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    Pancreatic Cancer Health Center

    Medical Reference Related to Pancreatic Cancer

    1. Pancreatic Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment Options by Stage

      A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.Stages I and II Pancreatic CancerTreatment of stage I and stage II pancreatic cancer may include the following:Surgery.Surgery followed by chemotherapy.Surgery followed by chemoradiation.A clinical trial of combination chemotherapy.A clinical trial of chemotherapy and targeted therapy, with or without chemoradiation.A clinical trial of chemotherapy and/or radiation therapy before surgery.Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I pancreatic cancer and stage II pancreatic cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about

    2. Pancreatic Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Cellular Classification of Pancreatic Cancer

      Pancreatic cancer includes the following carcinomas:MalignantDuct cell carcinoma (90% of all cases).Acinar cell carcinoma.Adenosquamous carcinoma.Cystadenocarcinoma (serous and mucinous types).Giant cell carcinoma.Invasive adenocarcinoma associated with cystic mucinous neoplasm or intraductal papillary mucinous neoplasm.Mixed type (ductal-endocrine or acinar-endocrine).Mucinous carcinoma.Pancreatoblastoma.Papillary-cystic neoplasm (Frantz tumor). This tumor has lower malignant potential and may be cured with surgery alone.[1,2]Papillary mucinous carcinoma.Signet ring carcinoma.Small cell carcinoma.Unclassified.Undifferentiated carcinoma.Borderline Malignancies Intraductal papillary mucinous tumor with dysplasia.[3]Mucinous cystic tumor with dysplasia.Pseudopapillary solid tumor.References: Sanchez JA, Newman KD, Eichelberger MR, et al.: The papillary-cystic neoplasm of the pancreas. An increasingly recognized clinicopathologic entity. Arch Surg 125 (11): 1502-5, 1990. Warshaw AL,

    3. Pancreatic Cancer Treatment (PDQ®): Treatment - Patient Information [NCI] - Stage Information for Pancreatic Cancer

      The staging system for pancreatic exocrine cancer continues to evolve. The importance of staging beyond establishing whether a tumor is resectable is uncertain since state-of-the-art treatment has demonstrated little impact on survival. However, knowledge of the extent of the disease is necessary to communicate a uniform definition of disease. AJCC Stage Groupings and TNM DefinitionsThe American Joint Committee on Cancer (AJCC) has designated staging by TNM classification.[1]Table 1. Definitions of TNM Stage 0aStageTNMDescriptiona Reprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9.b This also includes the pancreatic intraepithelial neoplasia (PanIN)-3 classification.0Tis, N0, M0Tis = Carcinomain situ.bN0 = No regional lymph node metastasis.M0 = No distant metastasis.Table 2. Definitions of TNM Stages IA and

    4. Pancreatic Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Glucagonoma

      As with the other pancreatic neuroendocrine tumors, the mainstay of therapy is surgical resection, and extended survival is possible even when the disease is metastatic. Resection of metastases is also a consideration when feasible.[1]Standard treatment options:Single small lesion in head or tail of pancreas:[1,2,3,4]Enucleation, if feasible.Large lesion in the head of the pancreas that is not amenable to enucleation:[1,2,3,4]Pancreaticoduodenectomy.Single large lesion in body/tail:[1,2,3,4]Distal pancreatectomy.Multiple lesions:[1,2,3,4]Enucleation, if feasible.Resect body and tail otherwise.Metastatic disease: lymph nodes or distant sites:[5,6,7,8,9,10,11,12]Resect when possible.Consider radiofrequency or cryosurgical ablation, if not resectable. Unresectable disease:[13,14,15,16,17,18,19,20,21,22]Combination chemotherapy.Somatostatin analogue therapy. Necrotizing erythema of glucagonoma may be relieved in 24 hours with somatostatin analogue, with nearly complete disappearance

    5. Pancreatic Cancer Treatment (PDQ®): Treatment - Patient Information [NCI] - About This PDQ Summary

      Purpose of This SummaryThis PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of pancreatic neuroendocrine tumors (islet cell tumors). It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.Reviewers and UpdatesThis summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH). Board members review recently published articles each month to determine whether an article should:be discussed at a meeting,be cited with text, orreplace or update an existing article that is already cited.Changes to the summaries are

    6. Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Cellular Classification of Pancreatic Neuroendocrine Tumors (Islet Cell Tumors)

