Pancreatic Cancer Issue - Essay Example

of the of the of the Pancreatic Cancer Introduction The cells in the human body die, and are replaced by new cells; if the old cells do not die, or if new cells are formed, even when there is no need, then a growth, called a tumor, results. Tumors are either benign or malignant. The malignant tumors are dangerous to life. Malignant cells are also known as cancer cells. Such cells have the capacity to invade and damage the tissues and organs, in their vicinity. Moreover, cancer cells separate from the malignant tumor and enter the blood stream or the lymphatic system, thereby spreading the disease over a much larger area (National Cancer Institute). The pancreas is the source for insulin and other hormones, and helps the body to store the energy from food. Pancreatic cancers originate in its ducts, and are also known as carcinoma of the pancreas. An infrequent variant of pancreatic cancer occurs in the insulin and hormone producing cells, which is known as islet cell cancer. On spreading, cancer cells are encountered in the lymph nodes or other tissues, such as those in the liver and lungs (National Cancer Institute). 1) What is the standard treatment option for inoperable pancreatic cancer and describe why it is inoperable? Oncologists frequently encounter cases of inoperable pancreatic adenocarcinoma. In some of the patients with pancreatic cancer, the disease develops to a stage, where it is difficult to resect the malignant tumors. A mere 15 to 20 percent of patients are diagnosed with cancer, in the earlier stages of the disease, where it is possible to surgically excise the malignant growth. Pancreaticoduodenectomy is a major surgical operation involving the pancreas, duodenum and other organs. It is performed to resect the cancerous tumors located on the head of the pancreas. This surgery is the only curative option for pancreatic cancer. It has to be applied to all the patients of this disease, if they do not suffer from appreciable comorbidities of the disease (Wisinski, Wahl and Small 1558). The objective of oncologists is to provide patients with inoperable pancreatic cancer, treatment that mitigates the symptoms of the disease and prolongs their life. Chemoradiation and fluorouracil have seen to be instrumental in promoting survival in cases involving locally advanced disease. These are the sophisticated medical interventions aimed at palliating the symptoms of the disease. In metastatic disease, the symptoms can be reduced with the use of single agent gemcitabine. This treatment has also been observed to prolongs the life span of patients. However, it was noticed in trials involving a combination of other chemotherapeutic agents with gemcitabine, that such intervention did not have any appreciable effect on the overall survival of patients (Wisinski, Wahl and Small 1558). Erlotinib hydrochloride, whose trade name is Tarceva, constitutes a drug that is used to treat non-small cell lung cancer, pancreatic cancer and several other types of cancer. Its use has shown a significant improvement in the overall survival of patients, when used in combination with gemcitabine. This is a very good combination for patients with locally advanced or metastatic pancreatic cancer. The chances of survival of patients with inoperable pancreatic cancer are not encouraging, despite the sophistication and advancement of medical science, and widespread research in this area. Future investigations will be required to understand the individual components that make up such malignancy. Interventions to be developed in this context, would have to be designed on the basis of such information (Wisinski, Wahl and Small 1558). 2) Identify oncogenes that are known in pancreatic cancer The combination of over-expression of oncogenes and the down-regulation or loss of tumor suppressors, results in the progression of cancer. Some of the proteins that promote such progression, have inducted a new entrant, namely, a species of RNA molecules that have been termed as microRNAs (miRNAs). miRNAs hinder gene expression, and they achieve this by inhibiting or inducing degradation in the translation of specific mRNAs. They are found in eukaryotes and belong to the family of non – coding RNAs. They diminish the efficiency of select mRNAs in fighting against the progression of cancer. Several miRNAs have been held to be the cause of either promotion of suppression of Tumorigenesis, in several types of tissues in the body (Gartela and Kandelb 103). 