Talk:Pancreatic cancer/Archive 1

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Updated statistics

I have updated the statistics. Source: PanCAN - Pancreatic Cancer Facts for 2005 EricNau 04:57, 5 June 2006 (UTC)[reply]

Pancreatic cancer listed as fourth most deadly - but after what other 3?

Statistics vary a great deal across the world. Pancreatic cancer undoubtedly has the worst prognosis of all cancers, with the highest death rate. However, lung cancer causes the highest number of deaths of all cancers. Stomach cancer causes the second highest number of deaths in the world, colorectal cancer causes the third highest number. Qzm (talk) 10:26, 15 September 2009 (UTC)[reply]


"The prognosis is relatively poor but has improved; the three-year survival rate is now about thirty percent (according to the Washington University School of Medicine), but less than 5 percent of those diagnosed are still alive five years after diagnosis". The latter fact is correct and sourced. The former fact (30% after three years) is absolutely incorrect and is not properly sourced. Somebody should delete this because it's clearly incorrect -- this article correctly cites that the median survival is only 6 months from diagnosis, which is inconsistent with a 3 year/30% survival rate. —Preceding unsigned comment added by 24.235.171.6 (talk) 03:10, 21 December 2009 (UTC)[reply]

Awareness

I added the "Awareness" (or lack thereof) section. Feel free to add more! Pancreatic Cancer is definitely a cancer that deserves more attention. EricNau 05:17, 5 June 2006 (UTC)[reply]

The Awareness section currently has three (redundant) entries relating to celebrity deaths:

I will be condensing these three entries into one entry:

EricNau 04:33, 5 December 2006 (UTC)[reply]

I have removed the list of victims/patients. None of these are relevant to mention - none of them have famously suffered such as Michael J Fox is doing from Parkinson's or Ronald Reagan from Alzheimer's. I've put the list here in case we need to revisit this at some point.

That is no longer accurate as Randy Pausch and Patrick Swayze have finally put the human face on this horrific disease. Rms125a@hotmail.com (talk) 23:46, 6 September 2010 (UTC)[reply]
People diagnosed with pancreatic cancer (recovered to date)
  • Colin Friels, UK-born/Australian-based actor (husband of Judy Davis)
  • Ruth Bader Ginsburg, American jurist; second female Supreme Court justice of the United States
  • Marilyn Horne, American opera singer who was diagnosed in December 2005 (in remission)
  • Debbie Ryan, Head women's basketball coach, University of Virginia; diagnosed in 2000, currently in remission
Victims of pancreatic cancer (all deceased)

It is even worse when people are listed because they are the brother or sister of someone. JFW | T@lk 18:59, 11 June 2006 (UTC)[reply]

I feel this list contributes a great deal to the article, and at one point, would like to put it back. However, I agree that the list is "bloated" and needs to be trimmed down, but I am unsure on the best way to do this. It would be hard to define who is "worthy" of being on the list, which is probably why it grew to such an extent. What are your thoughts? EricNau 03:56, 14 June 2006 (UTC)[reply]

We've had this discussion on many pages. I am strongly of the view that unless the patient's disease is notable (e.g. Kylie Minogue and breast cancer, Michael J Fox and Parkinson's) there is more grounds for inclusion than when someone develops a condition after the fame has gone. Relatives of famous people should not be included unless these famous people then make this their cause and go on record for fundraising etc. In all events we should have reliable sources for each mention. Still, these lists add very little to the article in absolute terms. JFW | T@lk 07:31, 14 June 2006 (UTC)[reply]

List restored on 18 June 2006. The people involved may not be ""famous suffers"" of the disease, but it is informative to know who has what medical condition and helps raise the profile of the disease in question. Franz-kafka 18:24, 19 June 2006 (UTC)[reply]

An anonymous user deleted the entire list of victims for no reason, without discussion and without authorization.

