There is a new solution for children with sleep apnea and bedwetting. Some professionals say that removing a child’s tonsils or adenoids can stop bedwetting among young sleep apnea sufferers.

In a recent study, researchers closely observed four hundred kids with the condition for a year after surgery. they said that half of the participants had sleep apnea and were bedwetters. However, they stopped wetting their bed after their tonsils were removed.

While this indicates that bedwetting and sleep apnea are linked, this needs further research and studies to solidify the relationship.

[EurekAlert press release] — Researchers have demonstrated the effectiveness of a novel treatment that stimulates the nerve that controls the diaphragm to normalize the breathing of patients who suffer from both heart failure and central sleep apnea.

“Many heart failure patients suffer from central sleep apnea, which a number of studies have shown increases mortality in these patients,” said Shahrokh Javaheri, MD, professor emeritus of medicine at the University of Cincinnati and medical director of Sleepcare Diagnostics in Mason, Ohio.

Systolic heart failure describes a medical condition in which the heart no longer pumps blood strongly enough to meet the body’s needs. according to the American Heart Association, the number of Americans living with heart failure is estimated at 5.8 million—a number that is expected to grow as people live longer and the population ages. Heart failure is also the leading cause of hospitalization among Medicare patients

Dr. Javaheri and his colleagues will present the results of their study, “Single Night Transvenous Nerve Stimulation Improves Central Sleep Apnea in Systolic Heart Failure Patients,” during the ATS 2011 International Conference, in Denver.

In this study, Dr. Javaheri and his colleagues conducted an acute, prospective investigation of 16 patients with a mean age of 59 and a mean body mass index of 27 kg/mk2. All 16 patients were diagnosed with heart failure (mean left ventricular ejection fraction of 30 percent) and central sleep apnea.

The patients served as their own control group, receiving on one night phrenic nerve stimulation and no therapeutic intervention on another. the intervention, which acts like a pacemaker for the nerve, dramatically reduced the number of times patients stopped, or almost stopped, breathing; improved blood oxygenation levels while sleeping; and resulted in a healthier heart rate.

Compared to the control night, phrenic nerve stimulation resulted in the virtual elimination of central sleep apnea as measured by the central apnea Index (25 ± 14 vs. 3 ± 4/hour, p ?0.001). there was a significant decrease in the apnea-hypopnea index (47 ± 12 vs. 24 ±15/hour, p=0.002) and in the associated arousal index (32 ±12 vs. 16 ±10/hour, p=0.001) and in the reduced number of times the patient experienced 4 percent oxygen desaturation (31 ± 11 vs. 16 ± 12/hour, p=0.002). Overnight sleep heart rate decreased significantly (73.3 ± 17.1 vs. 71.1 ± 16.3 bpm, p=0.002).

The current best treatment for these patients is Continuous Positive Airway Pressure (CPAP). In about half of all patients, CPAP suppresses central sleep apnea and improves cardiovascular health and mortality, according to Dr. Javaheri. However, even among those patients that could be helped by CPAP, many cannot tolerate sleeping an entire night with a nasal mask, so the percentage of patients helped by CPAP is considerably lower.

“our research suggests,” said Dr. Javaheri, “that there is a new therapy—one that, unlike CPAP and other existing mask-based therapies, could be tolerated by all patients.”

Dr. Javaheri added that a randomized clinical trial is now needed to determine the clinical implications on long-term phrenic nerve stimulation on morbidity and mortality of heart failure patients with central sleep apnea.

“Single Night Transvenous Phrenic Nerve Stimulation Improves Central Sleep Apnoea in Systolic Heart Failure” (B29, Monday, May 16, 8:15-10:45 a.m., Room 403-404 (Street Level), Colorado Convention Center; Abstract 22748)

* please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.

Snoring, morning fatigue, and afternoon naps. Don’t take these things lightly—they’re some of the many symptoms of sleep apnea.

This medical disorder causes the sufferer to stop breathing during his/her sleep, which leads to a general lack of rest. it can also lead to heart attacks, obesity, and headaches.

