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Medical Edge Newspaper Column from Mayo Clinic
ABLATION THERAPY NOT A PROMISING TREATMENT FOR PANCREATIC CANCER
DEAR MAYO CLINIC: I have a very close friend with pancreatic cancer.
Has anyone considered ablation techniques to subdue or reduce tumors,
either exocrine or endocrine, on the pancreas? She seems like a likely
candidate for this procedure. — Lynden, Wash.
ANSWER: Before I answer your question about ablation therapy, I’d
like to offer some background information on the pancreas and the types
of cancer that can affect it.
The pancreas is an organ about six inches long that stretches across the
back of the abdomen, behind the stomach. It makes pancreatic juices that
help digest food in the small intestine, and it makes insulin, which controls
the amount of sugar in the blood. The pancreas is a “compound” gland —
it’s composed of both exocrine and endocrine tissues. The exocrine function
of the pancreas involves the synthesis and secretion of pancreatic juices.
The endocrine function is to produce insulin in the islet cells.
There are many types of pancreatic cancers. Exocrine and endocrine tumors
are broad categories with many subtypes. For example, pancreatic ductal
adenocarcinoma is a lethal form of exocrine cancer. The endocrine cancers
have a much better outcome, despite the fact that they may spread to the
liver. Without knowing your friend’s exact diagnosis, it’s difficult for
me to provide detailed information on treatment options.
However, I can give you some facts about ablation therapy, in which tumors
are destroyed by various means, including heat, cold or chemicals. The
goal is to make the tumors smaller or, less commonly, to eliminate them.
The primary pancreatic tumor — be it endocrine or exocrine — is not treated
with ablation therapy, mainly because doing so can cause pancreatitis,
a potentially life-threatening inflammation of the pancreas.
In addition, it is unlikely that reducing the size of the tumor — the
main endpoint for ablation therapy — will improve outcomes in patients
who have exocrine cancer such as ductal adenocarcinoma. Even after all
visible portions of this cancer are surgically removed, it frequently
recurs. Attempts are being made to inject biologic agents into the tumor
for local action, but these are still experimental. Our hope is that future
technologies will prove effective.
Consequently, ablation therapy for pancreatic cancers is restricted to
the treatment of liver metastases from islet cell cancers. This therapy
can be effective in keeping this type of tumor at bay, sometimes for years.
However, ablation therapy is ineffective in managing liver metastases
from ductal adenocarcinoma .
— Suresh Chari, M.D., Gastroenterology and Hepatology, Mayo Clinic, Rochester,
Minn.
Additional Resources:
Treatment
of Pancreatic Cancer
Appointment
Information
More
Information on Pancreatic Cancer
READERS: New research shows that the risk of injury to patients
who suffer from epileptic seizures is low.
This information is helpful not just for the people diagnosed with epilepsy,
but to their family members, teachers and employers. If the epilepsy is
well controlled and there is no evidence to suggest extra caution is required,
most epilepsy patients are able to work and carry out daily activities
without undue risk of injury.
Most previous studies of seizure injury rate examined patients treated
for poorly controlled epilepsy. They cited injury risk rates as high as
one in three patients. This new study examined all patients — not just
those in a high-risk environment, such as an emergency room.
The two most common types of seizures that cause injuries are generalized
convulsive seizures caused by an abnormality affecting most or the entire
brain, and atonic seizures, which interfere with a patient’s muscle tone.
These types of seizures can cause injuries from falls or from loss of
consciousness. Complex partial seizures, in which only part of the brain
is affected, can lead to injury by interfering with a person’s awareness
or behavior, without any fall. Injuries from loss of awareness might include
drowning, burns and motor vehicle accidents.
Additional Resources:
Treatment of Epilepsy
Appointment
Information
More Information
on Epilepsy
News Release
on Epileptic Seizures and Injury
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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