pancreas cancer...very interesting

[Guest guest]

http://www.cancer.gov/cancerinfo/wyntk/pancreas

What You Need To Know AboutT Cancer of the Pancreas

Information about detection, symptoms, diagnosis, and treatment of pancreatic

cancer. NIH Publication No. 01-1560

Posted: 02/08/2002, Updated: 09/16/2002

Table of Contents

Introduction

The Pancreas

Understanding Cancer

Pancreatic Cancer: Who's at Risk?

Symptoms

Diagnosis

Staging

Treatment

Getting a Second Opinion

Preparing for Treatment

Methods of Treatment

Side Effects of Treatment

Surgery

Radiation Therapy

Chemotherapy

Pain Control

Nutrition

Followup Care

Support for People with Pancreatic Cancer

The Promise of Cancer Research

National Cancer Institute Booklets

National Cancer Institute Information Resources

Introduction

This National Cancer Institute (NCI) booklet has important information about

cancer of the pancreas. In the United States, cancer of the pancreas is

diagnosed in more than 29,000 people every year. It is the fifth leading cause

of cancer death.

This booklet discusses possible causes of cancer of the pancreas. It also

describes symptoms, diagnosis, treatment, and followup care. This information

can help patients and their families better understand and cope with this

disease.

Scientists are studying cancer of the pancreas to learn more about this disease.

They are finding out more about its causes. Doctors are exploring new ways to

treat it. Research already has led to better quality of life for people with

cancer of the pancreas.

Information specialists at the NCI's Cancer Information Service at

1-800-4-CANCER can help people with questions about cancer and can send NCI

publications. Also, many NCI publications are on the Internet at

http://cancer.gov/publications. People in the United States and its territories

may use this Web site to order publications. This Web site also explains how

people outside the United States can mail or fax their requests for NCI

publications.

Words that may be new to readers are in italics. The " Dictionary " gives

definitions of these terms. Some words in the " Dictionary " have a " sounds-like "

spelling to show how to pronounce them.

The Pancreas

The pancreas is a gland located deep in the abdomen between the stomach and the

spine (backbone). The liver, intestine, and other organs surround the pancreas.

The pancreas is about 6 inches long and is shaped like a flat pear. The widest

part of the pancreas is the head, the middle section is the body, and the

thinnest part is the tail.

This picture shows the pancreas and nearby organs.

The pancreas makes insulin and other hormones. These hormones enter the

bloodstream and travel throughout the body. They help the body use or store the

energy that comes from food. For example, insulin helps control the amount of

sugar in the blood.

The pancreas also makes pancreatic juices. These juices contain enzymes that

help digest food. The pancreas releases the juices into a system of ducts

leading to the common bile duct. The common bile duct empties into the duodenum,

the first section of the small intestine.

This picture shows the pancreas, common bile duct, and small intestine.

Understanding Cancer

Cancer is a group of many related diseases. All cancers begin in cells, the

body's basic unit of life. Cells make up tissues, and tissues make up the organs

of the body.

Normally, cells grow and divide to form new cells as the body needs them. When

cells grow old and die, new cells take their place.

Sometimes this orderly process breaks down. New cells form when the body does

not need them, or old cells do not die when they should. These extra cells can

form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

Benign tumors are not cancer. Usually, doctors can remove them. In most cases,

benign tumors do not come back after they are removed. Cells from benign tumors

do not spread to tissues around them or to other parts of the body. Most

important, benign tumors are rarely a threat to life.

Malignant tumors are cancer. They are generally more serious and may be life

threatening. Cancer cells can invade and damage nearby tissues and organs. Also,

cancer cells can break away from a malignant tumor and enter the bloodstream or

lymphatic system. That is how cancer cells spread from the original cancer

(primary tumor) to form new tumors in other organs. The spread of cancer is

called metastasis.

Most pancreatic cancers begin in the ducts that carry pancreatic juices. Cancer

of the pancreas may be called pancreatic cancer or carcinoma of the pancreas.

A rare type of pancreatic cancer begins in the cells that make insulin and other

hormones. Cancer that begins in these cells is called islet cell cancer. This

booklet does not deal with this rare disease. The Cancer Information Service

(1-800-4-CANCER) can provide information about islet cell cancer.