The condition is common among middle-aged men and post-menopausal women, which is attributed—by some experts—to the changes in sleep patterns that aging brings. Compared to younger people, older individuals tend to sleep less and in more fragmented patterns.

In America, more than 12 million are affected by the condition, making it a serious health concern.

You can avoid sleep apnea by simply exercising a healthier lifestyle: eat right and avoid alcohol and nicotine. these things can ruin your body clock. the condition can also be cured by consistent treatments and some surgeries.

[PRWeb press release] — Dr. Jin Zhou, DC, is now accepting new patients with sleep apnea who is unable to tolerate CPAP or any device and/or failed to benefit from standard surgeries, with a possible conservative approach by ZHT (Zhou’s Hypoxicology Therapy), a natural therapy with seven year clinical observations. Sleep Apnea is a well-known deadly disease, if without proper clinical management, among increasing population. CPAP is the Gold Therapy for sleep apnea, in addition to standard surgeries, but a significant number of sleep apnea patients failed to tolerate or benefit from standard CPAP or any device, and/or standard surgeries. ZHT therapy may provide an alternative natural approach for those sleep apnea patients without any available choices or clinical results from standard medical treatment. as an alternative chiropractic care, ZHT is not covered by most health plans. ZHT therapy costs may range from about $200-$350 for the initial visit and $57 – $150 for the subsequent visits. ZHT Appointments are available to patients nationwide without any need for referral.

Only as an alternative to standard medical care from sleep specialists, ZHT therapy is expected to provide immediate relief on the first visit, and significant relief in three visits, for most cases, with increased uvulo-palato-pharyngeal space (opening of windpipe), better sleep and decreased snoring, or if not, the ZHT program is to be discontinued. ZHT includes supernatural breathing exercises and ZHT manual therapies. ZHT therapy is only initiated and continued with immediate noticeable clinical relief on the first visit and significant clinical relief in three visits. Depending upon the severity of sleep apnea and complicating medical conditions, ZHT therapy may be completed in one week to three months.

ZHT Therapy may benefit obstructive sleep apnea (OSA) and central apnea (CA), as well as complex sleep apnea (OSA & CA).

ZHT was developed seven years ago and now available nationwide. Since sleep medicine industry Journal, Sleep Review, the Journal for Sleep Specialists, reported ZHT on August 10, 2006, Dr. Jin Zhou, DC, has significantly improved and refined ZHT therapy with intriguing anecdotal clinical observations. ZHT is neither a standard mainstream medical therapy nor a cure for sleep apnea.

“never claim for cure for any modern medical diagnosis, a natural solution with mother nature human body functions will be the most powerful protections against sleep apnea,” Dr. Zhou, the Inventor of Zhou’s Hypoxicology Therapy (ZHT), who coined the word, “Hypoxicology”.

In developing the new ZHT (Zhou’s Hypoxicology Therapy) alternatives for sleep apnea, Dr. Zhou, observed clinically that trachea caudal displacement (TCD) (the windpipe moving downward), resulted from diaphragm malfunction and baroreflex dysfunction, instead of weakened soft appellate as claimed by the mainstream scientists, is the main anatomical pathology for snoring, collapse of the upper airway and frequent breathing stops during the night for people with obstructive sleep apnea. In addition, as Dr. Zhou hypothesized, the dysfunction of the baroreflex, chemoreflex, metabo-reflex, mechanoreflex, psychosomato-reflex and respiration pace-making malfunction, due to psychological, environmental and anatomical causations, are primarily and intricately responsible for the obstructive and central sleep apnea development. Dr. Zhou further hypothesized that all of these sleep apnea etiological components are primarily controlled or regulated internally by the human body but induced externally. therefore, sleep apnea should be completely reversible primarily through volitional resuscitation, resetting of the baroreflex and revitalization of the upper airway defense reflex by working through patient’s body internally instead of externally through surgeries and devices.

