J. Neoptolemos — Pancreatic Cancer

Автор: J. Neoptolemos
Название книги: Pancreatic Cancer
Формат: PDF
Жанр: Медицина
Страницы: 1419
Качество: Изначально компьютерное, E-book

This handbook details advances in pancreatic cancer research that have a profound and lasting impact on the field. It features the work of authors who are the very best in their respective fields and will have widespread appeal among clinicians, pathologists and basic scientists who are now struggling to understand this complex and rapidly expanding field.

Trying to advance the agenda for pancreatic cancer has always been a huge challenge but we
are living in exciting times for cancer research as a whole. Although the numerous hurdles
hindering the understanding, diagnosis and treatment of pancreatic cancer seem as daunting
as ever, one by one these are now being dismantled. This has only been possible by bringing
together large multi disciplinary teams of world class scientists and clinicians in comprehen
sive cancer centres and specific centres of pancreas cancer excellence.
DNA sequencing has shown that pancreatic cancer has just over 1,000 somatic mutations
involving 12 critical pathways: apoptosis, DNA damage control, regulation of the G1/S transi
tion, Hedgehog signalling, homophilic cell adhesion, integrin signalling, c Jun N terminal
kinase signalling, KRAS signalling, other small GTPase dependent signalling, regulation of
invasion, TGFβ signalling and Wnt/Notch signalling. What is interesting is that there are
a similar number of genetic mutations in breast cancer involving the identical number of
pathways. Or at least that is how the vast amount of accumulated molecular data is perceived.
How can two human cancers appear so similar at the genetic level yet behave so differently in
the clinic? A few percent of patients with pancreatic cancer make it to five years and most are
dead well within the year. What shocks so much in pancreatic cancer is the unerring predict
ability of the time of death.
Yet there is now some real hope emerging. Even a few years ago it seemed unthinkable that
we could detect early pre invasive pancreatic cancer. Yet now, pancreas units all over the world
are resecting an increasing proportion of intraductal papillary mucinous neoplasms, often
with the welcome ‘no invasion seen’ in the histopathology report. Pancreas cancer resection
was once infrequently performed partly because of the technical difficulty and partly because
there was a fearsome post operative mortality rate (30 40%). Today, pancreas resection can be
performed in 20% or so of pancreas cancer patients with localized disease with a very low
mortality rate and producing a five year survival rate that readily exceeds 20% with adjuvant
therapy. There is some evidence that we can also improve survival even in advanced pancreatic
cancer. Moreover there is increasing optimism for successful novel therapies with over 200
therapeutic clinical trials underway, many using agents based on the concepts of the new biology.
Emulating the successes made in breast cancer over the past 30 years may still seem a long
way off except it is important to recall that mortality then for breast cancer exceeded 50% at
five years compared to an 80% ten year survival today. The clues as to why there is the gap
between pancreas cancer and other tumour types are contained within these pages.
The contributors have been put together as much for their style of thinking as well as
representing the best there is in their own areas of expertise. The outcome of this collective
endeavour is that it has met and exceeded expectations and much more importantly with
added value throughout.
This kind of labour becomes dated as soon as the keyboards are hit but by its very nature
and quality is invaluable for all those involved in any aspect of pancreatic cancer.