3) Identify potential drug targets in pancreatic cancer that are from clinical trials or preclinical experiments. Discuss unique drug targets. Scientists are engrossed with developing new strategies and interventions to effectively counter cancer. They have created a large number of innovative agents that can suppress and transform the behavior of cancerous cells. New strategies include concentration on targeted agents that promote these symptoms. Such initiatives are either individual or in combination with the available standard treatment procedures. The outcome of this development is the extremely large number of possible drug combinations that emerge, in this regard. This creates considerable difficulty in choosing the best course of treatment. Nevertheless, it is indispensable to determine the best possible combination of drugs for effecting a cure against the various types of cancer (Dancey and Chen). Targeted therapies have brought to the fore, initiatives to develop better therapeutic interventions for patients with pancreatic cancer. These treatments have proved to be more effective than the other strategies. Several studies had been conducted with farnesyltransferase and matrix metalloproteinase inhibitors, in the late 1990s. Such research had disclosed that the K – ras oncogene pathway, which was active in nearly 85 percent of pancreatic tumors, was targeted by the farnesyltransferase inhibitors. Moreover, the overexpression of matrix metalloproteinase had been exhibited in pancreatic tumors. These drugs failed to reveal activity that was restricted to any single agent (Philip). 4) What can be done to identify potential drug resistance in pancreatic cancer? The development of resistance to the drugs used in the treatment of cancer, has emerged as a major problem. It adversely affects the effectiveness of interventions used for treating pancreatic cancer, especially chemotherapy. Although, several of the molecular mechanisms that underlie drug resistance have been determined, there are a large number of such mechanisms that have defied attempts to comprehend their exact working. In order to, decipher the mechanisms responsible for drug resistance; scientists have used proteomics in models cancer cell lines. This research has led to the discovery of new mechanisms of resistance. In addition, it was observed that there were several mechanisms of resistance in cancer cell lines. Consequently, combination therapies that address multiple resistance systems are required for eradicating cancers (Zhang and Liu). Pancreatic cancer has several symptoms. Some of these are weight loss, fatigue, pain in the abdomen, pain in the back, diabetes mellitus, jaundice, and nausea. Many of these symptoms occur in the later stages of the disease. In general, these symptoms are observed in the advanced stages of this ailment. Consequently, the diagnosis of pancreatic cancer is usually at an advanced stage of the disease. Moreover, only 20% of pancreatic cancer patients respond to treatment by resection, which holds out some hope for cure. The gravity of the situation can be gauged from the fact that the median survival of patients with pancreatic cancers is less than six months (Michl, Pauls and Gress 227). It is essential to identify the stage of the disease in patients, whilst subjecting them to a diagnosis. In addition, it is indispensable to identify patients in an advanced stage of the disease; because most of these patients are unlikely to benefit from surgical interventions. In respect of such patients, palliative treatment with stent therapies to reduce their suffering proves to be of greater benefit. There has been considerable improvement in diagnostic techniques, in the recent past, with the result that several sophisticated techniques are available to the physician (Michl, Pauls and Gress 227). Some of these diagnostic techniques are ultrasound scan, multidetectorb row computed tomography (MDR-CT), endoluminal ultrasound scan (EUS), endoscopic retrograde cholangiopancreatography (ERCP), Magnetic Resonance Imaging (MRI) with MR- angiography (MRA), Magnetic Resonance Cholangiopancreatography (MRCP), Positron Emission Tomography (PET), and PET with CT (PET/CT). Unfortunately, there is no single individual imaging technique that can accurately assess tumor resectability in pancreatic cancer patients (Michl, Pauls and Gress 227). Some of the medical interventions in pancreatic cancer had achieved a measure of success. However, such success was temporary, and the majority of the patients underwent a relapse of the ailment, within eighteen months. Moreover, these patients had developed resistance to the drugs being used in their treatment. This stresses the need to employ several drug based therapies, in order to tackle drug resistant receptors (Weinberg 768). Furthermore, significant success had been achieved by utilizing multi drug therapy. These techniques hold promise for drug resistant receptors, suffering a relapse after prolonged drug therapy. Works Cited Dancey, Janet E. and Helen X. Chen. Strategies for optimizing combinations of molecularly targeted anticancer agents. 2006. 10 November 2009 . Gartela, Andrei L. and Eugene S. Kandelb. "miRNAs: Little known mediators of oncogenesis." Seminars in Cancer Biology 18.2 (2008): 103 – 110. Michl, Patrick, Sandra Pauls and Thomas M. Gress. "Evidence-based diagnosis and staging of pancreatic cancer." Best Practice & Research Clinical Gastroenterology 20.2 (2006): 227 – 251. National Cancer Institute. "Cancer of the Pancreas." 16 September 2002. National Cancer Institute. 9 November 2009 . Philip, Philip A. Targeted Therapies for Pancreatic Cancer. August 2008. 10 November 2009 . Wisinski, Kari B., et al. "Inoperable Pancreatic Cancer: Standard of Care." Oncology 21.13 (2007): 1558 – 1564. Weinberg, Robert Allan. The biology of cancer. :Garland Science, 2007. Zhang, Jian-Ting and Yang Liu. Use of comparative proteomics to identify potential resistance mechanisms in cancer treatment. 2008. 10 November 2009 . Read More