN26 has been validated for chronic pancreatitis. Results: Digestive symptoms, financial difficulties, fear of future health and general pain scales showed considerable effects of CP on QoL. We observed significant negative correlation between mean QoL scores and pain index in almost all domains (p ! 0.001, p ! 0.05). Pain intensity affects QoL scales more often than pain frequency. BMI correlated positively with QoL in global health status, altered bowel habits, body image and satisfaction with health care domains (p ! 0.01, p ! 0.05).

Gemcitabine potential myotoxicity has been described in several cases of radiation recall and in patients treated with gemcitabine alone or in combination with other chemotherapy agents. We report two cases of gemcitabine related myositis identified at our institution, and perform a literature review of cases which meet the criteria for gemcitabine induced myositis associated to either radiation therapy or chemotherapy alone.

Purpose To evaluate the eYcacy and safety of masitinib combined with gemcitabine in patients with advanced pancreatic cancer. Patients and methods Twenty-two non-randomised patients with unresectable, locally advanced (n = 9) or metastatic pancreatic cancer (n = 13) received oral masitinib (9 mg/ kg/day) combined with standard gemcitabine. All patients were naÂve to systemic chemotherapy or radiotherapy. The primary endpoint was time-to-progression (TTP) with eYcacy and safety analyses performed on the intent-to-treat population. Secondary endpoints included overall survival (OS), as well as, subgroup analyses according to baseline disease, and performance status. Results Overall median TTP was 6.4 months (95% CI [2.7-11.7]); 8.3 and 2.7 months, respectively, for locally advanced and metastatic patients; 6.4 and 0.8 months, respectively, for patients with KPS [80-100] or KPS [70]. Median OS was 7.1 months (95% CI [4.8-17.0]); 8.4 and 6.8 months for locally advanced or metastatic patients, respectively; 8.0 and 4.4 months in patients with KPS [80-100] or KPS [70]

About 80% of pancreatic cancer patients have glucose intolerance or frank diabetes. This observation has led to the following two hypotheses: i. pancreatic cancer causes the associated diabetes and ii. the conditions associated with diabetes promote the development of pancreatic cancer. Evidence supporting both hypotheses has been accumulated in previous studies. This article reviews these studies, especially those that have been conducted recently.

The clinical presentation of patients with pancreatic cancer may resemble the clinical picture of chronic pancreatitis. A de®nitive preoperative diagnosis is not always obtained in patients with a history of chronic pancreatitis despite the use of modern imaging techniques. Operative strategy therefore remains unclear before operation in these patients.

Respiration-induced movement of the upper abdominal organs (pancreas, liver and kidneys) was assessed in 12 subjects using dynamic magnetic resonance imaging. The movement of each organ in the cranio-caudal, the lateral and the anterior-posterior direction was deduced from the movement of the center of gravity on two-dimensional images. This center of gravity was computed from the volume delineated on sequential 8-mm slices of both sagittal and coronal dynamic series. The largest movements were noticed in the cranio-caudal direction for pancreas and liver (23.7^15.9 mm and 24.4^16.4 mm). The kidneys showed smaller movements in the cranio-caudal direction (left kidney 16.9^6.7 mm and right kidney 16.1^7.9 mm). The movements of the different organs in the anterior-posterior and lateral directions were less pronounced. It is of the greatest importance to be aware of these movements in the planning of a conformal radiation treatment for pancreatic cancer. q

The objective of this article is to introduce the early Chinese clinical experience of using extracorporeal focused ultrasound (US) surgery (FUS) for the treatment of solid tumors. From December 1997 to October 2001, a total of 1038 patients with solid tumors underwent FUS ablation in 10 Chinese hospitals. The tumors included primary and metastatic liver cancer, malignant bone tumors, breast cancer, soft tissue sarcomas, kidney cancer, pancreatic cancer, abdominal and pelvic malignant tumors, uterine myoma, benign breast tumors, hepatic hemangioma and other solid tumors. In this article, pathologic changes in tumors treated with FUS, real-time diagnostic imaging for targeting, monitoring and assessment of results by follow-up images are presented. Early clinical results and complications of the technique are also reported. (E-mail: [email protected]) © 2004 World Federation for Ultrasound in Medicine & Biology.

