Chemotherapy Can Extend a Patient's Life Who Has Rare Pancreatic Cancer

When a patient has pancreatic cancer most will do what it take to extend their life.  There is a rare pancreatic  cancer called periampullary adenocarcinoma in which chemotherapy will increase the patient's life span.

Ampullary cancer is a malignant tumor that arises from the Ampulla of Vater, the last centimeter of the common bile duct as it passes through the duodenum, the first section of the intestine. All pancreatic and biliary secretions enter the duodenum through the Ampulla of Vater.

A tumor blocking  the Ampulla of Vater will interfere with drainage of the pancreatic and biliary secretions into the intestine. Jaundice results when the drainage of bile into the duodenum is blocked causing it to accumulate in in the bloodstream. Jaundice, the yellowing of the skin, is typically one of the first symptoms present with Ampullary cancer.

The diagnostic tests used to for ampullary cancer  are similar to those for pancreatic cancer; endoscopy or endoscopic retrograde cholangiopancreatography (ERCP) are frequently used to make the diagnosis. 

                        Histology of Periampullay adenocarcinoma

Patients with periampullary cancer who received chemotherapy and surgery lived longer than patients who did not receive the chemotherapy.

This is the finding of a large multi-center research effort that was published in the July 11 issue of JAMA (Journal of the American Medical Association).

This an important large international multi-center study showing the benefit of chemotherapy after surgical resection of a specific type ofperiampullary cancer," James Farrell, MD, director of the University of California Los Angeles Medical Center Endoscopic Ultrasound Division of Digestive Diseases, told dailyRx in an email,

"It supports the use of adjuvant treatment with gemcitabine for this group of patients," Dr. Farrell said.

Additional study is needed to learn more about this treatment option. "There were different survival outcomes by tumor type, although age, poorly differentiated tumor grade, and lymph node involvement were also independent survival factors,” the authors write.

A Rare Cancer in Children

It is always heartbreaking when children have cancer. Usually cancer in children affects the blood cells or brain. A very rare cancer in children is rhabdomyosarcoma. Where is this cancer located in a child's body?

Fewer than 60 children are diagnosed with rhabdomyosarcoma in the UK each year. About the same number in the United States. Most of them are younger than 10 years old. It's more common in boys than girls.
Rhabdomyosarcoma is the most common of the soft tissue sarcomas in children. These tumors develop from muscle or fibrous tissue and can grow in any part of the body.
The most common areas of the body to be affected are around the head and neck, the bladder or the testes. Sometimes tumours are also found in a muscle or a limb, in the chest or in the abdominal wall. If the tumour is in the head or neck region, it can occasionally spread into the brain or the fluid around the spinal cord.

What causes this disease is unknown. Children who have rare genetic disorders are more prone to have rhabdommyosarcoma.

                               Image of rhabdomyosarcoma that has been removed from a child's body.

The images of the children with this cancer are very disturbing so they will not be displayed.

The signs and symptoms will depend on the part of the body that's affected by the rhabdomyosarcoma. The most common sign is a swelling or lump.

• If the tumor is in the head area, it can sometimes cause a blockage (obstruction) and a discharge from the nose or throat. Occasionally, an eye may appear swollen and protruding.
• If the tumor is in the abdomen (tummy), your child may have discomfort in the abdomen and difficulty going to the toilet.
• If the tumor is in the bladder, your child may have blood in the urine and difficulty passing urine.  

A variety of tests and investigations may be needed to diagnose a rhabdomyosarcoma. A small operation may be needed to remove a sample from the tumour to be looked at under a microscope. This called a biopsy. It's usually done under a general anaesthetic.
Various tests may be done to check the exact size of the tumour and whether it has spread to any other part of the body. These may include:

• a chest x-ray to check the lungs
• an ultrasound
• CT or MRI scans
• blood and bone marrow tests.

Any tests and investigations that your child needs will be explained to you. The booklet A parent's guide to children's cancer gives details of what the tests and scans involve.

Rhabdomyosarcomas are rare tumours and should be treated at specialist centres. 
Treatment depends upon the size of the tumour, its position within the body, and whether it has spread. Treatment of rhabdomyosarcoma usually includes surgery, radiotherapy or chemotherapy, or a combination of these treatments.

Surgery

If at all possible, surgery will be used to remove the tumour. Chemotherapy, using a combination of drugs, is often given before surgery to shrink the tumour. Radiotherapy may also be given to the area of the tumour, particularly if it cannot be completely removed by surgery.