List restored. 216.194.60.137 01:35, 25 May 2006 (UTC)[reply]

JFW is incredibly ignorant of pancreatic cancer. Because people die relatively quickly after diagnosis, they don't "suffer famously" in ways that are as overt as Michael J. Fox. Pancreatic patients simply don't live that long to get on TV and tug your heart strings. They're usually trying to find a chemo regimen that will give them some mroe time, or they're undergoing whipple surgery - and after THAT surgery, the last thing you're thinking of is ways to publicize your disease when you can't eat!
Because pancreatic cancer has THE highest mortality rate of any cancer, and because it gets almost no funding relative to other cancers, the list of famous people should be included in the article. There's apparently no way to get publicity for this disease, and certainly no way to get more money for it (PanCan being a "ladies who lunch" club which does approximately nothing to help anyone with pancreatic cancer.)
People who are ignorant of this disease should just STFU. —Preceding unsigned comment added by 68.36.127.193 (talk) 14:05, 10 October 2007 (UTC)[reply]

Predisposing factors: African-American ethnicity

Under predisposing factors, they list "African-American ethnicity" why "African-American" and not just "African"? I read the source which says "African Americans are 40% to 50% more likely to develop cancer of the pancreas than whites. This may be explained by smoking and diabetes in men and overweight in women.", and so it's not mulattos (specifically). They said African-Americans probably because the website is (US)American. There is no point in saying African-American just as it would be pointless to say African-European. --A Sunshade Lust 01:41, 1 July 2006 (UTC)[reply]

it says 'african-americans' because that's who was studied! pretty simple, huh? it is not appropriate to say 'africans' because no africans were studied. if the study had been conducted in africa, it would be incorrect to say african americans, but it wasn't.saying 'africans' in this instance would introduce other factors, which were not studied. i.e. various african diets, climate and who knows what else. what can be said is that one's chance of pancreatic ca is increased by being AFRICAN-AMERICAN.Toyokuni3 (talk) 03:25, 5 May 2008 (UTC)[reply]

doi:10.1111/j.1572-0241.2007.01202.x confirms this again. The same study gives other indicators as to which subgroups do better after surgery. JFW | T@lk 12:04, 24 June 2007 (UTC)[reply]

Incidence rates in Africa will be a lot lower, due to the fact that lives are much shorter, and incidence of the disease increases with age. Do people of African descent have a higher rate of pancreatic cancer when compared with whites in the same countries? We know it is true of the United States, but what about in the UK, France, Australia etc? Is the difference in incidence between races due to genetics or lifestyle? Qzm (talk) 10:26, 15 September 2009 (UTC)[reply]

Neuroendocrine prognosis

TH 03:47, 27 July 2006 (UTC)[reply]

I took out the several paragraphs that I put here by mistake.

TH 20:27, 10 October 2006 (UTC)[reply]

I really think we should put neuroendocrine pancreatic tumours on another page. They are different diseases, often benign and requiring different assessment and treatment altogether. JFW | T@lk 12:06, 24 June 2007 (UTC)[reply]

Genetic risk

doi:10.1111/j.1572-0241.2007.01475.x reviews genetic predisposition. JFW | T@lk 09:24, 12 August 2007 (UTC)[reply]

SNPedia shows these Single nucleotide polymorphisms as relevant

References section formatting problem

To whoever is watching this page, let me draw your attention to a problem in the reference list: there are numerous 'naked' URLs unintentionally visible (probably due to syntax problems in the source text). I apologize for not correcting this, but I cannot see how to edit the source text. The normal editing procedure that I am familiar with does not seem to work for this section. —Preceding unsigned comment added by Dwhutton (talk • contribs) 14:31, 1 November 2007 (UTC)[reply]

Improvements

Over the next week I'm planning to improve this article with the help of doi:10.1136/gut.2006.103333. This is an 18-page review with 236 references that surveys every aspect of pancreatic cancer, from molecular biology to diagnosis and therapeutics. I expect to be replacing a lot of news/website sources, although I will preserve the studies presently linked.

With regards to the risk factors, the Ghaneh review does not mention "gingivitis or periodontal disease", "diets high in meat", "occupational exposure" and "Helicobacter". Does anyone have references for these? Perhaps we ought to separate between causal links and mere associations (e.g. depression). JFW | T@lk 09:47, 23 August 2007 (UTC)[reply]