Cancer of the pancreas is one of the most rapidly fatal of all cancers and most cases are first recognized at a far advanced clinical stage. The American Cancer Society estimates that there will be 33,730 new cases of pancreatic cancer in 2006 and 32,300 deaths. Only cancers of the lung, colon and breast cause more deaths than pancreatic cancer each year. [1] Over the last few decades, the study of pancreatic cancer has assumed a position of growing importance because of its increasing incidence and poor prognosis. Approximately 170,000 new cases of pancreatic cancer or around 2.1% of all cancers occur worldwide every year. [2] The lifetime risk of pancreatic cancer in developed countries is approximately 1%. [ 3] Pancreatic carcinoma occurs quite frequently in West Africa and account for about 3.0% of all malignant tumors. [4]

We assessed dosimetric differences in pancreatic cancer radiotherapy via helical intensity-modulated radiotherapy (HIMRT), linac-based IMRT, and 3D-conformal radiation therapy (3D-CRT) with regard to successful plan acceptance and dose to critical organs. Dosimetric analysis was performed in 16 pancreatic cases that were planned to 54 Gy; both post-pancreaticoduodenectomy (n ‫؍‬ 8) and unresected (n ‫؍‬ 8) cases were compared. Without volume modification, plans met constraints 75% of the time with HIMRT and IMRT and 13% with 3D-CRT. There was no statistically significantly improvement with HIMRT over conventional IMRT in reducing liver V35, stomach V45, or bowel V45. HIMRT offers improved planning target volume (PTV) dose homogeneity compared with IMRT, averaging a lower maximum dose and higher volume receiving the prescription dose (D100). HIMRT showed an increased mean dose over IMRT to bowel and liver. Both HIMRT and IMRT offer a statistically significant improvement over 3D-CRT in lowering dose to liver, stomach, and bowel. The results were similar for both unresected and resected patients. In pancreatic cancer, HIMRT offers improved dose homogeneity over conventional IMRT and several significant benefits to 3D-CRT. Factors to consider before incorporating IMRT into pancreatic cancer therapy are respiratory motion, dose inhomogeneity, and mean dose.

Objective There are no specific biomarkers available for the definitive diagnosis of pancreatic cancer. Analysis of d-glucuronic acid (GlcUA) in bile could be valuable in this regard. Materials and methods Bile samples obtained from patients with pancreatic cancer (n = 4), chronic pancreatitis (n = 3) and control patients with biliary obstruction (n = 10) were analyzed by 1 H NMR spectroscopy. GlcUA was quantified from the peak area of the α-1 CH signal (at 5.24 ppm) obtained by deconvolution. Results GlcUA was detected in human bile by one-dimensional 1 H NMR and two-dimensional 1 H-1 H COSY and TOCSY experiments. Quantification of GlcUA was achieved by measuring the peak area of the α-1 CH signal using CPMG experiment, and the quantities of GlcUA were calibrated to account for the attenuation due to T 2 relaxation. GlcUA was observed at elevated levels in bile samples obtained from pancreatic cancer patients, whereas it was either absent or found in negligible amounts in control and chronic pancreatitis patients. The reason for the presence of elevated levels of GlcUA could be the hydrolysis of biliary bilirubin diglucuronide by β-glucuronidase, released excessively from pancreatic tissue during the course of malignancy.