ZHT breathing exercises and manual therapy are developed based on Eastern philosophy with acupuncture holistic health concept, and modern anatomy and physiology as well as latest worldwide scientific research on sleep apnea.

sleepapneausa.net/ZHT_Science.htm

Clinically, most ZHT patients may have been usually treated with sleep specialists and may have failed to tolerate or benefit from standard CPAP device or UPPP surgery, or a patient with possible sleep apnea will be referred to a sleep specialist for sleep study, diagnosis and management. as an alternative to those without any conventional options, ZHT therapy employs unique breathing and reflex exercises in conjunction with chiropractic manual and therapeutic exercises to reset baroreflex and functional fitness of upper airway. ZHT is simple, natural and quick for clinical results. the patient is the only judge for the clinical merits, based on the clinical outcome with better breathing, sleep and less snoring as well as relief for sleep apnea related symptoms, such as headaches, fatigue, arthritis, low back pain, sciatica, fatigue, depression, anxiety, fibromyalgia, arthritis and countless sleep apnea related medical conditions.

A Google Web search with words “apnea” + “your symptoms or diagnosis” will show the connection between sleep apnea and your medical condition, according to Dr. Zhou.

Dr. Jin Zhou, D.C. has been a licensed chiropractic physician in Hanover Park, IL since 1991. He was a former orthopedic surgeon at China Air Force General Hospital in Beijing, China 23 years ago. Dr. Zhou is dedicated to developing a revolutionary breakthrough, an extremely simple and super natural therapy that could potentially save millions of lives and trillions of dollars without having to rely upon only medication, surgery and device. He coined the new word, “Hypoxicology”.

For more scientific information on ZHT, please visit SleepapneaUSA.net, or contact Dr. Jin Zhou at 630-808-7237.

For more clinical information and an appointment, please visit PainUSA.com, or contact Dr. Jin Zhou at 630-736-1646.

[EurekAlert press release] — In the largest study of it kind to establish a link between sleep and diabetes, researchers found that people with diabetes who sleep poorly have higher insulin resistance, and a harder time controlling the disease.

The findings, published in the June issue of Diabetes Care, suggest that poor sleep may contribute to worse outcomes in people with diabetes.

“Poor sleep quality in people with diabetes was associated with worse control of their blood glucose levels,” said Kristen Knutson, PhD, assistant professor of medicine and lead author of the study. “People who have a hard time controlling their blood glucose levels have a greater risk of complications. they have a reduced quality of life. And, they have a reduced life expectancy.”

People with diabetes generally have poorer sleep than the general population, and poor sleep has been proposed as a risk factor for developing the disease. Sleep disorders, such as obstructive sleep apnea, are more prevalent in people with type 2 diabetes, Knutson said.

For the study, researchers monitored the sleep of 40 people with diabetes for six nights. the subjects also reported if they generally suffered from symptoms of sleep disturbances like insomnia, snoring or sleep apnea. at clinical examinations, they gave blood samples to allow researchers to measure insulin and glucose levels.

The subjects wore activity monitors on their wrists at night, which measure their wrist movements throughout the night. Poor sleep, or insomnia, was determined by both poor sleep quality based on the activity monitors and the subject telling the researchers that they often had a hard time falling asleep or woke up during the night.

Among the diabetics, poor sleepers had 23% higher blood glucose levels in the morning, and 48% higher blood insulin levels. using these numbers to estimate a person’s insulin resistance, the researchers found that poor sleepers with diabetes had 82% higher insulin resistance than normal sleepers with diabetes.

Knutson said the next step for researchers is to see if treating poor sleep can improve long-term outcomes and quality of life for diabetics. “For someone who already has diabetes, adding a sleep treatment intervention, whether it’s treating sleep apnea or treating insomnia, may be an additional help for them to control their disease,” Knutson said.

In fact, restoring a healthy amount of sleep may be as powerful an intervention as the drugs currently used to treat type 2 diabetes. “this suggests that improving sleep quality in diabetics would have a similar beneficial effect as the most commonly used anti-diabetes drugs,” said Eve Van Cauter, PhD, professor of medicine and co-author of the study.

