Net 4 Articles

Author: Wilson Ngai

Prevalence

Pancreatic cancer is the fourth most common cause of adult cancer death, accounting for an estimated 42,470 new cases and 35,240 deaths in USA for 2009.  The high mortality rate is due to the high incidence of metastatic disease at initial diagnosis, the aggressive clinical course and the failure of current therapies.

Causes

It is not clear what causes pancreatic cancer, but some risk factors have been linked to the disease.  Modifiable risk factors that have been associated with pancreatic cancer include:

• Smoking: Smokers have 2 to 3 times higher risk of getting pancreatic cancers.. About 2 to 3 out of 10 cases of pancreatic cancer are thought to be caused by smoking.
• Obesity and lack of exercise: Overweight people and those who don’t get much exercise are more likely to develop pancreatic cancer.
• Diabetes: Patients with type 2 diabetes have an increase risk of getting pancreatic cancer.
• Chronic pancreatitis: Some patients with chronic pancreatitis develop pancreatic cancer
• Cirrhosis of the liver: People with cirrhosis due to hepatitis and alcohol consumption seem to have an increased risk of pancreatic cancer.
• Work exposure: Heavy exposure to certain pesticides, dyes, and chemicals may increase the risk of getting pancreatic cancer.
• Stomach problems: Having too much stomach acid or having bacteria called H. pylori in the stomach may increase the risk of pancreatic cancer.

Prevention

At this moment, there is no way to prevent pancreatic cancer. Similar to the prevention of other cancer, stop smoking, having a healthy diet and exercise are important in keeping pancreatic cancer at bay.

Symptoms of pancreatic cancer

It is very difficult to find pancreatic cancer early in the course of the disease since the pancreas lies deep inside the body and it is not easy to fell the tumors during a routine physical exam. Currently, there are no blood tests or other tests that can find the pancreatic cancer early in patients without symptoms.

When a person has symptoms, the cancer is usually large and has spread to other organs. Thus, patients with pancreatic cancer usually have a poor outlook.

Symptoms of pancreatic cancer include jaundice, abdomen pain (belly area), pain in the middle of the back, weight loss, pale and greasy stools, swollen gallbladder, blood clots and increase in blood sugar level.

Physical exam

To confirm whether the tumor is cancerous, the physician will need to do a biopsy to confirm the cell types.

The physician might also examine your lymph nodes and conduct imaging tests such as CT, MRI, PET, endoscopic ultrasound, ERCP (endoscopic retrograde cholangiopancreatography) to see whether the tumor has spread to lymph nodes or distant organs.

Prognosis

Only 20% of the patients presenting with pancreatic cancer will the tumor be operable.  The median disease-free survival following complete resection of pancreatic cancer and adjuvant administration of gemcitabine is 13.4 months versus 6.9 months for untreated patients.  The longer disease-free survival after surgery and adjuvant chemotherapy, unfortunately, has not translated into any advantage in overall survival.

For the other patients who had locally advanced (40%) or metastatic (40%) disease at diagnosis, the median survival is 8-12 months and 3-6 months respectively.

Treatment

Surgery

Pancreatic cancer surgery is one of the hardest operations for surgeon and patients.  Surgery results in complications and may take many weeks for patients to recover.

There are 2 types of surgery used for pancreatic cancer:

• Curative surgery when it looks like it is possible to remove all the cancer.
• Palliative surgery may be done if tests show that the tumor is too widespread to be completely removed.  In this case, surgery is done to relieve symptoms or to prevent the blockage of the bile ducts or the intestine by the cancer.

Studies have shown that palliative surgery does not help most patients to live longer.

Curative Surgery

If the cancer is contained within the pancreas, the surgeon might conduct a Whipple procedure. In this surgery, the surgeon remove parts of the pancreas, parts of the stomach and small intestine, the gallbladder, part of the common bile duct, and some nearby lymph nodes. It is a very complex operation that carries high risk of complications and might be fatal.  It is usually done by experienced surgeons who have done this many times.

For patients who have surgery, the 5-year survival rate is only 20%.  It is because a small number of cancer cells may already have spread to other parts of the body.  Only a small number of pancreatic cancer patients (about 10%) has their cancer contains within the pancreas.

Palliative surgery

When the surgeon discovers that the tumor has spread and it is impossible to cure the patients, the surgeon may continue the operation as a palliative procedure to relieve the symptoms. For example, the surgeon may relieve blockage of the bile duct to relieve the pain and the problems with digestion.

There are 2 options to relieve a bile duct blockage. One is to re-route the flow of bile from the common bile duct into the small intestine. This requires a large incision and it may take weeks for the patient to recover. An advantage is that during the surgery, the doctor may be able to cut the nerves leading to the pancreas and will reduce the pain for the patient.