When cancer of the pancreas spreads (metastasizes) outside the pancreas, cancer

cells are often found in nearby lymph nodes. If the cancer has reached these

nodes, it means that cancer cells may have spread to other lymph nodes or other

tissues, such as the liver or lungs. Sometimes cancer of the pancreas spreads to

the peritoneum, the tissue that lines the abdomen.

When cancer spreads from its original place to another part of the body, the new

tumor has the same kind of abnormal cells and the same name as the primary

tumor. For example, if cancer of the pancreas spreads to the liver, the cancer

cells in the liver are pancreatic cancer cells. The disease is metastatic

pancreatic cancer, not liver cancer. It is treated as pancreatic cancer, not

liver cancer.

Pancreatic Cancer: Who's at Risk?

No one knows the exact causes of pancreatic cancer. Doctors can seldom explain

why one person gets pancreatic cancer and another does not. However, it is clear

that this disease is not contagious. No one can " catch " cancer from another

person.

Research has shown that people with certain risk factors are more likely than

others to develop pancreatic cancer. A risk factor is anything that increases a

person's chance of developing a disease.

Studies have found the following risk factors:

Age -- The likelihood of developing pancreatic cancer increases with age. Most

pancreatic cancers occur in people over the age of 60.

Smoking -- Cigarette smokers are two or three times more likely than nonsmokers

to develop pancreatic cancer.

Diabetes -- Pancreatic cancer occurs more often in people who have diabetes than

in people who do not.

Being male -- More men than women are diagnosed with pancreatic cancer.

Being African American -- African Americans are more likely than Asians,

Hispanics, or whites to get pancreatic cancer.

Family history -- The risk for developing pancreatic cancer triples if a

person's mother, father, sister, or brother had the disease. Also, a family

history of colon or ovarian cancer increases the risk of pancreatic cancer.

Chronic pancreatitis -- Chronic pancreatitis is a painful condition of the

pancreas. Some evidence suggests that chronic pancreatitis may increase the risk

of pancreatic cancer.

Other studies suggest that exposure to certain chemicals in the workplace or a

diet high in fat may increase the chance of getting pancreatic cancer.

Most people with known risk factors do not get pancreatic cancer. On the other

hand, many who do get the disease have none of these factors. People who think

they may be at risk for pancreatic cancer should discuss this concern with their

doctor. The doctor may suggest ways to reduce the risk and can plan an

appropriate schedule for checkups.

Symptoms

Pancreatic cancer is sometimes called a " silent disease " because early

pancreatic cancer often does not cause symptoms. But, as the cancer grows,

symptoms may include:

Pain in the upper abdomen or upper back

Yellow skin and eyes, and dark urine from jaundice

Weakness

Loss of appetite

Nausea and vomiting

Weight loss

These symptoms are not sure signs of pancreatic cancer. An infection or other

problem could also cause these symptoms. Only a doctor can diagnose the cause of

a person's symptoms. Anyone with these symptoms should see a doctor so that the

doctor can treat any problem as early as possible.

Diagnosis

If a patient has symptoms that suggest pancreatic cancer, the doctor asks about

the patient's medical history. The doctor may perform a number of procedures,

including one or more of the following:

Physical exam -- The doctor examines the skin and eyes for signs of jaundice.

The doctor then feels the abdomen to check for changes in the area near the

pancreas, liver, and gallbladder. The doctor also checks for ascites, an

abnormal buildup of fluid in the abdomen.

Lab tests -- The doctor may take blood, urine, and stool samples to check for

bilirubin and other substances. Bilirubin is a substance that passes from the

liver to the gallbladder to the intestine. If the common bile duct is blocked by

a tumor, the bilirubin cannot pass through normally. Blockage may cause the

level of bilirubin in the blood, stool, or urine to become very high. High

bilirubin levels can result from cancer or from noncancerous conditions.

CT scan (Computed tomography) -- An x-ray machine linked to a computer takes a

series of detailed pictures. The x-ray machine is shaped like a donut with a

large hole. The patient lies on a bed that passes through the hole. As the bed

moves slowly through the hole, the machine takes many x-rays. The computer puts

the x-rays together to create pictures of the pancreas and other organs and

blood vessels in the abdomen.