Further investigation into which leads to the other – the chronic poor sleep or chronic insulin resistance – could improve the quality of life for people with type 2 diabetes. “Anything that we can do to help people improve their ability to control their glucose will help their lives in the long run,” Knutson said.

The data was collected as part of the CARDIA study, an ongoing longitudinal study of the heart health. it has tracked thousands of people for over 20 years.

The study, “Cross-sectional associations between measure of sleep and markers of glucose metabolism among persons with and without diabetes” was published online March 16, 2011, in the journal Diabetes Care and is freely available. In addition to Drs. Knutson and Van Cauter, authors include Phyllis Zee and Kiang Liu at Northwestern University, and Diane Lauderdale at the University of Chicago Department of Health Studies.

The research was funded by a grant from the National Institute on Aging at the U.S. National Institutes of Health. the CARDIA study is supported by the National Heart, Lung, and Blood Institute.

Royal Philips Electronics will be displaying its new sleep diagnostics and therapy solutions in the eight edition of the Otolaryngology Exhibition Conference at Madinat Jumeirah, Dubai.

“There are a number of potential causes for a disturbed night’s sleep,” explained Diederik Zeven, general manager of Philips Healthcare in the Middle East. “These include sleep disorders such as obstructive sleep apnea (OSA), which affects approximately four per cent of the adult population.”

Zeven added: “It’s a disorder characterized by airway collapse behind the tongue during sleep, which obstructs breathing. if untreated, it can contribute to the development of high blood pressure, diabetes, heart attacks, and strokes.”

The company has developed an innovative collection of sleep products, including diagnostic tools and therapy devices.

During the conference, Philips will also be conducting sleep therapy solutions and demonstrating how its tools and products work.

Don’t take snoring lightly. it may just be an indicator of a more serious health problem, sleep apnea.

Dr. Charles Hawkins of the Zanesville Dental Sleep Medicine Center says that snoring and sleep apnea are sometimes related.

“What happens is the body feels itself starting to choke because you stop breathing,” says Dr. Hawkins. “Your oxygen level actually drops in your blood; the body picks that up and associates it with choking.”

To solve the problem, the doctor recommends using a device, which allows the sufferer to breath more easily. Hawkins explains: “It’s actually something like CPR. it opens up the airway by bringing the lower jaw forward. now we can’t fit this device until you have a sleep test and get diagnosed with sleep apnea or snoring.”

Studies have proven that if sleep apnea is left untreated, it can result in cardiovascular complications, obesity, and even stroke.

The Irish Times – Monday, January 24, 2011

CERVICAL CANCER is one of the leading causes of early mortality among Irish women under 44, with more than 90 lives lost every year.

It is a cancer that takes a long time to develop and often has no symptoms until it is at an advanced stage. Regular screening can therefore save lives by detecting abnormalities early on.

This was the main message delivered at the launch of European Cervical Cancer Prevention Week in Dublin yesterday. during the coming week, women will be urged to avail of free screening from a registered GP or family planning clinic of their choice.

The campaign is being promoted by the Irish Family planning Association (IFPA) with the support of broadcaster Maura Derrane; CervicalCheck, the national cervical screening programme, and the Irish Hairdresser Federation.

Launching the awareness campaign, IFPA medical director Dr Caitríona Henchion said: “Cervical cancer is unique because we know how to prevent it. Now that Ireland has a free cervical screening programme in place and a school-based vaccination programme, we are in a position to almost eliminate cervical cancer in a generation.

“With access to these prevention strategies, the vast majority of girls growing up today can look forward to a cervical cancer-free future.”

Malignant Neoplasm is the other name for Cancer.. Spreading of uncontrolled growth of cells of the body from one part to another or invade in adjacent tissues. this makes more dangerous by metastasis.Most important is diagnosis of cancer at an early stage. Treatment becomes difficult when at later stages and is easy and cure during at early stage. High mortality and morbidity rates, one of the most dreaded disease.