The second and the most popular way to treat bile duct blockage is to use metal tubes called stents to keep the bile duct open. The doctor puts the stents in through an endoscope. Bigger stents are also used to keep the small intestine open, too.

Pharmacotherapy

First-line therapy

Gemcitabine (Gem)- Gemzar

Gemcitabine is the gold standard chemotherapy for pancreatic cancer since its approval in 1996.  The approval was based a phase III trial which involves 126 patients randomized either to gemcitabine or weekly injection of 5-fluorouracil (5-FU).

• Clinical response was experienced in 23.8% of gemcitabine-treated patients compared with 4.8% of 5-Fu-treated patients (p=0.004)
• The median overall survival durations were 5.65 and 4.41 months for gemcitabine-treated and 5-FU-treated patients (p=0.003)
• The 1 year survival rate was 18% and 2% for the gemcitabine and the 5-FU group, respectively (p=0.0009)

Gemcitabine + Oxaliplatin (GemOx) – Gemzar and Eloxatin

For patients who like extend the time without disease progression and are willing to tolerate the adverse effects of chemotherapy may consider the GemOx regimen.  GemOx was evaluated in 313 patients with advanced pancreatic cancer.  Patients were randomly assigned to either GemOx or gemcitabine.

At the end of the study, GemOx was superior to gemcitabine in

• Response rate (26.8% vs 17.3% for GemOx and Gem, respectively; p=0.04)
• Progression-free survival (5.8 vs 3.7 months for GemOx and Gem, respectively; p=0.04)
• Clinical benefit (5.8 vs. 3.7 months for GemOx and Gem, respectively; p=0.04)

However, there was no difference in median overall survival (9.0 and 7.1 months for GemOx and Gem, respectively; P=0.13)

Also, patients who were assigned to the GemOx arm had a higher incidence of grade 3 and 4 toxicity in platelets (14.0% for GemOx vs 3.2% for Gem), vomiting (8.9% for GemOx vs 3.2% for Gem) and neurosensory symptoms (19.1% for GemOx vs. 0% for Gem).

Gemcitabine + Capecitabine (GemCap) – Gemzar and Xeloda

GemCap is another alternative to gemcitabine for pancreatic cancer.  However, results of two phase III trials showed conflicting results.

The first trial randomized 319 patients to receive either GemCap or Gem.

• There was no difference in median overall survival time between the two arms (8.4 and 7.2 months in the Gem Cap and Gem arms respectively; p=0.234).
• Frequency of grade 3 or 4 adverse events, including neutropenia, was similar in both arms.
• Post hoc analysis reviewed that patients in the GemCap arm with good Karnofsky performance status experienced a significant prolongation of median overall survival time when compared with the Gem arm (10.1 vs 7.4 months, respectively; P=0.014)

Another phase III trial randomized 533 patients to receive gemcitabine plus capecitabine or gemictabine.  The trial demonstrated a statistically significant improvement in overall survival time in the GemCap arm (7.4 months vs 6 months, p =0.0014).  The result might be attributed to the prolonged administration of capecitabine.

Erlotinib + Gemcitabine – Tarceva + Gemzar

Beside chemotherapy, targeted therapy plus chemotherapy has also been shown to improved survival.  Erlotinib, a targeted therapy, has been approved as treatment for locally advanced and metastatic pancreatic cancer patients.

In a randomized, double-blind, phase III trial, 569 patients were randomly assigned to receive gemcitabine plus erlotinib or gemcitabine plus placebo.

• Overall median survival was significantly prolonged by 2 weeks in the erlotinbi/gemcitabine arm (6.2 months vs. 6.0 months, p=0.028).
• One-year survival was also greater with erlotinib plus gemcitabine arm (24% vs. 19%; p =0.023).
• Progression-free survival was significantly longer with erlotinib plus gemcitabine (3.75 months vs. 3.55 months, p = 0.004).
• Of the 282 patients who received erlotinib, 79 had no rash, 102 had grade 1 rash, and 101 had a grade 2 or higher skin rash.
• The occurrence of skin rash was associated with a significant and clinically meaningful difference in survival.  The median survival rates for patients with grade 0, 1, and 2 rash were 5.3, 5.8, and 10.5 months and the 1-year survival rate were 19%, 9% and 43%, respectively (p=0.001).

Bevacizumab + Erlotinib + Gemcitabine – Avastin + Tarceva + Gemzar

Another target regimen that has been tested is the bevacizumab plus erlotinib and gemcitabine.  This regimen, however, have only been shown to improve progression-free survival (4.6 months vs. 3.6 months, p = 0.0002), but not overall survival (7.1 months vs. 6 months, p =0.2) when compared with erlotinib plus gemcitabine.