Ultrasonography -- The ultrasound device uses sound waves that cannot be heard

by humans. The sound waves produce a pattern of echoes as they bounce off

internal organs. The echoes create a picture of the pancreas and other organs

inside the abdomen. The echoes from tumors are different from echoes made by

healthy tissues.

The ultrasound procedure may use an external or internal device, or both types:

Transabdominal ultrasound: To make images of the pancreas, the doctor places the

ultrasound device on the abdomen and slowly moves it around.

EUS (Endoscopic ultrasound): The doctor passes a thin, lighted tube (endoscope)

through the patient's mouth and stomach, down into the first part of the small

intestine. At the tip of the endoscope is an ultrasound device. The doctor

slowly withdraws the endoscope from the intestine toward the stomach to make

images of the pancreas and surrounding organs and tissues.

ERCP (endoscopic retrograde cholangiopancreatography) -- The doctor passes an

endoscope through the patient's mouth and stomach, down into the first part of

the small intestine. The doctor slips a smaller tube (catheter) through the

endoscope into the bile ducts and pancreatic ducts. After injecting dye through

the catheter into the ducts, the doctor takes x-ray pictures. The x-rays can

show whether the ducts are narrowed or blocked by a tumor or other condition.

PTC (percutaneous transhepatic cholangiography) -- A dye is injected through a

thin needle inserted through the skin into the liver. Unless there is a

blockage, the dye should move freely through the bile ducts. The dye makes the

bile ducts show up on x-ray pictures. From the pictures, the doctor can tell

whether there is a blockage from a tumor or other condition.

Biopsy -- In some cases, the doctor may remove tissue. A pathologist then uses a

microscope to look for cancer cells in the tissue. The doctor may obtain tissue

in several ways. One way is by inserting a needle into the pancreas to remove

cells. This is called fine-needle aspiration. The doctor uses x-ray or

ultrasound to guide the needle. Sometimes the doctor obtains a sample of tissue

during EUS or ERCP. Another way is to open the abdomen during an operation.

A person who needs a biopsy may want to ask the doctor the following questions:

What kind of biopsy will I have?

How long will it take? Will I be awake? Will it hurt?

Are there any risks?

How soon will I know the results?

If I do have cancer, who will talk to me about treatment? When?

Staging

When pancreatic cancer is diagnosed, the doctor needs to know the stage, or

extent, of the disease to plan the best treatment. Staging is a careful attempt

to find out the size of the tumor in the pancreas, whether the cancer has

spread, and if so, to what parts of the body.

The doctor may determine the stage of pancreatic cancer at the time of

diagnosis, or the patient may need to have more tests. Such tests may include

blood tests, a CT scan, ultrasonography, laparoscopy, or angiography. The test

results will help the doctor decide which treatment is appropriate.

Treatment

Many people with pancreatic cancer want to take an active part in making

decisions about their medical care. They want to learn all they can about their

disease and their treatment choices. However, the shock and stress that people

may feel after a diagnosis of cancer can make it hard for them to think of

everything they want to ask the doctor. Often it helps to make a list of

questions before an appointment. To help remember what the doctor says, patients

may take notes or ask whether they may use a tape recorder. Some patients also

want to have a family member or friend with them when they talk to the doctor-to

take part in the discussion, to take notes, or just to listen.

Cancer of the pancreas is very hard to control with current treatments. For that

reason, many doctors encourage patients with this disease to consider taking

part in a clinical trial. Clinical trials are an important option for people

with all stages of pancreatic cancer. The section on " The Promise of Cancer

Research " has more information about clinical trials.

At this time, pancreatic cancer can be cured only when it is found at an early

stage, before it has spread. However, other treatments may be able to control

the disease and help patients live longer and feel better. When a cure or

control of the disease is not possible, some patients and their doctors choose

palliative therapy. Palliative therapy aims to improve quality of life by

controlling pain and other problems caused by this disease.

The doctor may refer patients to an oncologist, a doctor who specializes in

treating cancer, or patients may ask for a referral. Specialists who treat

pancreatic cancer include surgeons, medical oncologists, and radiation

oncologists. Treatment generally begins within a few weeks after the diagnosis.