Chemotherapy

If the tumour cannot be removed with surgery, treatment will usually involve a combination of chemotherapy and radiotherapy. Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells and is usually given every three weeks. It may be given to shrink the tumour before surgery or with radiotherapy when the tumour can't be removed by surgery. The drugs used and the length of treatment depends on the type and stage of the rhabdomyosarcoma.

Radiotherapy

Radiotherapy treats cancer by using high-energy rays, which destroy the cancer cells while doing as little harm as possible to normal cells. It's given to the area where the rhabdomyosarcoma occurs.

Side effects of treatment 

Treatment for rhabdomyosarcoma often causes side effects, and your child’s doctor will discuss this with you before treatment starts. Any possible side effects will depend on the particular treatment being given and the part of the body that's being treated.
Chemotherapy can make your child feel better by relieving the symptoms of the cancer, but it can sometimes have side effects such as feeling sick (nausea) and being sick (vomiting), hair loss, an increased risk of infection, bruising and bleeding, tiredness and diarrhoea.

Late side effects

A small number of children may develop side effects many years after their treatment for a rhabdomyosarcoma. Long-term side effects depend on the type of treatment used, and may include a possible reduction in bone growth, infertility, a change in the way the heart and the kidneys work, and a slight increase in the risk of developing another cancer in later life.
Your child’s doctor or nurse will talk to you about any possible late side effects. There is more detailed information about these late side effects in the booklet A parent’s guide to children’s cancer.

                                        Mayo Clinic Oncologist Explains Rhabdomyosarcoma

                                       Holly's Journey Dealing With This Rare Cancer

http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Rhabdomyosarcoma.aspx

New Biomarkers Tests for Ovarian Cancer

Great new article about new biomarker testing at the end of this year concerning ovarian cancer. Every woman needs to read this to educate yourself and share with others about what is involved with this life threatening cancer.

Autotelic Lab, Fountain Valley, a developer of quantitative rapid tests, announced today that it will be presenting a poster “The Hormones BNP and FSH in Ovarian Cancer: Potential as Diagnostic Biomarkers” at ENDO 2012. Ovarian cancer accounts for approximately 3 percent of all cancers in women and is the fifth leading cause of cancer-related death among women in the United States. Ovarian cancer has the highest mortality of all cancers of the female reproductive system. This reflects, in part, a lack of early symptoms and effective ovarian cancer screening tests. Thus, ovarian cancer is often diagnosed at an advanced stage, after the cancer has spread beyond the ovary. Cancer Antigen 125 (CA125, aka Mucin16) is overproduced by ovarian cancer cells; however, it cannot be used as a diagnostic biomarker for ovarian cancer as it can be absent when disease is present, or levels can be high when no disease or no malignant disease exists. Serial changes in CA125 levels, if elevated, however, can be useful in assessment of disease status and progression. Ovarian epithelial cancer is more common in individuals with elevated Gonadotropin-releasing hormones (GnRH) including Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) such as postmenopausal women or women who have received treatment to induce ovulation. Conversely, reduced risk of ovarian cancer is associated with a history of multiple pregnancies, breastfeeding, oral contraceptive use, and estrogen replacement therapy, all of which are related to lower levels of and reduced exposure to FSH and LH. FSH regulates gene expression in ovarian tumors and causes neovascularization of ovarian cancers by increasing Vascular Endothelial Growth Factor (VEGF) expression through upregulation of survivin. We therefore examined FSH levels in relation to CA125 as potential diagnostic marker for ovarian cancer using a quantitative point-of-care device for FSH that was recently developed for therapeutic drug monitoring. The surprising potential of FSH and/or Brain Natriuretic Peptide (BNP) as diagnostic biomarkers for ovarian cancer will be presented.

These tests are performed on serum from a blood draw. It usually take a few days to get the results,but are very informative for the oncologist as far as plan of treatment.

                                  An Inspiring Story of a woman (physician) Diagnosed With Ovarian

Cancerhttp://news.topwirenews.com/2012/06/23/fsh-and-bnp-as-potential-diagnostic-biomarker-for-ovarian-cancer/%

Blood Test and Early Stage Breast Cancer

 Through cancer research it has been determined that a current blood test can determine which patients who were diagnosed with early stages of breast cancer and who had their tumors surgically removed may see their cancer return.
The following study will explain how this was determined.