Second-line therapy

Oxaliplatin plus 5-FU and folinic acid (OFF regimen)

Patients who failed first line gemcitabine can use the OFF regiment to control their disease.  The CONKO 003 trial have shown that metastatic pancreatic patients whose disease had progressed from the first-line gemcitabine treatment, had significant survival benefit with the OFF regimen than the FF regimen (5-FU plus folinic acid).

The progression-free survival was significantly different (p=0.012) and the median survival time from initiation of second-line therapy was 20 weeks for the OFF vs 13 weeks for the FF arms (p=0.014).

Conclusions

Pancreatic cancer remains a major challenge to the medical field.  Only 10% of the pancreatic cancer patients have their cancer contained with the pancreas.  This group of patients might be cured by surgery. The rest might need chemotherapy and targeted therapy to extend their survival.

Gemcitabine is the standard 1st line therapy for pancreatic cancer.  Patients with good performance status can also consider oxaliplatin + capecitabine to achieve prolonged survival.

For patients who fail the first line treatment, oxaliplatin-5FU-folinic acid should be used to improve survival.

In the adjuvant setting, current studies have supported the role of gemcitabine, either as monotherapy or in combination with chemoradiotherapy with 5-FU.

Please visit us at healthreason.com for more health related articles.

Article Source: http://www.articlesbase.com/cancer-articles/pancreatic-cancer-causes-prevention-prognosis-diagnosis-and-latest-treatment-2171730.html

About the Author

Wilson is a registered pharmacist with a bachelor and master degree in Pharmacy.  He has published 5 reviewed articles and has strong medical knowledge in cardiovascular disease, diabetes and cancer.

In the past 15 years, he has worked in medical, licensing and product development department at major pharmaceutical companies such as Merck, Bristol-Myers Squibb and Novartis.

He was also the recipient of the Merck Frosst Award in Nuclear Medicine, Mitchell Scholarship in Cancer Research and Pharmacy Alumni Graduate Studies Award.

Author: Thomas Ajava

A diagnosis of Mesothelioma has often been viewed as a death sentence. While it is still a brutal diagnosis, treatment options have come a long way. This is particularly true when it comes to chemotherapy. There are two specific drugs that are making a big difference – Alimta and Cisplatin.

Mesothelioma is a cancer of the lining known as the mesothelium. It is associated with asbestos exposure. There are three forms of the cancer – pleural, pericardial and peritoneal. All three are deadly and the average five year survival rates is less than 10 percent. The problem is the cancer is often very hard to diagnose and is thus often discovered only in the very latest of stages. That is very problematic with just about any form of cancer.

There are many different ways of trying to treat Mesothelioma. The three most common are surgical extraction, radiation therapy and chemotherapy. Unlike most medical situations, many doctors will go very aggressive with the treatment in an effort to stop the spread of the disease. Chemotherapy plays a huge role in this and Altimta and Cisplatin are two newer drugs being used.

Alimta has been hailed as a major breakthrough in the chemotherapeutic treatment of patients. It has shown massive effects on Mesothelioma suffers. In one test at Newcastle Freeman Hospital, nearly every patient had improvements on symptoms caused by the cancer. More importantly, nearly half saw their tumors shrink instead of grow. The drug is given over a 21 day period and usually in combination with Cisplatin.

Cisplatin is an older chemotherapy drug that is used as a base treatment for many types of cancer. It is somewhat akin to taking penicillin as an antibiotic. It is given over a 21 day period and is considered an effective treatment of tumors and general cancer growth. Unfortunately, it has many side effects that are the type of thing often stereotypically associated with chemotherapy. This includes hair loss, extreme fatigue, weight loss, and potentially kidney damage if not handled carefully.

Will these drugs save you? Well, every case is different and you should speak with your physician. That being said, they are considered two standard approaches to the chemotherapy treatment for Mesothelioma, which means you will probably be introduced to them at one point or another.

Article Source: http://www.articlesbase.com/cancer-articles/mesothelioma-the-chemotherapy-drugs-you-might-be-given-2010076.html

About the Author

Thomas Ajava writes for MesotheliomaandAsbestosInformation.com – your online source for answers to questions such as is there a food that can help cure Mesothelioma.

Author: Joe Golson

Most mesothelioma deaths tend to be traced to a shortage of enough or appropriate Mesothelioma Info Resources. Till some years back, most folk were completely uninformed regarding the damaging consequences of asbestos, the top features of mesothelioma cancer and the treatment ways available. This led to many individuals losing their lives unnecessarily. We might discuss what mesothelioma resources are and in what way they can be instrumental in saving lives.