Not sure what "occupational exposure" means... H. pylori is an "association", though perhaps not quite a "risk factor" yet - see PMID 11416115, PMID 9428370, and PMID 12837831 (which covers N-nitroso compounds as a possible risk factor, which may be where the "diets high in meats" and "occupational exposure" comes from - though the authors are very clear that this is a hypothesis). And don't forget the well-recognized pathogenic role of Mycoplasma... :) MastCell Talk 16:54, 23 August 2007 (UTC)[reply]
Heh Mycoplasma.
Ghaneh does actuall mention diet, so that's sorted. Perhaps we should leave H. pylori out for the time being.
doi:10.1111/j.1365-2036.2007.03495.x seems to suggest that aspirin/NSAIDs probably do not confer protection, but that there was so much NSAID use in the American studies that it may have obscured an association. JFW | T@lk 21:01, 23 August 2007 (UTC)[reply]
Up to you. I'd be inclined to note the papers that have reported an association with H. pylori, but indicate that a causal relationship is unproven. Mostly to forestall another round of cancer-bacteria arguments. MastCell Talk 21:12, 23 August 2007 (UTC)[reply]

More risk factors

More on risk profile - smoking, family history etc doi:10.1111/j.1572-0241.2007.01510.x JFW | T@lk 21:40, 2 September 2007 (UTC)[reply]

a recent edit changed the risk increase form +75% to 'nearly double'. is going from a specific # to a term less specific an improvement?Toyokuni3 (talk) 15:25, 4 June 2008 (UTC)[reply]
doi:10.1111/j.1572-0241.2007.01475.x another review on genetic risk. JFW | T@lk 22:54, 5 November 2007 (UTC)[reply]

Fair use rationale for Image:PanCAN Ribbon.gif

Image:PanCAN Ribbon.gif is being used on this article. I notice the image page specifies that the image is being used under fair use but there is no explanation or rationale as to why its use in this Wikipedia article constitutes fair use. In addition to the boilerplate fair use template, you must also write out on the image description page a specific explanation or rationale for why using this image in each article is consistent with fair use.

Please go to the image description page and edit it to include a fair use rationale. Using one of the templates at Wikipedia:Fair use rationale guideline is an easy way to insure that your image is in compliance with Wikipedia policy, but remember that you must complete the template. Do not simply insert a blank template on an image page.

If there is other fair use media, consider checking that you have specified the fair use rationale on the other images used on this page. Note that any fair use images lacking such an explanation can be deleted one week after being tagged, as described on criteria for speedy deletion. If you have any questions please ask them at the Media copyright questions page. Thank you. BetacommandBot (talk) 16:37, 2 January 2008 (UTC)[reply]

Fine, let's leave it as it is. JFW | T@lk 07:21, 3 February 2008 (UTC)[reply]

Diabetes

About 40% of cases have diabetes, and much of those is recent-onset when temporarily related with diagnosis of pancreatic cancer. While most new diabetics do not have pancreatic cancer, it may prompt a noninvasive approach. Ca19-9 anyone? doi:10.1053/j.gastro.2007.10.040 JFW | T@lk 07:21, 3 February 2008 (UTC)[reply]

Alternative treatments

I got these comments from JFW as a motivation why he remved the studies on Ukrain:

"We have a good tradition on Wikipedia to avoid discussing phase II trials unless the results are headline-grabbing NEJM-publishingly shocking. Unless I missed this coverage, Ukrain is not quite of that calibre (otherwise Patrick Swayze would be receiving it?) Looking at your contributions to pancreatic cancer, you seem to devote a large amount of space to two very small trials with possibly interesting results that need replicating on larger studies before any guideline-producing or licensing body would dare considering a substance like Ukrain. Hope you understand. Let me know if you have any questions"

I definetely think the result of the studies on Ukrain and Pancreas Cancer are headline-grabbing and that Patrick Swayze should have Ukrain. 25% 5 year survival of Pancreatic Cancer is a lot more than a few percent. You do not need big trials to demonstrate effects when the effect is big. The research on Ukrain have been sabotaged for decennias by the establishment. I agree that less space can be devoted so i took away some sentences. I believe this information is vital in the sense that it literally can save libes out there. BTW Ukrain is already a licensed drug in many countries. —Preceding unsigned comment added by Jmstenborg (talk • contribs) 08:46, 10 April 2008 (UTC)[reply]