pressed in response to various acute liver injuries including those associated with subsequent carcinogenesis. Here we show that MIC-1 is overexpressed in chronic human liver disease, and furthermore, that GDF-15 is expressed in liver, kidney, and lung in various models of acute organ injury, including toxic/genotoxic, ischemic, surgical, and hyperoxic. We also show that Gdf15 is an immediateearly gene. GDF-15 expression after injury may be induced by the inflammatory response, since administration of TNF and, to a lesser extent IL-6, induced expression of Gdf15. Injury-induced Gdf15 expression was not reduced in mice deficient for both TNF receptor subtypes, however, suggesting that cytokine signaling is not required for GDF-15 expression. As well, although the stress sensor p53 is widely recognized to induce MIC-1 expression, injury-induced Gdf15 expression was unchanged in p53 null mice. Our results demonstrate that GDF-15 expression following injury is regulated by both paracrine (cytokine) and autocrine (p53) mechanisms, and in more tissues than previously recognized. Taken together with its described activities, these data suggest that MIC-1/GDF-15 production may regulate inflammation, cell proliferation, apoptosis, and perhaps migration in injured tissues, and moreover, may influence carcinogenesis and cancer progression in settings of genotoxic injury.

Pancreaticoduodenectomy is an accepted procedure for management of pancreatic carcinomas. The procedure is associated with significant operative blood loss. Therefore, blood transfusion is an important supportive measure.  Jehovah's Witnesses are widely known for their prohibition on the acceptance of blood transfusion. Despite their belief regarding transfusion, Jehovah's Witnesses do not have a higher mortality rate after traumatic injury or surgery. We represent the case of pancreaticoduodenectomy with vein resection in Jehovah’s Witness. During the November - December 2011 period 2 female Jehovah’s Witness underwent pancreaticoduodenectomies for pancreatic cancer. Preoperative biliary stent was placed in second patient. Both patients had Whipple operation, using inferior pancreatoduodenal artery first approach. In the first case en-block resection of the affected superior mesenteric vein was done. Intraoperative blood loss was 100 ml in the first case and 200 ml in the second case. No postoperative complications occurred in the first case; postoperative period was complicated by pancreatic fistula grade B in the second case. No transfusion of blood and blood products was done in both cases. We did not use сell-saver in both cases. The contemporary surgical techniques make it possible to perform pancreaticoduodenectomy with minimal blood loss and low risk of surgical complications.

Background & aims: Cancer-induced weight loss is associated with poor outcomes and is common in pancreatic cancer. The aims were to determine whether stabilising weight loss for patients with unresectable pancreatic cancer was associated with improved survival and quality of life (QoL) and to identify determinants of weight stabilisation.

PNC-28 is a p53 peptide from its mdm-2-binding domain (residues 17-26), which contains the penetratin sequence enabling cell penetration on its carboxyl terminal end. We have found that this peptide induces necrosis, but not apoptosis, of a variety of human tumor cell lines, including several with homozygous deletion of p53, and a ras-transformed rat acinar pancreatic carcinoma cell line, BMRPA1. Tuc3. On the other hand, PNC-28 has no effect on untransformed cells, such as rat pancreatic acinar cells, BMRPA1, and human breast epithelial cells and no effect on the differentiation of human stem cells. In this study, we now test PNC-28 in vivo for its ability to block the growth of BMRPA1. Tuc3 cells. When administered over a 2-week period in the peritoneal cavities of nude mice containing simultaneously transplanted tumors, PNC-28 causes complete destruction of these tumors. When delivered concurrently with tumor explantation at a remote site, PNC-28 causes a complete blockade of any tumor growth during its 2-week period of administration and 2 weeks posttreatment, followed by weak tumor growth that plateaus at low tumor sizes compared with tumor growth in the presence of a control peptide. When administered after tumor growth has occurred at a site remote from the tumor, PNC-28 causes a decrease in tumor size followed by a slow increase in tumor growth that is significantly slower than growth in the presence of control peptide. These results suggest that PNC-28 may be effective in treating cancers especially if delivered directly to the tumor. ' 2006 Wiley-Liss, Inc.