Mesothelioma resources means a group of associated activities regarding mesothelioma all grouped in one place. Information and videos concerning the causes, remedies and prevention of mesothelioma, detailed inputs related to cancer centers and doctors in the field, information about the services of mesothelioma litigation firms and attorneys, specifics with regards to the continuous researches to find better treatment options and cures for the disease, legal rights of patients etc are clearly part of mesothelioma resources.

Mesothelioma cancer is diagnosed only during the advanced stages of the infection. There are four major stages, the first two having better chances of survival and the last two practically having no chances at all. The medication imparted by the cancer centers depend on the stages of the cancer. Vigorous treatment actions are successful or partially successful in stage 1,2 and 3 patients. Palliative treatment methods are given to stage 4 patients. Mesothelioma patients can claim for financial compensation also.

Mesothelioma Info & Videos is a highly competent Videos Mesothelioma Directory Of Resources. All sorts of information pertaining to mesothelioma and all its related subjects including treatment, law suits and research are available there. Therefore , a patient should check such resources first before deciding on his mesothelioma treatment centers and lawyers.

Article Source: http://www.articlesbase.com/cancer-articles/the-majority-of-mesothelioma-resources-have-failed-to-really-assist-people-2009961.html

About the Author

Most Mesothelioma Information Resources Have Failed To Help People.For Mesothelioma Information that includes videos,visit our Videos Mesothelioma Info directory

Author: Wilson Ngai

Which is the best chemotherapy adjuvant regimen sequence for early breast cancer?

It is widely known that anthracyclines (epirubicin and doxorubicin) and taxanes is the best adjuvant chemotherapy regimen for early breast cancer.  However, should anthracyclines be always administered before taxanes?  An article published in the March issue of Lancet Oncology suggested the reverse sequence may be more preferable.

The article, written by Wildiers, provided clear evidences that the taxane-first regimens provided better dose intensity, adverse effects, long-term resistance and survival.

1) Dose Intensity

In a dose sequencing study of 284 patients who first received three cycles of FEC (fluorouracil, epirubicin, and cyclophosphamide) followed by three cycles of docetaxel, the mean relative dose intensity was 91% for FEC and 76% for docetaxel, whereas in another dose sequencing study of 378 patients who received three cycles of docetaxel followed by four cycles of EC (epirubicin plus cyclophosphamide), a median docetaxel dose intensity of 100% was achieved.

2) Adverse effects

Studies have showed that patients who were started with taxane-first adjuvant regimens have fewer skins and grade 4 toxicities.  Also, data form the FinHer Trial suggested that the incidence of cardiotoxicity was lower when taxane plus trastuzumab (Herceptin) was given before rather than after anthracyclines.

3) Long-term resistance

An in-vitro study showed that breast cancer cells that were initially resistant to paclitaxel have limited cross-resistance (4 times) to doxorubicin whereas cell lines that were resistant to doxorubicin, exhibited a 4,700-times cross-resistance to paclitaxel.

4) Survival

In a large phase 3 neoadjuvant study, paclitaxel administered before epirubicin-cyclophosphamide (EC) showed a higher complete responses rate than the reverse order.

The above evidences indicated that it is reasonable to administer taxane cycles before anthracycline-containing chemotherapy cycles in the routine clinical setting.

www.thelancet.com/oncology Vol 11 March 2010

Please visit us at healthreason.com

Article Source: http://www.articlesbase.com/cancer-articles/best-regimen-sequence-for-early-breast-cancer-patients-1951241.html

About the Author

Wilson is a registered pharmacist with a bachelor and master degree in Pharmacy.  He has published 5 reviewed articles and have strong medical knowledge in cardiovascular disease, diabetes and cancer.   In the past 15 years, he has worked in medical, licensing and product development department at major pharmaceutical companies such as Merck, Bristol-Myers Squibb, Novartis and Sanofi-aventis.

He was also the recipient of the Merck Frosst Award in Nuclear Medicine, Mitchell Scholarship in Cancer Research and Pharmacy Alumni Graduate Studies Award.

Author: Divya gupta

Asbestos Mesothelioma Risk – The Silent Killer Stalking in Your Vicinity

What are the asbestos risk factors?Visit here http://mesotheliomatreatment-option.blogspot.com

Mesothelioma cancer statistics indicate that specific environments, industries and jobs have a higher mesothelioma risk. The risk of getting cancer from asbestos is very real.

A risk factor is anything that increases your chance of getting the diagnosis: malignant mesothelioma. But having a risk factor, or even several asbestos disease risk factors, does not mean that you will develop mesothelioma lung cancer.