Different categories of cancer are carcinoma,Sarcoma, Leukemia and Lymphome. Malignant growth of elithelial cells is the Carcinoma. Oesophagus, colon, nose, prostrate, urinary bladder, ureter etc are the body parts which are affected. the symptoms of this depends on the parts which are affected. for example, in case of the esophageal carcinoma, the main symptoms are weight loss and dysphagia.

This type of tumour which arise in bone, muscle, fat, fibrous tissue or cartilage is Sarcoma. Pain, fever and sweeling are the common symptoms of Sarcoma.the common types of sarcomas are Kaposi’s sarcoma & Ewing sarcoma.

Cancer in blood is leukemia. In this, there is over-production of abnormal blood cells especially white blood cells. Normal functioning is not possible. the common symptoms of leukemia are fever, chills, weakness, loss of appetite, weight loss, petechiae under skin, bleeding gums, bone pain, sweating at night etc.

Lymphoma is the cancer of lymphatic system which acts as the filter system of the body. Common type of Lymphoma is the Hodgkin’s disease.Fever,night sweats,painless swelling of lymph nodes, itching of skin, constant fatigue, weight loss, red patches on skin etc are the symptoms.

On the body parts, breast cancer, colon cancer, lung cancer and prostrate cancer are the common cancers. In the age group of 45-55, breast cancer is more common in females than males. Diagnosis is generally made on the breast or nipple which affects the shape, color or texture.When it is noticed, physician should be contacted immediately. the other common symptoms are itching, increases sensitivity, burning, pain etc in the breast.

When there is bleeding from the rectum is mainly suspected as colon cancer. Indication of color of blood, position of the tumor in the colon.There may be a change in the bowel habits like heavy diarrhoea or constipation. other symptoms include fatigue, weakness, loss of appetite & weight, vomiting, nausea, morning sickness, pain in rectum etc.

Then comes the Lung cancer,it is more common in males.the high risk factor of this is cigarette smoking. Lung cancer symptoms are cough, bleeding with cough, pain in chest, difficulty in breathing, loss of weight, fatigue, hoarseness or loss of voice, respiratory infection like bronchitis, swelling of fingertips etc. Metastasis is very common in case of lung cancer. the parts which are more effected are bones, liver, adrenal gland etc.

Know more about cancer symptoms and lip cancer symptoms.

Pancreatic Cancer Symptoms, Diagnosis and Treatment The cancer of the pancreas or carcinoma is a pancreatic cancer tract. the tumors of neuroendocrine pancreas are another type of cancer, whose presentation is radically different. they are presented in the article neuroendocrine tumor.

Incidence and mortality of pancreatic cancer rate for 100 000 people

Impact

Mortality

CountryHFHFFinland13,09,912,8 Sweden9,8 Switzerland11,37,611,87,8 European Union9,76,510,77,3 France8,04,2 Luxembourg8,3 Portugal4,9It affects slightly more often men than women with incidence increasing with age (peak incidence at 75 years for men, 80 years for women). in older ages the rate is high e.g. 65 and above, the pancreatic cancer in Geneva about 5% and 6.5% respectively of male and female patients with cancer (at the front for men from lung cancer with 22.4% and for women the breast cancer with 19.8%). Pancreatic cancer is responsible for 2500 deaths per year in France.

Risk factors:

Contributing factors are a known pancreatitis chronic (post-alcoholic, tropical, or as part of a cystic fibrosis) or smoking. the obesity is another risk factor.

Familial forms exist four but genes involved remain unknown.

Symptoms

The development of cancer at the pancreatic head (60-70% of cases) creates a barrier biliary responsible for a rapid expansion of the gallbladder, a jaundice (for retention bladder) and pruritus (itching) caused by jaundice.

If cancer develops in the tail of the pancreas (7%), the clinical picture is dominated by transfixing epigastric pain (radiating to the loin), accompanied by a mass epigastric.

Other signs of cancer are sometimes significant alteration in general health (asthenia, anorexia, and weight loss), high occlusion by compression or invasion of the stomach or duodenum, a hepatomegaly irregular secondary to metastatic liver.