Radionuclide contamination in terrestrial ecosystems has reached a dangerous level. The major artificial radionuclide present in the environment is cesium (137-Cs and 134-Cs). In humans, animals, and plants cesium ion (Cs+) behaves like potassium ion (K+) and it is localized mainly inside the cells. Pancreas and salivary glands accumulate, secrete and eliminate Cs in the intestine and with the feces and by the kidney with the urine. Ingested radiocesium can cause several pancreatitis and secondary diabetes (type 3c), which are on the rise in the world. Venturi studied the correlation between the geographical map of these diseases and the map of nuclear plant accidents, atomic bomb testing, and radioactive fallout and reported that pancreas is able to absorb in great quantity radioactive cesium causing pancreatitis and cancer with damage of pancreatic islands with diabetes [1-2]. In fact, diabetes mellitus increased in contaminated population, particularly children and adolescents, after Chernobyl and Fukushima [3-4] nuclear incidents. At the same time, worldwide pancreatic diseases, diabetes and environmental radiocesium are also increasing.

The aim of the study is to analyze pancreatic metastases and their clinical, radiological, therapeutic and prognostic features. Three cases of pancreatic metastases observed and a world literature review of 333 cases were recorded. Pancreatic metastases are due more frequently to renal cell carcinoma; they are usually metachronous and characterized by a long period of time between the resection of the primary tumor and their detection. The differential diagnosis with other pancreatic masses is difficult, but an accurate anamnesis, some peculiar findings of imaging techniques and percutaneous fine needle aspiration could allow preoperative diagnosis. Pancreatic resections are the treatment of choice allowing the better palliation and improving survival. 150/234 pancreatic metastases underwent pancreatic resections (resectability index = 64.1%); 88/132 patients are alive with a mean follow-up of 27.1 months; of the 44 dead patients the mean survival time was 21.3 months. Among pancreatic metastases the primary tumor with better prognosis is renal cell carcinoma. Pancreatic metastases are rare; their preoperative diagnosis is difficult but useful and possible. Surgical resection is suggested because the patient still may have a prolonged survival.

Diagnosis of pancreatic tumors can be accurately made on imaging studies such as CT, MRI, and US based on pathologic, morphologic, and hemodynamic features of the tumors. The techniques of examination can be properly designed to answer clinical questions.

The overarching goal of this review is to highlight the current progress of immunotherapy in pancreatic cancer. Despite all the efforts, pancreatic cancer remains a disease that is refractory to almost all therapies and immunotherapy for pancreatic cancer remains in its infancy. In this review, we summarize promising advances and major hurdles in developing immunotherapeutic strategies for pancreatic cancer as presented in recent publications and a clinical trial database. Notably, a combination regimen of chemotherapy followed by immunotherapy appears to be superior to chemotherapy alone, wherein chemotherapeutic agents may play a dual role by reducing overall tumor burden through direct killing of cancerous cells and by indirect release of pro-inflammatory molecules and tumor associated antigens which, when presented in an immunogenic fashion, may function as an in situ " vaccine ". Critically, the timing of administration of standard chemotherapy can markedly impact the induction of antitumor responses. We anticipate that among the gamut of combination immunotherapy and chemo-radiation therapies that are now being evaluated, we will eventually be able to optimize a regimen that can generate long-lasting responses and usher a new weapon in the fight against pancreatic cancer.