Exposure to asbestos is the main risk factor for developing mesothelioma injury. This injury could develop into full fledged mesothelioma lung cancer.

So, what are the risk asbestos factors? And how do we manage the risk of asbestos exposure?

Mesothelioma Statistics

Mesothelioma statistics reveal that 2,000 to 3,000 new mesothelioma cases annually receive the diagnosis: malignant mesothelioma. Approximately 70 to 80 percent of all cases of mesothelioma are found to be the direct result of asbestos exposure.

According to the U.S. Environmental Protection Agency (EPA), as many as a three quarter million schools and public buildings in the country today contain asbestos insulation. These were built before new asbestos mesothelioma law started to constrain the use of asbestos early in the 1970s. Asbestos insulation may be found in as many as 10% to 15% of schools in the United States.

Industrial Risk

What is the industrial asbestos risk of your work place? The mesothelioma risk attached to various industries can be plotted on a continuum: from high industrial risk – to the least risk.

Firstly, you must identify asbestos content inherent to your building, equipment, raw materials or products. Then compare this information with mesothelioma statistics for your industry.

Environmental Risk

What is the asbestos risk of your environment? Asbestos minerals are widespread in the global environment.

Asbestos risk may occur in large natural deposits, or as contaminants in other minerals and products. If you are exposed to asbestos, many factors determine asbestos exposure risk and potential asbestos related diseases.

These factors include the how much, how long, the mineral form and size distribution, and how you come in contact with it. Studies have shown that smokers are more prone to asbestos disease than non-smokers.

Does the Silent Killer stalk your work place? The Control of Asbestos at Work Regulations (CAWR) place the duty on employers to identify and assess occupational asbestos risk.

Asbestos Disease Risk

Asbestos disease risk, is the risk of serious disease after inhaling asbestos dust. In industry, they separate and process asbestos fibers into new compounds and textures, forming a microscopic dust.

If inhaled, it can collect in the lungs, stomach or other organs and eventually lead to the development of serious, life threatening asbestos diseases. A mesothelioma prognosis is almost never favourable.

Asbestos Products Risk

Asbestos products risk? The Silent Killer Stalking? The risk of mesothelioma lung cancer from asbestos insulation, asbestos siding, asbestos tile, asbestos flooring, and a host of other products exist everywhere around us.

Asbestos was not only cheap to buy, but it is also pliable and sometimes, soft like cotton. Some forms of asbestos fibers have cloth-like qualities.

Asbestos fibers can therefore be easily woven into fireproof protection apparel for rescue officials and firefighters. Items for other professionals and workers, who are exposed to high heat, are also manufactured, creating asbestos products risk.

Its industrial properties was in strong demand during the industrial revolution. An estimated 4,000 products made during the 1900s contained asbestos fibers

Asbestos Risk Assessment

You need specialist advisors to perform an asbestos risk assessment in managing and preventing mesothelioma injury. Their asbestos testing protocol and results are also invaluable for mesothelioma research projects.

All entries in a company’s asbestos register become vital in the event that you receive a call from an asbestos lawyer who works on a mesothelioma claim.

City and town management are increasingly being held responsible for asbestos exposure in the areas under their management.

It is expected that the focus in this regard will soon expand to seaside venues. Asbestos used to be the building material of choice close to the oceans.

Asbestos Risk Management

Asbestos risk management is the legal responsibility of every manager or owner of a business, or landlord. Asbestos mesothelioma law is clear i.t.o. management’s responsibility.

There is an increased global effort to minimise asbestos exposure, cut down on mesothelioma injury and asbestosis mesothelioma.

This was driven in part by the large asbestos settlements granted in mesothelioma lawsuits.

Early in the 1970s we saw the first drafts of mesothelioma cancer law accepted by various regulating bodies of developed countries internationally.

However in a country like South Africa, laws were only made in 2008 to finally control the mining and manufacturing of asbestos products.

Most asbestos products are reasonably safe if it is kept undisturbed, painted and well maintained. However, most people will be surprised to notice the large number of asbestos products in their living and work environments, that are poorly maintained.

Pieter Pepler is a management consultant to small and medium enterpises. He has a keen interest in in health aspects and spends much of his time researching and writing about the causes and alternative treatment options for the natural treatment of various chronic diseases.Visit here http://mesotheliomatreatment-option.blogspot.com

Article Source: http://www.articlesbase.com/cancer-articles/asbestos-mesothelioma-risk-the-silent-killer-stalking-in-your-vicinity-1958423.html

About the Author

Visit here http://mesotheliomatreatment-option.blogspot.com