Pancreatic cancer 4th most deadly, treatments few

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FILE - In this Jan. 6, 2004 file photo, Apple CEO Steve Jobs displays the iPod mini at the Macworld Conference and Expo in San Francisco. Jobs, the Apple founder and former CEO who invented and masterfully marketed ever-sleeker gadgets that transformed everyday technology, from the personal computer to the iPod and iPhone, died Wednesday. He was 56. (AP Photo/Marcio Jose Sanchez, File) FILE - In this Jan. 6, 2004 file photo, Apple CEO Steve Jobs displays the iPod mini at the Macworld Conference and Expo in San Francisco. Jobs, the Apple founder and former CEO who invented and masterfully marketed ever-sleeker gadgets that transformed everyday technology, from the personal computer to the iPod and iPhone, died Wednesday. He was 56. (AP Photo/Marcio Jose Sanchez, File) FILE - In this April 24, 2009 file photo, Dr. Ralph Steinman of Rockefeller University speaks during a news conference in Albany, N.Y. Rockefeller University in New York says Ralph Steinman, co-winner of this year's Nobel Prize in medicine, has died. The university says Steinman was diagnosed with pancreatic cancer four years ago and died on Sept. 30, three days before the announcement. (AP Photo/Mike Groll, File) FILE - In this Jan. 15, 2008, file photo, Apple CEO Steve Jobs holds up the new MacBook Air after giving the keynote address at the Apple MacWorld Conference in San Francisco. Apple on Wednesday, Oct. 5, 2011 said Jobs has died. He was 56. (AP Photo/Jeff Chiu, File) Fred Velez, of San Francisco, holds an Apple iPhone displaying an early picture of Steve Jobs, as he and others gather outside an Apple store in San Francisco on Wednesday, Oct. 5, 2011. Jobs, the Apple founder and former CEO who invented and masterfully marketed ever-sleeker gadgets that transformed everyday technology, from the personal computer to the iPod and iPhone, died Wednesday. He was 56. Apple announced his death without giving a specific cause. He died peacefully, according to a statement from family members who said they were present. (AP Photo/Darryl Bush)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); Pancreatic cancer is notoriously lethal — there are almost as many deaths from it each year as there are new cases. The deaths this week of Apple founder Steve Jobs and Nobelist Ralph Steinman bring unusual attention to this less-well-known type of cancer.

Jobs lived more than seven years after being diagnosed with a neuroendocrine tumor — a less common, slower-growing and more treatable type of pancreatic cancer than the kind that killed Steinman a week ago and actor Patrick Swayze two years ago.

The Apple chief kept details of his illness behind a firewall and declared he was cured after cancer surgery in 2004. However, five years later, gaunt and having lost a lot of weight, Jobs had a liver transplant. Experts said it was likely because his cancer had returned or spread.

A liver transplant sometimes can cure the type of cancer that Jobs had. But if it comes back, "it's usually in one to two years," said Dr. Michael Pishvaian of Georgetown University's Lombardi Comprehensive Cancer Center.

In January, Jobs announced his third and final leave of absence. He resigned in August and died on Wednesday.

Part of what makes pancreatic cancer so deadly is that the pancreas is as vital as the heart. You can live with just part of a liver or a colon, or only one kidney or lung. But the pancreas is a fish-shaped organ that makes digestive enzymes and insulin and other hormones that enable the body to make energy from food.

In the United States, pancreatic cancer is the fourth leading cause of cancer deaths. About 44,030 people will be diagnosed with it and about 37,660 people will die of it this year in the U.S., the American Cancer Society estimates.

Over the past 15 to 25 years, rates of pancreatic cancer have dropped slightly, possibly because of a decline in smoking, the cancer society says. However, cases have been rising since around 2002 and rose about 1 percent per year over the period 1998 to 2007, said the cancer society's deputy chief medical officer, Dr. Len Lichtenfeld.

Possible symptoms are fatigue, back pain, abdominal pain, unexplained weight loss, loss of appetite, jaundice and nausea, according to the Lustgarten Foundation, a private group that finances research on the disease.

This cancer often is not found until it is advanced or has spread, and overall survival is dismal: 20 percent after one year and only 4 percent after five years.

However, with a neuroendocrine tumor like the one Jobs had, "people can live a longer time; median survival is five to eight years," said Dr. Alan Venook, a pancreatic cancer specialist at the University of California, San Francisco.

The lifetime risk of developing pancreatic cancer is about 1 in 71, according to the cancer society. Men and blacks account for more cases than women and whites, possibly because of differences in smoking rates. Smokers have two to three times more risk of developing the disease. Use of smokeless tobacco also raises the risk.

Obese people, those who don't exercise much and diabetics also have more risk for pancreatic cancer. Alcohol use might play a role: Most studies haven't tied it to pancreatic cancer, but heavy drinking can lead to diabetes and liver and pancreas problems that pose a cancer risk, the cancer society says.

The best hope for a patient is that the tumor is operable. That was the case in February 2009, when U.S. Supreme Court Justice Ruth Bader Ginsburg had a small, early-stage pancreatic tumor removed at New York's Memorial Sloan-Kettering Cancer Center.

On the horizon are immune system treatments — research that Steinman, the Nobel recipient from Rockefeller University in New York, was studying in the lab and trying on his own pancreatic cancer.

The immune system has a hard time recognizing and fighting cancer because the enemy is not an invading germ but our own cells gone rogue. Treatments called therapeutic cancer vaccines are ways to modify cells to help the immune system recognize the risk.