Glyphosate is the active ingredient in the pervasive herbicide, Roundup, and its usage,
particularly in the United States, has increased dramatically in the last two decades, in step with
the widespread adoption of Roundup®-Ready core crops. The World Health Organization
recently labelled glyphosate as “probably carcinogenic.” In this paper, we review the research
literature, with the goal of evaluating the carcinogenic potential of glyphosate. Glyphosate has a
large number of tumorigenic effects on biological systems, including direct damage to DNA in
sensitive cells, disruption of glycine homeostasis, succinate dehydrogenase inhibition, chelation
of manganese, modification to more carcinogenic molecules such as N-nitrosoglyphosate and
glyoxylate, disruption of fructose metabolism, etc. Epidemiological evidence supports strong
temporal correlations between glyphosate usage on crops and a multitude of cancers that are
reaching epidemic proportions, including breast cancer, pancreatic cancer, kidney cancer,
thyroid cancer, liver cancer, bladder cancer and myeloid leukaemia. Here, we support these
correlations through an examination of Monsanto’s early studies on glyphosate, and explain how
the biological effects of glyphosate could induce each of these cancers. We believe that the
available evidence warrants a reconsideration of the risk/benefit trade-off with respect to
glyphosate usage to control weeds, and we advocate much stricter regulation of glyphosate.
Keywords: cataracts, CYP 450 enzymes, glyphosate, gut microbiome, interstitial disease,
kidney cancer, non-Hodgkin’s lymphoma, pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that continues to be challenging to treat. PDAC has the lowest 5-year relative survival rate compared with all other solid tumor malignancies and is expected to become the second-leading cause of cancer-related death in the United States by 2030. Given the high mortality, there is an increasing role for concurrent anticancer and supportive care in the management of patients with PDAC with the aims of maximizing length of life, quality of life, and symptom control. Emerging trends in supportive care that can be integrated into the clinical management of patients with PDAC include standardized supportive care screening, early integration of supportive care into routine cancer care, early implementation of outpatient-based advance care planning, and utilization of electronic patient-reported outcomes for improved symptom management and quality of life. The most common symptoms experienced are nausea, constipation, weight loss, diarrhea, anorexia, and abdominal and back pain. This review article includes current supportive management strategies for these and others. Common disease-related complications include biliary and duodenal obstruction requiring endoscopic procedures and venous thromboembolic events. Patients with PDAC continue to have a poor prognosis. Systemic therapy options are able to palliate the high symptom burden but have a modest impact on overall survival. Early integration of supportive care can lead to improved outcomes.

Keywords: abdominal pain; advance care planning; back pain; cholestasis; early involvement; palliative care; pancreatic neoplasms; patient-reported outcome measures; terminal care; venous thromboembolism.

Since the journal Science deemed cancer immunotherapy as the “breakthrough of the year” in 2014, there has been an explosion of clinical trials involving immunotherapeutic approaches that, in the last decade - thanks also to the renaissance of the immunosurveillance theory (renamed the three Es theory) - have been continuously and successfully developed. In the latest update of the development of the immuno-oncology drug pipeline, published last November by Nature Review Drug Discovery, it was clearly reported that the immunoactive drugs under study almost doubled in just two years. Of the different classes of passive and active immunotherapies, “cell therapy” is the fastest growing. The aim of this review is to discuss the preclinical and clinical studies that have focused on different immuno-oncology approaches applied to pancreatic cancer, which we assign to the “dark side” of immunotherapy, in the sense that it represents one of the solid tumors showing less response to this type of therapeutic strategy.

Despite many years of continuous effort, pancreatic carcinoma remains a highly lethal disease and a challenge to the medical community. Most patients will be diagnosed in an advanced stage of the disease and will be candidates for oncological palliative therapy or supportive care only. These patient groups have a life expectancy of only a few months. It is documented that less than one of these patients will be alive after five years. 1,2 Surgical resection remains the only hope for long-term survival, but this option is available only for patients with a tumour confined to the pancreas. In population studies, 5-12% of patients were candidates for pancreatic resection. 3-6