Well, Ukrain hasn't grabbed the headlines and Patrick Swayze is not reportedly receiving it. You can claim suppression and sabotage all you like, but at the moment your contribution is completely disproportionate to all other content on the page. In which countries is it licensed?
I feel Ukrain shouldn't be mentioned at all. Please provide evidence why it is so notable that it should be mentioned even though it is only in phase II trials and we presently don't mention any other drugs undergoing phase II trials on this page, for reasons I've given before. JFW | T@lk 13:55, 10 April 2008 (UTC)[reply]

There are really many things that has not grabbed the headlines, who in my opinion really deserves it, and many things who grabs headlines without deserving it. According to the manufacturer "NSC 631570=Ukrain was approved in Belarus (White Russia, 8.1.1995, reg. #1330/95), Ukraine (15.10.1998 and 3.9.2003, reg. #3641), Georgia (5.8.1999, reg. #002861), Turkmenistan (13.4.2000, reg. #0001707), Azerbaijan Republic (5.9.2000, reg. #00267), and Tadshikistan (7.9.2000, reg. #000568) (Information for physicians in Ukrainian and English). Recently, Ukrain has got the orphan drug status for the treatment of pancreatic cancer in Australia and in the United States of America.

I am myself a medical doctor, and gave it to my father, who suffered from a myelodysplastic syndrome. My father previously needed at least one blood transfusion each month and was getting worse. After one year of Ukrain administration he now got his most recent transfusion more thaan six months ago. If you consider a suspected ten fold increase in five year survival not to be interesting, I really wonder what you find more interesting? —Preceding unsigned comment added by Jmstenborg (talk • contribs) 18:27, 10 April 2008 (UTC)[reply]

Is wikipedidia only for big pharma? There is basically only one entity on ths planet that can finance phase III trials, and that is big pharma. In order to pay for investigations with thousands of participants, you need a patentable compound, leaving al natural medicines out. Big pharma aspo have the marketing resources to deliver their messages to medical personnel and patients. By having a principle of only including phase III trials, wikipedia will simply be severely diluted and act as yet another advertizing channel for big pharma. I think this is totally against the founder of Wikipedias intentions. —Preceding unsigned comment added by Jmstenborg (talk • contribs) 04:07, 11 April 2008 (UTC)[reply]

You are completely missing my points, but then you seem to be a strong believer in Ukrain and you are resorting to the usual arguments presented by editors who want to emphasise a particular treatment against content guidelines ("big pharma gets all the airtime, it's not fair"). Wikipedia does not operate according to the perceived viewpoints of its founder; Wikipedia operates according to clear policy. WP:WEIGHT (which you need to read) is one of these policies. JFW | T@lk 06:23, 11 April 2008 (UTC)[reply]

Satanism

I have eliminated the following: "People who get pancreatic cancer worship satan." I have a feeling it's not true. —Preceding unsigned comment added by 216.15.125.46 (talk) 16:12, 24 April 2008 (UTC)[reply]

I tend to agree here. It is actually a pretty awful thing to say. JFW | T@lk 00:28, 26 August 2008 (UTC)[reply]
"I have a feeling it's not true." and "I tend to agree here." --- ????
I seriously hope you guys were being sarcastic. Rms125a@hotmail.com (talk) 11:04, 7 September 2010 (UTC)[reply]

Raw soy flour as a cause

"is known to cause pancreatic cancer in rats.[60] http://en.wikipedia.org/wiki/Soybean#Carcinogen —Preceding unsigned comment added by 63.193.144.79 (talk) 05:30, 5 May 2008 (UTC)[reply]

Well, good that we're not rats then. JFW | T@lk 00:28, 26 August 2008 (UTC)[reply]

Ditch the NCI source?

The NCI source is authoritative and so on, but I think we should try to use peer-reviewed clinical sources in preference. JFW | T@lk 00:28, 26 August 2008 (UTC)[reply]

JFW, I strongly agree with your sentiments. I believe we need to overhaul the source list in its entirety and ensure that only scientific information is available. This is especially pertinent, given that this is a scientific subject and many people may rely on this article to learn about the subject matter. The information given should be as reliable as possible. 141.218.17.3 (talk) 17:40, 13 April 2011 (UTC)[reply]

Neuroendocrine tumours

doi:10.1053/j.gastro.2008.05.047 recent review. JFW | T@lk 14:20, 11 November 2008 (UTC)[reply]

Acid Reflux link?