Finally, the destruction of the pancreas can cause pancreatic insufficiency (malabsorption and diarrhea) and endocrine (diabetes).

Diagnosis

The diagnosis rests on biopsy, pancreatic or liver metastases. this biopsy can be performed by trans-dermal, during a fiber optic gastro-duodenal, or during surgery.

An assay of CEA and CA 19-9 may refer to an adenocarcinoma; hormonal assays may characterize an endocrine tumor.

Imaging

The ultrasound is the gold standard to visualize the pancreas, an organ located deep in the abdomen and the observance of which is hampered by the interposition of bowel gas. this review remains frequent first-line exploration of abdominal pain. it allows, through this, to discover a significant number of tumors of the pancreas. its sensitivity is 75% lower than the scanner5. a normal ultrasound does not eliminate pancreatic cancer.

The scanner with abdominal injection of contrast medium iodine remains the gold standard. it allows also better assessing the local extent and existence of metastases, particularly in the liver and thereby determining the operability.

The MRI has a sensitivity intermediate between the scanner and ultrasound.

The endoscopy may insert a tube into the duodenum until the emergence of the pancreatic duct. Injection at this level of contrast with radiography allows a CHOLANGIOPANCREATOGRAPHY. this examination may detect a narrowing occasionally to one of the channels, which may reflect a compressive tumor. this review, however, a low-level performance diagnosis. By coupling the endoscope with an ultrasound probe, gives an ultrasonography. this review has a very good sensitivity for detecting tumors, even small sizes7. this examination also allows directed biopsy.

The goal is to visualize the pancreatic tumor, and seek lymph node metastases, liver, or peritoneal. we also study the relationship with the portal vein.

Pancreatic cancer can take many different forms: – in 90% of cases, reached the head of the pancreas – 10% of cancer cases correspond to the body or tail of the pancreas.

The CA 19.9 marker is the most interesting, primarily in assessing the effectiveness of treatment (rate collapses) and the detection of recurrence (rate rises again). it is, cons, little used in routine screening, its elevation is not specific for pancreatic cancer.

The pancreatic adenocarcinoma histology may have several forms:

There are cystic tumors of the pancreas that can degenerate (cystadenocarcinoma) or tumors of the excretory ducts of the pancreas (IPMT).

Differential Diagnosis

There are cancers of the endocrine pancreas (very rare twenty times less common than exocrine), revealed by their hormonal secretion, thus giving: insulinoma, glucanome, VIPomas … Tumors, often very small, are difficult to locate and resect. An ampulloma (tumor of the ampulla of Vater) can give symptoms similar to adenocarcinoma of the head, but it is a tumor of the bile ducts, much better prognosis. Similarly the lower bile duct cholangiocarcinoma may be confused with pancreatic cancer. the prognosis is very bleak.

Classifications

1.       TNM classification (UICC 2002)

2.       T (tumor)

3.       Tx Insufficient information to classify the primary tumor

4.       T0 No evidence of primary tumor

5.       Tis Carcinoma in situ

6.       T1 Tumor limited to pancreas <2 cm in greatest diameter

7.       T2 Tumor limited to pancreas,> 2 cm in greatest diameter

8.       T3 Tumour extends directly to any of the following organs: duodenum, bile duct, peripancreatic tissue.

9.       T4 Tumour extends directly to any of the following organs: stomach, spleen, colon, adjacent large vessels

N (Regional Lymph Nodes)

10.   Nx Insufficient information to classify the regional lymph nodes

11.   N0 No regional lymph node metastasis

12.   N1 Regional lymph node

13.   N1a invasion of a single node

14.   N1b Metastasis in multiple lymph

M (Distant metastasis)

15.   Mx Insufficient information to classify distant metastases

16.   M0 No distant metastasis

17.   M1 Presence of metastasis (s) remotely

Prognostic Factors

Pancreatic cancer is a tumor with very poor prognosis.