Background: Gemcitabine/nab-paclitaxel (GN) and FOLFIRINOX (FFX) are two standard first-line therapies for metastatic pancreatic cancer (PC) but have rarely been compared, especially in patients with locally advanced PC (LAPC). Methods: This is a retrospective European multicenter study including patients with LAPC treated with either GN or FFX as the first-line therapy between 2010 and 2019. Coprimary objectives were progression-free survival (PFS) and overall survival (OS), both estimated using the Kaplan–Meier method. Results: A total of 147 patients (GN: n = 60; FFX: n = 87) were included. Tumor resection rates were similar between the two groups (16.7% vs. 16.1%; p = 1), with similar R0 resection rates (88.9%). Median PFS rates were not statistically different: 9 months (95% CI: 8–13.5) vs. 12.1 months (95% CI: 10.1–14.6; p = 0.8), respectively. Median OS rates were 15.7 months (95% CI: 12.6–20.2) and 16.7 months (95% CI: 14.8–20.4; p = 0.7), respectively. Abdominal pain at the...

Long-term clinical observations and ongoing studies have shown significant antitumor effect of external Qi of Yan Xin Qigong which originated from traditional Chinese medicine. In order to understand the molecular and cellular mechanisms underlying the antitumor effect of external Qi of Yan Xin Qigong, we have examined its cytotoxic effect on BxPC3 pancreatic cancer cells and its effect on the Akt and extracellular signal-regulated kinase pathways. We found that external Qi of Yan Xin Qigong dramatically inhibited basal phosphorylation levels of Akt and extracellular signal-regulated kinases, epidermal growth factor-mediated phosphorylation of extracellular signal-regulated kinases, and phosphatidylinositol 3-kinase activity. External Qi of Yan Xin Qigong also inhibited constitutive and inducible activities of nuclear factor-kappa B, a target of the Akt and epidermal growth factor receptor pathways. Furthermore, a single 5 min exposure of BxPC3 cells to external Qi of Yan Xin Qigong induced apoptosis, accompanied by a dramatic increase of the sub-G1 cell population, DNA fragmentation, and cleavage of caspases 3, 8 and 9, and poly(ADP-ribose) polymerase. Prolonged treatment with external Qi of Yan Xin Qigong caused rapid lysis of BxPC3 cells. In contrast, treatment of fibroblasts with external Qi of Yan Xin Qigong induced transient activation of extracellular signal-regulated kinases and Akt, and caused no cytotoxic effect. These findings suggest that external Qi of Yan Xin Qigong may differentially regulate these survival pathways in cancer versus normal cells and exert cytotoxic effects preferentially on cancer cells, and that it could potentially be a valuable approach for therapy of pancreatic carcinomas.

Context The European Organization for Research and Treatment of Cancer has developed the PAN26 instrument to measure quality of life in patients with pancreatic cancer. Its use has been increasing, but it has not yet undergone psychometric validation in a large cohort or in the setting of pancreatic resection. Objective We aimed to validate the PAN26 in patients undergoing pancreatic resection using a high-quality Phase III clinical trial dataset. Methods The European Organization for Research and Treatment of Cancer core questionnaire and pancreatic cancer module were administered pre-operatively and at 14 and 60 days post-operatively to 300 patients enrolled in a Phase III trial of pasireotide to prevent pancreatic fistula. Multi-trait scaling analysis was performed; construct validity and internal consistency were assessed. Results With the exception of the hepatic scale, the PAN26 scales had adequate internal consistency (Cronbach's alpha = 0.69-0.97), and items were more correlated with their own scale than other scales, indicating appropriate aggregation. Adenocarcinoma diagnosis was associated with worse scores on multiple scales. As expected, the PAN26 and C30 pain scales were highly correlated (>0.7). Conclusions In the largest psychometric analysis to date of the PAN26, we demonstrated that the scales are reliable and valid, although the appropriateness of the hepatic scale in the post-operative setting may need more examination. We observed differences by final diagnosis (adenocarcinoma or benign), and have shown previously that scores on symptom scales were worse post-operatively than at baseline, confirming the sensitivity of the PAN26 to detect clinically meaningful differences in quality of life.