There will be time for patients to talk with the doctor about treatment choices,

get a second opinion, and learn more about the disease.

Getting a Second Opinion

Before starting treatment, a patient may want a second opinion about the

diagnosis and the treatment plan. Some insurance companies require a second

opinion; others may cover a second opinion if the patient requests it. Gathering

medical records and arranging to see another doctor may take a little time. In

most cases, a brief delay to get another opinion will not make therapy less

helpful.

There are a number of ways to find a doctor for a second opinion:

The doctor may refer patients to one or more specialists. At cancer centers,

several specialists often work together as a team.

The Cancer Information Service (1-800-4-CANCER) can tell callers about treatment

facilities, including cancer centers and other programs supported by the

National Cancer Institute, and can send printed information about finding a

doctor.

A local medical society, a nearby hospital, or a medical school can usually

provide the name of specialists.

The American Board of Medical Specialties (ABMS) has a list of doctors who have

met certain education and training requirements and have passed specialty

examinations. The Official ABMS Directory of Board Certified Medical Specialists

lists doctors' names along with their specialty and their educational

background. The directory is available in most public libraries. Also, ABMS

offers this information on the Internet at http://www.abms.org. (Click on " Who's

Certified. " )

Preparing for Treatment

The doctor can describe treatment choices and discuss the results expected with

each treatment option. The doctor and patient can work together to develop a

treatment plan that fits the patient's needs.

Treatment depends on where in the pancreas the tumor started and whether the

disease has spread. When planning treatment, the doctor also considers other

factors, including the patient's age and general health.

These are some questions a person may want to ask the doctor before treatment

begins:

What is the diagnosis?

Where in the pancreas did the cancer start?

Is there any evidence the cancer has spread? What is the stage of the disease?

Do I need any more tests to check whether the disease has spread?

What are my treatment choices? Which do you recommend for me? Why?

What are the expected benefits of each kind of treatment?

What are the risks and possible side effects of each treatment?

What is the treatment likely to cost? Is this treatment covered by my insurance

plan?

How will treatment affect my normal activities?

Would a clinical trial (research study) be appropriate for me?

People do not need to ask all of their questions or understand all of the

answers at one time. They will have other chances to ask the doctor to explain

things that are not clear and to ask for more information.

Methods of Treatment

People with pancreatic cancer may have several treatment options. Depending on

the type and stage, pancreatic cancer may be treated with surgery, radiation

therapy, or chemotherapy. Some patients have a combination of therapies.

Surgery may be used alone or in combination with radiation therapy and

chemotherapy.

The surgeon may remove all or part of the pancreas. The extent of surgery

depends on the location and size of the tumor, the stage of the disease, and the

patient's general health.

Whipple procedure: If the tumor is in the head (the widest part) of the

pancreas, the surgeon removes the head of the pancreas and part of the small

intestine, bile duct, and stomach. The surgeon may also remove other nearby

tissues.

Distal pancreatectomy: The surgeon removes the body and tail of the pancreas if

the tumor is in either of these parts. The surgeon also removes the spleen.

Total pancreatectomy: The surgeon removes the entire pancreas, part of the small

intestine, a portion of the stomach, the common bile duct, the gallbladder, the

spleen, and nearby lymph nodes.

Sometimes the cancer cannot be completely removed. But if the tumor is blocking

the common bile duct or duodenum, the surgeon can create a bypass. A bypass

allows fluids to flow through the digestive tract. It can help relieve jaundice

and pain resulting from a blockage.

The doctor sometimes can relieve blockage without doing bypass surgery. The

doctor uses an endoscope to place a stent in the blocked area. A stent is a tiny

plastic or metal mesh tube that helps keep the duct or duodenum open.

After surgery, some patients are fed liquids intravenously (by IV) and through

feeding tubes placed into the abdomen. Patients slowly return to eating solid

foods by mouth. A few weeks after surgery, the feeding tubes are removed.

These are some questions a person may want to ask the doctor before having

surgery:

What kind of operation will I have?

How will I feel after the operation?

How will you treat my pain?

What other treatment will I need?

How long will I be in the hospital?