      Table 1. Endocrine Tumors of the PancreasIslet CellsSecreted Active AgentTumor and SyndromeACTH = adrenocorticotropin; MSH = melanocyte-stimulating hormone; VIP = vasoactive intestinal peptide; WDHA = watery diarrhea, hypokalemia, and achlorhydria; 5-HT = serotonin.AlphaGlucagonGlucagonoma (diabetes, dermatitis)BetaInsulinInsulinoma (hypoglycemia)DeltaSomatostatinSomatostatinoma (mild diabetes); diarrhea/steatorrhea; gallstonesDGastrinGastrinoma (peptic ulcer disease)A -> DVIP and/or other undefined mediatorsWDHA5-HTACTHMSHCarcinoidCushing syndromeHyperpigmentationInteracinar CellsSecreted Active AgentTumor and SyndromeFPancreatic polypeptideMultiple hormonal syndromesEC5-HTCarcinoid

    7. Pancreatic Cancer Treatment (PDQ®): Treatment - Patient Information [NCI] - Stages of Pancreatic Neuroendocrine Tumors

      The plan for cancer treatment depends on where the NET is found in the pancreas and whether it has spread. The process used to find out if cancer has spread within the pancreas or to other parts of the body is called staging. The results of the tests and procedures used to diagnose pancreatic neuroendocrine tumors (NETs) are also used to find out whether the cancer has spread. See the General Information section for a description of these tests and procedures. Although there is a standard staging system for pancreatic NETs, it is not used to plan treatment. Treatment of pancreatic NETs is based on the following: Whether the cancer is found in one place in the pancreas.Whether the cancer is found in several places in the pancreas.Whether the cancer has spread to lymph nodes near the pancreas or to other parts of the body such as the liver, lung, peritoneum, or bone.There are three ways that cancer spreads in the body.The three ways that cancer spreads in the body are:Through tissue.

    8. Pancreatic Cancer Treatment (PDQ®): Treatment - Patient Information [NCI] - Changes to This Summary (07 / 31 / 2014)

      The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.This summary was reformatted.Stage I and Stage II Pancreatic Cancer TreatmentAdded text about a 5-year update of the Radiation Therapy Oncology Group (RTOG)-9704 trial, which reported that patients with pancreatic head tumors had a median survival and 5-year overall survival of 20.5 months and 22% survival rate with gemcitabine, versus 17.1 months and 18% with 5-fluorouracil. Also added text about a secondary analysis of RTOG-9704 that explored the correlation of adherence to protocol-specified radiation with patient outcomes. Added text to state that the European Organization for the Research and Treatment of Cancer/U.S. Gastrointestinal Intergroup (RTOG-0848) phase III adjuvant trial evaluating the impact of chemoradiation after completion of a full course of gemcitabine with or without

    9. Pancreatic Cancer Treatment (PDQ®): Treatment - Patient Information [NCI] - To Learn More About Pancreatic Neuroendocrine Tumors (Islet Cell Tumors)

      For more information from the National Cancer Institute about pancreatic neuroendocrine tumors (NETs), see the following:Pancreatic Cancer Home PageUnderstanding Cancer Series: Targeted Therapies (Advances in Targeted Therapies)Targeted Cancer TherapiesFor general cancer information and other resources from the National Cancer Institute, see the following:What You Need to Know About™ CancerUnderstanding Cancer Series: CancerCancer StagingChemotherapy and You: Support for People With CancerRadiation Therapy and You: Support for People With CancerCoping with Cancer: Supportive and Palliative CareQuestions to Ask Your Doctor About CancerCancer LibraryInformation For Survivors/Caregivers/Advocates

    10. Pancreatic Cancer Treatment (PDQ®): Treatment - Patient Information [NCI] - Stage Information for Pancreatic Neuroendocrine Tumors (Islet Cell Tumors)

      Note: The American Joint Committee on Cancer has published the 7th edition of the AJCC Cancer Staging Manual, which for the first time incorporates pancreatic neuroendocrine tumors in the same staging system as pancreatic exocrine tumors.[1] The classification of these tumors as benign versus malignant is not always consistent, so the AJCC recommends that all pancreatic neuroendocrine tumors be staged using this system and reported to cancer registries. It also recommends that the protocol developed by the College of American Pathologists for endocrine pancreatic tumors be used to examine and stage specimens.[2]Definitions of TNMThe American Joint Committee on Cancer has designated staging by TNM classification to define pancreatic neuroendocrine tumors (islet cell tumors).[1]Table 2. Primary Tumor (T)aa Reprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer,

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