La duodenopancreatectomía cefálica (DPC) es la única opción potencialmente curativa para tratar el adenocarcinoma (ADC) de cabeza de páncreas. La tasa de mortalidad postoperatoria varía entre un 0 y un 8% en series recientes y la supervivencia a 5 años varía del 7 al 12% 1 . Los resultados son peores cuando la resección es incompleta o los márgenes quirúrgicos son positivos, y no ofre-

The development at a university hospital of radical surgery for exocrine pancreatic cancer has been studied for the time period 1958-1989. It was found that the number of operations per year increased gradually, being 6.6/year during the last 5 years, giving a resection rate of 15%. The resection rate did not change during the studied time period. The size, grade of differentiation, or stage of tumor did not change. There was no significant tendency toward decreasing operation time and blood loss, although a technically more complicated operation has been done in the last 30 cases (change from total to subtotal duodenopancreatectomy). The hospital mortality rate decreased from 33 to 3%. The rate and severity of post-operative complications also strongly decreased. For the last 30 cases, there was also a prolonged long-term survival. We conclude that the total management of patients radically operated on for exocrine pancreatic cancer is today much better than it was a decade or two ...

BACKGROUND: Patients with borderline resectable pancreatic adenocarcinoma (PA) include those with localized disease who have tumor or patient characteristics that preclude immediate surgery. There is no optimal treatment schema for this distinct stage of disease, so the role of surgery is undefined. STUDY DESIGN: We defined patients with borderline resectable PA as fitting into one of three distinct groups.

Cancer is hyperproliferative disorder that involves transformation, dysregulation of apoptosis, proliferation, invasion, angiogenesis and metastasis. Millions of people die every year with different types of cancer such as lung cancer and mesothelioma from inhaling asbestos fibers and tobacco smoke, or leukemia from exposure to benzene at their workplaces. In the last century, great advances were made in modern medical system in cure and prevent of this disease. However, success rates are very low. Withania somnifera (WS) has been used as traditional medicine for decades for the treatment of various ailments. The various parts of WS and its constituents are effective in prevention and treatment of different kinds of cancer like colon cancer, lung cancer, blood cancer, skin cancer, breast cancer, renal cancer, fibrosarcoma, prostate cancer, pancreatic cancer. We are conducting clinical studies to prove the efficacy of WS in prevention and treatment of different forms of cancer including prostate and lung cancers, especially in last stages, and this wonder medicinal herb is found to be beneficial in many patients. We have some cases of lung cancer that were refused modern therapy and recovered clinically and radiologically with our therapy of Ashwagandha. Clinical studies suggest its use as anti-tumor and immunomodulatory agent in sarcoma, brain cancer, uterine tumor, fibroids and other tumors including endodermal carcinoma. Therefore, this medicinal herb WS alone can be used as alternative medicine in the treatment of cancer patients or it can also be used as adjunct/ complimentary medicine along with chemotherapy or radiotherapy to patients. As the causative factors in formation and development of cancerous conditions can be multifactorial eg. stress-physical, chemical, biological and emotional, viral infection like Herpes cause several time more cancer of bladder, low immune syndrome plays major role in spread and causation of cancer, environmental chemical toxins, allopathic drugs, pesticide infected food with heavy metals and some not properly developed metallic preparation of Ayurvedic or other Folk Medicine can be a causative factor, leave aside genetic processes of the Individual for the development of the risk of cancer. If we look in the properties of WS like adaptogen/ anti-stress agent, immunomodulator, antioxidant (reducing free radical damage, anabolic effect, improving resistance of body, reducing fatigue and detoxificant effects, we are inclined to suggests that WS works through all above mechanisms in controlling the dreaded cancer, rather than its effect on stopping the cell division. As during radio and chemotherapy body's natural normal cells are also killed and low immunity develops, WS helps prevent these adverse effects of both and helps patients better recovery and life styles. However, multicentric long term clinical studies by oncologists, although deviated from their routine, must be carried out on WS to prove our contentions.