I can't find a citation for this so I won't add it to the article. However, I've known several people who died of pancreatic cancer and they all developed acid reflux a couple years before being diagnosed. Its possible that someday they may find it to be an early indicator. --66.60.137.134 (talk) 06:33, 12 November 2008 (UTC)[reply]

Tumour and cancer

The article needs some attention of an expert. The lead paragraph discusses pancreatic tumours (e.g. serous cystadenomas)-- which aren't pancreatic cancer.[3] Cancer is a tumour that is malignant, i.e. can metastasize. Tumours that cannot metastasize are not cancer. I think the article confuses the terms tumour and cancer-- they are not the same thing. Nephron  T|C 04:59, 15 December 2008 (UTC)[reply]

I think much of this needs clarification. Neuroendocrine tumours are also being treated as cancer, which is incorrect if they are not invasive. I'm personally in favour of slashing information about tumours in the pancreas and restrict ourselves to pancreatic adenocarcinoma. I'm not sure if {{expert}} has anything to do with that. JFW | T@lk 23:03, 15 December 2008 (UTC)[reply]
I've gone through the article and restricted it to pancreatic cancer. I removed the benign neoplasms that were erroneously placed in the lead. As for JFW's comment, we can't really restrict the article to pancreatic adenocarcinoma since other carcinomas (albeit rare) do occur in the pancreas. However, an article certainly could be created at Pancreatic adenocarcinoma. I'm going to removed the expert needed tag for now, but feel free to replace it if you feel the article needs further attention. Dgf32 (talk) 19:55, 7 April 2009 (UTC)[reply]


The acid reflux is usually due to the tumor effecting the stomach in some way. Particularly, when the tumor reaches a size that enables it to "squeeze" the duodenum, or the exit from the stomach, shut. Without a way for the stomach to push food one way, it will try and push the food the other way, invariable causing acid reflux and vomiting. —Preceding unsigned comment added by 64.146.238.2 (talk) 23:52, 3 January 2010 (UTC)[reply]

Pain

Pancreatic cancer can be extremely painful. doi:10.1053/j.gastro.2008.09.029 shows that not only is there a form of localised neuropathy mediated by Gap-43 protein expression but also that pain is a strongly predictive negative prognostic indicator. JFW | T@lk 13:46, 31 December 2008 (UTC)[reply]

Survival after diagnosis: contradiction

The article begins with

less than 5 percent of those diagnosed still alive 3 months after diagnosis

then in the Prognosis section

Median survival from diagnosis is around 3 to 6 months; 5-year survival is less than 5%.

Is it 3 months or 5 years, can anyone check? Okud (talk) 07:58, 29 January 2009 (UTC)[reply]

I found the edit in the last week or so -- looks like the editor leaped before they looked. Reverted. Srain (talk) 22:03, 5 February 2009 (UTC)[reply]

Obesity

Being fat not only increases the risk but also reduces chance of succesful treatment http://jama.ama-assn.org/cgi/content/abstract/301/24/2553 JFW | T@lk 22:56, 23 June 2009 (UTC)[reply]

LDN

I have removed the single patient stories under chemotherapy as wells as the references to very small studies in phase I. Reason: I belive there should only be referenced to large randomized or good trials, since very sick desperate people read these pages. It is unfair to tell them fantastic stories about novel treatment. I can only imagine the rea$$on why anyone would promote drugs/strategies tested on so few patients. A study can be poor even if it is peer-reviewed. I sincerely hope we find new good drugs to combat this disease, but information on this page should be as objective as possible. —Preceding unsigned comment added by Boulevard100 (talk • contribs) 21:52, 30 September 2009 (UTC)[reply]

Agree. Thanks. JFW | T@lk 20:01, 1 October 2009 (UTC)[reply]
Given repeated attempts to insert the same material I have now semiprotected the article for two months. JFW | T@lk 11:59, 29 November 2009 (UTC)[reply]

Given that the prognosis for patients with pancreatic cancer is extremely poor, and that research into the ALAN approach has been promising, what justification do you have to remove information that could potentially save lives? The National Cancer Institute is interested in this work, and large scale trials are expected to occur. Shouldn’t people who have run out of other options be informed of this work, now, before they have run out of time? The cited information you removed doesn’t benefit any specific person or company, only patients who have run out of other options. Having lost 3 friends to pancreatic cancer in the last 4 years, I believe it belongs on Wikipedia and I am offended you took a hatchet to it without first engaging in open discussion.JLBenjamin (talk)JLBenjamin —Preceding undated comment added 18:54, 14 March 2011 (UTC).[reply]