Will I need a feeding tube after surgery? Will I need a special diet?

What are the long-term effects?

When can I get back to my normal activities?

How often will I need checkups?

Radiation therapy (also called radiotherapy) uses high-energy rays to kill

cancer cells. A large machine directs radiation at the abdomen. Radiation

therapy may be given alone, or with surgery, chemotherapy, or both.

Radiation therapy is local therapy. It affects cancer cells only in the treated

area. For radiation therapy, patients go to the hospital or clinic, often 5 days

a week for several weeks.

Doctors may use radiation to destroy cancer cells that remain in the area after

surgery. They also use radiation to relieve pain and other problems caused by

the cancer.

These are some questions a person may want to ask the doctor before having

radiation therapy:

Why do I need this treatment?

When will the treatments begin? When will they end?

How will I feel during therapy? Are there side effects?

What can I do to take care of myself during therapy? Are there certain foods

that I should eat or avoid?

How will we know if the radiation is working?

Will I be able to continue my normal activities during treatment?

Chemotherapy is the use of drugs to kill cancer cells. Doctors also give

chemotherapy to help reduce pain and other problems caused by pancreatic cancer.

It may be given alone, with radiation, or with surgery and radiation.

Chemotherapy is systemic therapy. The doctor usually gives the drugs by

injection. Once in the bloodstream, the drugs travel throughout the body.

Usually chemotherapy is an outpatient treatment given at the hospital, clinic,

doctor's office, or home. However, depending on which drugs are given and the

patient's general health, the patient may need to stay in the hospital.

Patients may want to ask these questions about chemotherapy:

Why do I need this treatment?

What will it do?

What drugs will I be taking? How will they be given? Will I need to stay in the

hospital?

Will the treatment cause side effects? What can I do about them?

How long will I be on this treatment?

Side Effects of Treatment

Because cancer treatment may damage healthy cells and tissues, unwanted side

effects are common. These side effects depend on many factors, including the

type and extent of the treatment. Side effects may not be the same for each

person, and they may even change from one treatment session to the next. The

health care team will explain possible side effects and how they will help the

patient manage them.

The NCI provides helpful booklets about cancer treatments and coping with side

effects, such as Radiation Therapy and You, Chemotherapy and You, and Eating

Hints for Cancer Patients. See the sections called " National Cancer Institute

Information Resources " and " National Cancer Institute Booklets " for other

sources of information about side effects.

Surgery

Surgery for pancreatic cancer is a major operation. Patients need to stay in the

hospital for several days afterward. Patients may feel weak or tired. Most need

to rest at home for about a month. The length of time it takes to regain

strength varies.

The side effects of surgery depend on the extent of the operation, the person's

general health, and other factors. Most patients have pain for the first few

days after surgery. Pain can be controlled with medicine, and patients should

discuss pain relief with the doctor or nurse. The section on " Pain Control " has

more information.

Removal of part or all of the pancreas may make it hard for a patient to digest

foods. The health care team can suggest a diet plan and medicines to help

relieve diarrhea, pain, cramping, or feelings of fullness. During the recovery

from surgery, the doctor will carefully monitor the patient's diet and weight.

At first, a patient may have only liquids and may receive extra nourishment

intravenously or by feeding tube into the intestine. Solid foods are added to

the diet gradually.

Patients may not have enough pancreatic enzymes or hormones after surgery. Those

who do not have enough insulin may develop diabetes. The doctor can give the

patient insulin, other hormones, and enzymes. The section " Nutrition for Cancer

Patients " has more information.

Radiation Therapy

Radiation therapy may cause patients to become very tired as treatment

continues. Resting is important, but doctors usually advise patients to try to

stay as active as they can. In addition, when patients receive radiation

therapy, the skin in the treated area may sometimes become red, dry, and tender.

Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or other

problems with digestion. The health care team can offer medicine or suggest diet

changes to control these problems. For most patients, the side effects of

radiation therapy go away when treatment is over.

Chemotherapy

The side effects of chemotherapy depend mainly on the drugs and the doses the

patient receives as well as how the drugs are given. In addition, as with other

types of treatment, side effects vary from patient to patient.

