Dr. F.W. Nugent is a medical oncologist specializing in gastrointestinal cancers with a special interest in pancreatic cancer. Dr. Nugent graduated from Middlebury College with a bachelors degree in religion before graduating from Albany Medical College. He presently serves as vice-chairman of medical oncology at the Lahey Clinic in Burlington, Massachusetts.
Dr. Keith E. Stuart is a medical oncologist specializing in the study and treatment of cancers involving the gastrointestinal tract, with a special interest in tumors involving the liver. He was educated at Harvard University (graduating magna cum laude) and Albert Einstein College of Medicine and did his medical training at the New England Deaconess Hospital.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Cancers that develop within the pancreas fall into two major categories: (1)
cancers of the endocrine pancreas (the part that makes insulin) are called
"islet cell" or "pancreatic neuroendocrine" cancers and (2) cancers of the
exocrine pancreas (the part that makes enzymes). Islet cell cancers are rare and
typically grow slowly compared to exocrine pancreatic cancers. Islet cell tumors
often release hormones into the bloodstream and are further characterized by the
hormones they produce (insulin, glucagon, gastrin, and other hormones). Cancers
of the exocrine pancreas develop from the cells that line the system of ducts
that deliver enzymes to the small intestine and are called commonly referred to
as pancreatic adenocarcinomas. Adenocarcinoma of the pancreas comprises 95% of
all pancreatic ductal cancers and is the subject of this review.
Cells that line the ducts in the exocrine pancreas divide more rapidly than
the tissues that surround them. For reasons that we do not understand, these
cells can make a mistake when they divide and an abnormal cell can be made. When
an abnormal ductal cell begins to divide in an unregulated way, a growth can
form. These changes are called "dysplasia." Often, dysplastic cells can undergo
additional genetic mistakes over time and become even more abnormal. If these
dysplastic cells then begin to invade through the walls of the duct from which
they arise into the surrounding tissue, a frank cancer develops.
What are pancreatic cancer causes and risk factors?
About 40,000 cases of pancreatic cancer occur yearly in the United States.
Most people who develop pancreatic cancer do so without any predisposing risk
factors. Perhaps the biggest risk factor is increasing age; being over the age
of 60 puts an individual at greater risk. Rarely, there can be genetic
syndromes that run in families that put individuals at higher risk such as
BRCA-2 and, to a lesser extent, BRCA-1 gene mutations. Familial syndromes are
unusual but it is important to let your doctor know if anyone else in your
family has been diagnosed with cancer. Additionally, certain behaviors or
conditions are thought to slightly increase an individual's risk for developing
pancreatic cancer. For example, African-Americans may be at greater risk as may
individuals with close family members who have been previously diagnosed with
the disease. Other behaviors or conditions that may put people at risk include
tobacco use, obesity, a sedentary lifestyle, a history of diabetes, chronic
pancreatic inflammation (pancreatitis), and a fatty (or Western) diet. Prior
stomach surgery may moderately increase one's risk as can certain chronic
infections such as hepatitis B and H. pylori (an infection of the stomach
lining). Certain types of pancreatic cysts may put individuals at risk of
developing pancreatic cancer. Despite these associated risks, no identifiable
cause is found in most people who develop pancreatic cancer.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Muscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation (gastritis) of the inner lining of the stomach in humans. This bacteria also is the most common cause of ulcers worldwide.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Pancreatic cysts are collections of fluid within the pancreas. Some are benign, malignant, or pseudocysts. There are two major types of pancreatic cysts, inflammatory cysts and non-inflammatory cysts. Non-inflammatory cysts include: serous cyst adenomas, mucinous cyst adenomas, intraductal papillary mucinous neoplasm (IPMN), and solid pseudopapillary tumor of the pancreas. Symptoms of pancreatic cysts include abdominal pain, jaundice, fever, chills, and sepsis. Treatment depends on the type of cyst, and patient health.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Smokeless tobacco can have negative health effects such as cancers, poor oral health (gum disease and tooth decay), infertility, pregnancy complications, and nicotine addiction.
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