Doctors at the M.D. Anderson Cancer Center in Houston, Texas, took blood samples from 302 women with stage 1, 2 or 3 breast cancer right before they had their tumor surgically removed.  None of the women had been treated with chemotherapy. The patients' progress was followed for nearly 3 years (35 months).

According to the study published Tuesday in the journal Lancet Oncology , 25% of women whose cancer was confined to the breast had at least one circulating tumor cell in their 7.5 milliliter sample of blood (about the equivalent of half a tablespoon).  Normally a lymph node biopsy is used to determine the likelihood of the cancer coming back.

Researchers found 73 women (24%) had at least one circulating tumor cell; 29 women (about 10%) had at least two circulating tumor cells in their sample and 16 (5%) had at least 3 or more tumor cells in their blood sample.

Women with early stage breast cancer aren't usually thought to be at high risk for having their cancer come back, but some do and doctors don't know why, which is why lead study author Dr. Anthony Lucci says he and his colleagues decided to investigate this.

The study found that if a women had just one circulating tumor cell in her sample, she had a 4 times greater chance of dying, compared to a woman with no CTCs.

"If three or more tumor cells were found in a blood sample, the woman had an almost 11 times higher risk of dying from the cancer compared to those who didn't have any circulating tumor cells," says Lucci.

All in all, 31% of the women in this study found their cancer came back or died during the study period.

Lucci likens circulating tumor cells to seeds in a garden. If you dump a bag of seeds in the dirt, he says, the odds that one or several take hold and grow is much higher than planting just one seed.

                                                           Circulating Tumor Cells

"While the findings of an association between circulating tumor cells  and outcome in breast cancer is not novel," says Dr. Boris Pasche, Director of the Division of Hemotology and Oncology at the University of Alabama at Birmingham.  "The strength of this new paper is its capability to characterize the magnitude of the impact of CTCs on breast cancer outcome."   He says the other strength of this study is that the blood samples were taken just before surgery, giving a more accurate picture of where traces of cancer are outside the breast.

Once a tumor is removed, it's possible for cells to break off, thus skewing the accuracy of how much cancer is already circulating outside the breast.

According to a commentary in the Journal of the American Medical Association in March 2010 , the first documented research on circulating tumors was conducted in 1846. Since then, studies have shown that looking for circulating tumor cells in patients, who've already seen their cancer spread, can be an important tool to determine how a patient does in the future.

This hasn't been proven to be the case for early stage breast cancer, where the cancer has not spread beyond the breast and it is something this new study doesn't do either.

However, Pasche, who was not involved with the research, says if the results are validated in larger clinical trials, this may lead to a new screening method for predicting which women may be more likely to see their cancer come back.

"This provides a new train of thought of how we should handle women with early-stage breast cancer because we could identify the women who have a high risk of recurrences and early death and treat them differently."   Pasche suggests those patients  get more aggressive removal of lymph nodes, they may be put on chemotherapy (something they may not normally be prescribed) and their doctors will probably have a much tighter follow-up schedule for them.

Lucci and Pasche say this type of screening is not yet ready for prime time, and M.D. Anderson already has further studies underway.

                                                         Circulating Tumor Cells and  Breast Cancer Recurrencehttp://www.wtnh.com/dpps/health/cancer/blood-test-may-signal-breast-cancers-return_4198976#.T9-D67UTpJs

What is Happening Now In Cancer Research

Research for a cure for cancer is moving at a rapid pace. Labs are thinking outside the box and finding ways to kill cancer cells of one's type of cancer. . Areas of active basic cancer research in the Department of Molecular and Cell Biology include tumor cell biology; the use of model systems to discover novel genes involved in carcinogenesis; tumor immunology and immunotherapeutics; and structural biology of protein targets for cancer therapeutics.


Cancer arises by a multi-step involving the accumulation of activating mutations in proto-oncogenes and inactivating mutations in tumor suppressor genes. The process is accelerated by the genetic instability of cancer cells, which is believed to result from passage through “telomere crisis.” Thus, cancer cells may contain many – perhaps hundreds – of genetic changes. One of the challenges we now face is to be able to develop a complete description of the genetic changes that have taken place in each individual tumor, so that therapies can be targeted that are specific for the tumors of each individual patient.