Systemic chemotherapy affects rapidly dividing cells throughout the body,

including blood cells. Blood cells fight infection, help the blood to clot, and

carry oxygen to all parts of the body. When anticancer drugs damage healthy

blood cells, patients are more likely to get infections, may bruise or bleed

easily, and may have less energy. Cells in hair roots and cells that line the

digestive tract also divide rapidly. As a result, patients may lose their hair

and may have other side effects such as poor appetite, nausea and vomiting,

diarrhea, or mouth sores. Usually, these side effects go away gradually during

the recovery periods between treatments or after treatment is over. The health

care team can suggest ways to relieve side effects.

Pain Control

Pain is a common problem for people with pancreatic cancer. The tumor can cause

pain by pressing against nerves and other organs.

The patient's doctor or a specialist in pain control can relieve or reduce pain

in several ways:

Pain medicine -- Medicines often can relieve pain. (These medicines may make

people drowsy and constipated, but resting and taking laxatives can help.)

Radiation -- High-energy rays can help relieve pain by shrinking the tumor.

Nerve block -- The doctor may inject alcohol into the area around certain nerves

in the abdomen to block the feeling of pain.

Surgery -- The surgeon may cut certain nerves to block pain.

The doctor may suggest other ways to relieve or reduce pain. For example,

massage, acupuncture, or acupressure may be used along with other approaches to

help relieve pain. Also, the patient may learn relaxation techniques such as

listening to slow music or breathing slowly and comfortably.

More information about pain control can be found in the NCI publications called

Pain Control: A Guide for People with Cancer and Their Families, Get Relief from

Cancer Pain, and Understanding Cancer Pain. The Cancer Information Service can

send these booklets.

Nutrition

People with pancreatic cancer may not feel like eating, especially if they are

uncomfortable or tired. Also, the side effects of treatment such as poor

appetite, nausea, or vomiting can make eating difficult. Foods may taste

different. Nevertheless, patients should try to get enough calories and protein

to control weight loss, maintain strength, and promote healing. Also, eating

well often helps people with cancer feel better and have more energy.

Careful planning and checkups are important. Cancer of the pancreas and its

treatment may make it hard for patients to digest food and maintain the proper

blood sugar level. The doctor will check the patient for weight loss, weakness,

and lack of energy. Patients may need to take medicines to replace the enzymes

and hormones made by the pancreas. The doctor will watch the patient closely and

adjust the doses of these medicines.

The doctor, dietitian, or other health care provider can advise patients about

ways to maintain a healthy diet. Patients and their families may want to read

the National Cancer Institute booklet Eating Hints for Cancer Patients, which

contains many useful suggestions and recipes. The " National Cancer Institute

Booklets " section tells how to get this publication.

Followup Care

Followup care after treatment for pancreatic cancer is an important part of the

overall treatment plan. Patients should not hesitate to discuss followup with

their doctor. Regular checkups ensure that any changes in health are noticed.

Any problem that develops can be found and treated. Checkups may include a

physical exam, laboratory tests, and imaging procedures.

Support for People with Pancreatic Cancer

Living with a serious disease such as pancreatic cancer is not easy. Some people

find they need help coping with the emotional and practical aspects of their

disease. Support groups can help. In these groups, patients or their family

members get together to share what they have learned about coping with their

disease and the effects of treatment. Patients may want to talk with a member of

their health care team about finding a support group.

People living with pancreatic cancer may worry about the future. They may worry

about caring for themselves or their families, keeping their jobs, or continuing

daily activities. Concerns about treatments and managing side effects, hospital

stays, and medical bills are also common. Doctors, nurses, and other members of

the health care team can answer questions about treatment, diet, working, or

other matters. Meeting with a social worker, counselor, or member of the clergy

can be helpful to those who want to talk about their feelings or discuss their

concerns. Often, a social worker can suggest resources for financial aid,

transportation, home care, emotional support, or other services.

Materials on coping with cancer are available from the Cancer Information

Service (1-800-4-CANCER) and through other sources listed in the " National

Cancer Institute Information Resources " section. The Cancer Information Service

can also provide information to help patients and their families locate

programs, services, and publications.