One such vaccine by NewLink Genetics, a small biotech firm in Ames, Iowa, is in late-stage testing now for pancreatic cancer. The company website says the larger study was initiated after a mid-stage test suggested improvement in survival.

Dr. Roderich Schwarz, chief of surgical oncology at the University of Texas Southwestern Medical Center in Dallas, has enrolled a few patients in some immune therapy studies, which have not paid off in the past.

"Vaccines are coming along," and last year's approval of one for advanced prostate cancer suggests researchers may be learning to overcome some of the drawbacks of the past, he said.

"It's quite possible that vaccines will claim their territory in the treatment of these challenging tumors," Schwarz said. "It's still in the development stage rather than the proven stage."

___

Online:

Cancer Institute: http://www.cancer.gov/cancertopics/types/pancreatic

Cancer Society: http://www.cancer.org/Cancer/PancreaticCancer/index

Survival rates: http://bit.ly/oAxKl5

Research and support: www.curePC.org and www.lustgarten.org

Vaccine study: http://www.linkp.com/products/hyperacute-pancreas.html

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Stem cell treatments abroad

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Indianapolis Colts quarterback Peyton Manning reportedly flew abroad for stem cell treatment for a chronic neck injury.Colts quarterback Peyton Manning reportedly sought a stem cell therapy in EuropeMedical tourism as an industry is projected to grow 35% annuallyExperts say it's dangerous to try treatments that haven't been approved and regulated

(CNN) -- There's great potential in the field of regenerative medicine, but doctors caution against seeking experimental treatments in an unregulated environment.

Having had three surgeries for a neck injury already, Indianapolis Colts quarterback Peyton Manning reportedly took a private jet to Europe to get a stem cell treatment that is not approved in the United States. The therapy involved injecting fat cells from Manning's body into his neck, according to Fox Sports.

Colts head coach Jim Caldwell declined to discuss Manning's health situation when asked about the stem cell treatment at a press conference Monday. Further details of Manning's treatment are not available.

Discussing the choice to go abroad for stem cell treatments puts researchers in an awkward position, because the therapies offered abroad are unregulated and not confirmed to work, but they are based on concepts that the American medical community believes have potential. Generally, however, the consensus is that patients should not try to seek experimental stem cell treatments elsewhere, as there's no telling if they will work or have serious side effects.

"We believe that there is merit to this approach, we just want to see it (carried out) well, ethically and rigorously," said Dr. Joshua Hare, director of the Interdisciplinary Stem Cell Institute at the University of Miami's Miller School of Medicine. Scientists like Hare are trying to gather medical evidence through clinical trials to ensure that these treatments are safe and effective.

Leaving the country to seek experimental treatments abroad is common, experts say, although no one has exact numbers for how many people seek stem cell treatments in other countries. Medical tourism as an industry is projected to grow 35% annually, and could reach 1.6 million American patients going elsewhere for treatments by 2012, according to the Deloitte Center for Health Solutions. (The agency had previously predicted 6 million by 2010, but those numbers have not panned out.)

Besides orthopedic injuries like Manning's, there are stem cell therapies available elsewhere aimed at heart disease and neurological conditions, even autism. Germany, Panama and Thailand are all popular countries for seeking these kinds of treatments, Hare said.

The basic idea is that stem cells have regenerative potential, and can even form new tissues. Mesenchymal stem cells are a particular kind that can become a variety of cell types, including bone cells and cartilage cells.

While there is a lot of exciting research going on in the field of stem cells, the results aren't all good. A 2009 study in the journal PLoS Medicine documented the case of an Israeli boy who had gone to Russia to get fetal stem cells injected into his brain and spinal cord. He developed a brain tumor, apparently as a result of the treatment, although the tumor was slow-growing and benign.

And earlier this year, authorities closed down a large stem cell clinic in Germany called the XCell-Center, which had operated through a loophole in the country's regulations regarding unapproved experimental treatments. The clinic had been implicated in the death of an 18-month-old boy after a stem cell treatment; a 10-year-old almost died after receiving something similar.

One problem with going abroad for these unapproved treatments is that there's no follow-up; you won't have anyone back home to take care of any complications that might result, Hare said. In cardiac stem cell trials conducted in this country in people with advanced heart disease, medical professionals do follow up with patients and treat any complications that may arise.

Another concern is that, without proper regulation, any given stem cell therapy abroad may actually be different every time you receive a treatment, said Jeffrey Karp, director of the Laboratory for Advanced Biomaterials and Stem-Cell-Based Therapeutics at Brigham & Women's Hospital in Cambridge, Massachusetts.

There also may not be any regulations on the quality of the treatment, so you really don't know what you're getting, he said.

"Regulatory agencies such as the FDA can ensure that cell therapy that reaches patients is safe, effective, and that quality control is established for isolating the cells, manipulating them outside of the body, and delivering them," Karp said.

A lot of parents believe that stem cell therapies could help their children with autism, although there haven't been any clinical trials in the U.S. to substantiate this, Hare said. In orthopedics and cardiology, on the other hand, there are ongoing investigations; someone like Manning could have potentially joined a clinical trial instead of going abroad, although there's no guarantee that he would have received the treatment rather than a placebo.

The idea of placebo also comes into play here, as with any therapy -- sometimes, just believing strongly that a treatment will heal you actually does change your body, even if that "treatment" isn't actually doing anything.

But there are still significant risks from anything that's unregulated, Karp said.

"While stem cell treatments have been shown to have significant placebo effects during controlled clinical trials, I think patients considering unregulated stem cell treatments need to be aware that they are not optimized and may even do harm," he said.

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