                                                       Tumor Genetics-Sloan Kettering


Below is a chart of Tumor Immunology

                                        

Prof. Ofer Mandelboim, IMRIC Researcher - General and Tumour Immunology - 1 of 3

http://crl.berkeley.edu/cancer_research_at_berkeley.htm#MCB

What to Expect During Chemotherapy Treatments

The following video does an excellent job of explaining your journey as a patient with cancer that requires chemotherapy treatment. Watching this tutorial will greatly reduce the anxiety of a patient's first infusion.

                                            Chemotherapy at Norris Memorial Cancer Center

Please share this article with anyone you know that has been diagnosed with cancer and has been prescribed chemotherapy for treatment of killing cancer cells.

Advanced Therapies Are Aimed at Cancer

How would you like chemotherapy with less side affects? How would you like chemo that delivered poison to kill only cancer cells and not destroy healthy cells? According to new research there has been a sharp increase in the medical artillery to fight cancer. Many high tech approaches that were only dreamed about were not possible or successful until this decade.

Smart drugs are being developed that only kills the cancer cells. Also, there is a new tool that helps the immune system to attack a broad range of types of cancer. Another wonderful for treatments that aimed at new genes and cancer pathways, plus better tests to predict which patient will benefit from them.

Dr. Richard Pazdur who is the cancer chief for the Food and Drug Administration talks about the new 'smart bombs'.  I see major advances being made in big diseases"

In fact, an emerging class of "smart bombs" was one of the most hopeful developments reported at the meeting of the American Society of Clinical Oncology.

These are two-punch weapons that combine substances called antibodies, which bond with specific cancer cells, and toxins that are too potent to be given by themselves. A chemical link holds them together until they attach to a tumor cell, releasing the poison inside it and killing the cell.

"This is a classic example of the magic bullet concept" first proposed more than 100 years ago but only now possible with advances in technology, said Dr. Louis Weiner, director of Georgetown Lombardi Comprehensive Cancer Center.

"The antibody basically targets this very toxic drug right to the cancer cell and places it inside the cancer cell where the drug can do its damage" without harming healthy cells nearby, he said.

On Sunday, a large study showed that one such drug - Genentech's T-DM1 - delayed the time until cancer got worse in women with very advanced breast cancer. The drug also seems to be improving survival, although it will take more time to know for sure. So far, women on the new treatment were living more than a year longer than a comparison group of women who were given two other drugs.

Dozens of similar "smart bomb" drugs are in development. On Monday, Pfizer Inc. plans to report on one it is testing for certain types of lymphoma and leukemia. Only one such drug is on the market now - Adcetris, sold by Seattle Genetics Inc. for some less common types of lymphoma.

The other big news at the conference involved a very different approach: using the immune system to fight cancer. For more than a century, doctors have been trying to harness its power, but tumor cells have cloaking mechanisms that have kept the immune system from recognizing them as "enemy" and going on the attack.

Bristol-Myers Squibb Co. has developed two drugs - one aimed at cancer cells and the other at key soldier cells of the immune system - to remove one of these invisibility cloaks. Two studies involving nearly 500 people found some tumor shrinkage in up to one quarter of patients with lung and kidney cancers as well as the deadly skin cancer, melanoma. The treatments had less impact against colon and prostate cancer.

These are only early results - not survival comparisons or definitive tests, doctors warn. More testing is needed to even establish safety. In one study, three patients died of a lung inflammation considered due to the treatment.

However, ordinary chemotherapy can prove fatal, too, said one study leader, Dr. Julie Brahmer of Johns Hopkins University.

"There were a few patients who had a complete remission" from the immune system treatments and most patients suffered few side effects, she said. "It's great to see patients feeling well. They don't have hair loss, they don't have a drop in blood counts and are not as prone to infections."

Dr. Roy Herbst, medical oncology chief at Yale Cancer Center in New Haven, Conn., was hopeful.

"I haven't seen anything this good" for many years for treating lung cancer, he said. "I'd be very surprised if there wasn't some benefit" on survival, said Herbst, who has consulted for the drug's maker.

Other doctors, including Pfizer's cancer drug development chief, Dr. Mace Rothenberg, noted progress on new diagnostic tests to predict which drugs will work for which patients. Cost, time and difficulty have kept many of them from being practical in everyday settings for cancer patients, but "a lot of these barriers are falling," Rothenberg said.

"Every time we say 'this technology is 5 to 10 years off, we've been wrong" and progress has come sooner, he said.

For more info: http://www.heraldonline.com/2012/06/03/4017939/more-advanced-therapies-are-being.html and www.cancer.org

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