The Promise of Cancer Research

Laboratory scientists are studying the pancreas to learn more about it. They are

studying the possible causes of pancreatic cancer and are researching new ways

to detect tumors. They also are looking for new therapies that may kill cancer

cells.

Doctors in clinics and hospitals are conducting many types of clinical trials.

These are research studies in which people take part voluntarily. In these

trials, researchers are studying ways to treat pancreatic cancer. Research

already has led to advances in treatment methods, and researchers continue to

search for more effective approaches to treat this disease.

Patients who join clinical trials have the first chance to benefit from new

treatments that have shown promise in earlier research. They also make an

important contribution to medical science by helping doctors learn more about

the disease. Although clinical trials may pose some risks, researchers take very

careful steps to protect their patients.

In trials with people who have pancreatic cancer, doctors are studying new

drugs, new combinations of chemotherapy, and combinations of chemotherapy and

radiation before and after surgery.

Biological therapy is also under investigation. Scientists are studying several

cancer vaccines to help the immune system fight cancer. Other studies use

monoclonal antibodies to slow or stop the growth of cancer.

Patients who are interested in joining a clinical study should talk with their

doctor. They may want to read Taking Part in Clinical Trials: What Cancer

Patients Need To Know. This NCI booklet describes how research studies work and

explains their possible benefits and risks. NCI's Web site at http://cancer.gov

on the Internet provides general information about clinical trials. It also

offers detailed information about specific ongoing studies of pancreatic cancer

by linking to PDQ®, NCI's cancer information database. The Cancer Information

Service at 1-800-4-CANCER can answer questions about cancer clinical trials and

can provide information from the PDQ database.

National Cancer Institute Booklets

These National Cancer Institute (NCI) booklets are available from the Cancer

Information Service by calling 1-800-4-CANCER. They are also available on the

NCI Publications Locator Web site, which is located at

http://cancer.gov/publications on the Internet.

Booklets About Cancer Treatment

Chemotherapy and You: A Guide to Self-Help During Treatment

Eating Hints for Cancer Patients

Get Relief From Cancer Pain

Understanding Cancer Pain

Pain Control: A Guide for People with Cancer and Their Families

Helping Yourself During Chemotherapy: 4 Steps for Patients

Radiation Therapy and You: A Guide to Self-Help During Treatment

Taking Part in Clinical Trials: What Cancer Patients Need To Know

If You Have Cancer... What You Should Know About Clinical Trials

La quimioterapia y usted: Una guía de autoayuda durante el tratamiento del

cáncer (Chemotherapy and You: A Guide to Self-Help During Treatment for Cancer)

El dolor relacionado con el cáncer (Understanding Cancer Pain)

El tratamiento de radioterapia: Guía para el paciente durante el tratamiento

(Radiation Therapy and You: A Guide to Self-Help During Treatment)

La participación en los estudios clínicos: Lo que los pacientes de cáncer deben

saber (Taking Part in Clinical Trials: What Cancer Patients Need To Know)

Si tiene cáncer...lo que debería saber sobre estudios clínicos (If You Have

Cancer... What You Should Know About Clinical Trials)

Booklets About Living With Cancer

Advanced Cancer: Living Each Day

Facing Forward: Life After Cancer Treatment

Siga Adelante: la vida después del tratamiento del cáncer (Facing Forward

Series: Life After Cancer Treatment)

Taking Time: Support for People With Cancer and the People Who Care About Them

When Cancer Recurs: Meeting the Challenge

National Cancer Institute Information Resources

You may want more information for yourself, your family, and your doctor. The

following National Cancer Institute (NCI) services are available to help you.

Telephone

Cancer Information Service (CIS)

Provides accurate, up-to-date information on cancer to patients and their

families, health professionals, and the general public. Information specialists

translate the latest scientific information into understandable language and

respond in English, Spanish, or on TTY equipment.

Toll-free: 1-800-4-CANCER (1-)

TTY (for deaf and hard of hearing callers): 1-

Internet

http://cancer.gov

NCI's Web site contains comprehensive information about cancer causes and

prevention, screening and diagnosis, treatment and survivorship; clinical

trials; statistics; funding, training, and employment opportunities; and the

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See the complete index of What You Need To Know AboutT Cancer publications.

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