When the diagnosis of pancreatic cancer is increased, the chance of survival at 5 years is 1 to 4%. twenty percent of patients operated on are fully alive at 5 years. in contrast to patients unrespectable and metastatic median survival was 6 months and 5-year survival is zero.

Treatment

Given the poor prognosis, it is legitimate to consider aggressive treatment for patients in good general condition for which surgery is best possible. when the patient is inoperable (bad condition, lesion unrespectable metastases) the quality of life must be preserved as long as possible. Supportive cares were then predominant.

Therapeutic Approaches

Surgery

The surgery was the first-line treatment for a tumor not exceeding a certain size and with no metastasis or too intimate contact with the portal vein, but the location of this tumor because it is not easily accessible (many veins behind). moreover, recent protocols show an advantage to pursue a radio-chemotherapy pre-and postoperatively in selected cases. there section is possible only in 20% of cases. Loco regional relapse occurs, however, in 70 to 80% of cases. the surgical resection of the pancreatic head (cephalic duodeno-pancreatectomy) is heavy, due to venous reports, tracts, and bile. it may not be offered to a patient in good general condition, in the absence of respiratory or cardiac defect. for tumors of the tail of the pancreas, surgery is the reference spleno-pancreatic tail.

In the case where no curative surgery is possible, we prefer, if necessary, palliative surgery to treat the symptoms, allowing the flow of bile and food bowl:

Double bilio-digestive. These diversions are more often performed endo-scopically, with placement of stents and duodenal bile.

Radiotherapy or Chemo Radiotherapy

In cases of advanced tumor, the radio-chemotherapy is used either after surgery or in lieu thereof. Radiation therapy delivers 45-50 Gy in 5-6 weeks and is associated with 5-FU continuous low dose. Used after surgery, experiencing “adjuvant” radio chemotherapy allows a reduction in local recurrence but the gain in survival remains low. this strategy is controversial at present.

Chemotherapy

The chemotherapy is used mainly in the metastatic setting, in addition to symptomatic treatment (bypass surgery, nutrition, analgesics, psychological support). the products are mainly used gemcitabine9, and to a lesser extent, 5-FU, cisplatin andoxaliplatin.

In metastatic disease, the palliative effect is demonstrated for the combination of gemcitabine and 5-FU and cisplatin. in the adjuvant setting, that is to say after curative surgery, chemotherapy reduces the risk of recurrence or delaying it.

The chemotherapy protocols validated in pancreatic cancer are:

Gemcitabine

Cisplatin – sLV5FU2

GEMCEA

GemOx

Therapeutic strategies presented here are based on the repository of the French Federation of Digestive Oncology, 2005. Modes of treatment may vary from one country to another and from one region to another.

Resectable tumor

The small tumors in patients are able to withstand a surgical resection with curative intent. the standard treatment is surgery with curative type duodeno-cephalic pancreatectomy for tumors of the pancreas head and caudal spleno-pancreatectomy for tumors of the pancreatic tail. Adjuvant treatment depends on the quality of resection.

In case of complete resection with adequate margins (R0 resection), adjuvant chemotherapy include LV5FU2 for 6 months.

If microscopic incomplete resection (R1) or macroscopic (R2) will include either the adjuvant chemotherapy of 5FU-cisplatin type or gemcitabine for six months or a radio-chemotherapy.

Unresectable Tumor

If the tumor is not resectable at the outset but it is likely that treatment with radiotherapy or chemotherapy will reduce the tumor enough to make it operable, it is possible to begin treatment, said “neo-adjuvant ‘by a combination radio-chemotherapy (cisplatin with 5FU) and then reassess the operability of the lesion. in one third of cases, curative surgery may be prolonged, leading to a more prolonged survival10. If the lesion is permanently inoperable, there is a choice between chemotherapy alone, a combination radio-chemotherapy and chemotherapy followed by an association of radio-chemotherapy for patients whose tumors decreased under chemotherapy.

Metastatic tumor

1st line: 5FU-cisplatin or gencitabine 2e online: gencitabine, or 5FU-cisplatin GemOx according to the first line.

Author: Peter Norman

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