"Promising" is not the same as "working". Potentially it could save lives, potentially it can raise false hopes and make people chase treatment while they should be getting access to high-quality palliative care. 50% of clinical trials are negative, so this one stands a reasonable chance of failing.
Please review WP:CRYSTAL. JFW | T@lk 19:08, 14 March 2011 (UTC)[reply]

Reference to Oettler in Surgery Should be Oettle

I have checked the reference in ASCO and found no Oettler but there is a Oettle, Helmut. Please see the link: [fau&index=n]. This reference was mentioned under the Surgery heading. This must be the correct name. Aknxy (talk) 22:07, 8 June 2010 (UTC)[reply]

Chemotherapy

Rod57 (talk · contribs) added a raft of information about pharmacological treatment (last time I checked nelfinavir was not a form of chemo) in the "chemotherapy" section. I removed it because of the following problems:

  • Phase I and II trials are simply not useful for encyclopedia articles. They may never lead to an approved agent for one of numerous reasons. The treatment is by definition not widely available.
  • The sourcing was so poor as to completely fail WP:V.

When sourcing drug treatment for any medical condition, it would be most appropriate to use a recent high-quality secondary source (see WP:MEDRS). That way, we can provide information that is actually useful to the general reader. JFW | T@lk 09:58, 1 December 2010 (UTC)[reply]

Thanks for the explanation, but I dispute most of the above. jfw may not have looked at my edits in enough detail. He threw out my verifiable reports on notable clinical results of nelfinivar, and also threw out some earlier poorly sourced material that I had merely rearranged into chronological order. The phase I report was notable because it is rare for such good results to come from a phase I trial.
In some cancers the standard of care nowadays is to get on a clinical trial. Many medical practices have not yet been approved for a specific indication but that doesn't mean an encyclopedia should ignore them. Rod57 (talk) 12:08, 4 December 2010 (UTC)[reply]


Is there any way to update the courses currently used? While gemabectine/Gemzar (sp) is currently still standard palliative care, there are other alternatives that have been used increasingly in the past 5 years or so, including use of Folfirinox (Fluorouracil with Irinotecan Plus Oxaliplatin)... I'm not a doctor, nor do I play one on TV, but I know that the treatments have changed. Would an oncologist care to help update? Sasouthcott (talk) 02:31, 2 December 2012 (UTC)[reply]

itching

Re: the recent edits by an IP, they have presented the following sources on my talk page:

Seems like a reasonable set of sources, any objections to their inclusion? --Nuujinn (talk) 03:09, 1 February 2011 (UTC)[reply]

[copied from your talk page in response to editor's remark:]

Sorry, but the first source does not mention itchiness as something that's misdiagnosed. Besides, it's a notification on a website, not a scientific publication. The second source is the BBC--sure, that's reliable, but we're dealing with a little sidebar (and nothing about misdiagnosis). The third and fourth, those again are not reliable sources.

No one is going to be bothered by a little itch in this article, but if you want to make claims about misdiagnosis, you'll have to come up with something better than your own observation. Drmies (talk) 03:09, 1 February 2011 (UTC)[reply]

Seriously, this is an article on a medical topic. We should have medical journal articles and such to verify the information in here. Drmies (talk) 03:13, 1 February 2011 (UTC)[reply]

I've just come back from the hospital where my 63 year old dad suddenly has less than a year to live. I don't have the stomach for this right now but trust me if it literally kills me itching will be a side effect on this website permanently. —Preceding unsigned comment added by 82.2.1.93 (talk) 20:58, 2 February 2011 (UTC)[reply]

Itch

82.2.1.93 (talk · contribs) has repeatedly added the point that itching can be a symptom of pancreatic cancer. It has now been removed 10 times. I suggest that we discuss the addition rather than engaging in an edit war. The main problems with the edits are the following:

  • It is implied that the diagnosis is missed because itching is not appreciated. This claim is not supported by the sources.
  • It is implied that the itching is independent of jaundice. This claim is not supported by the sources, and to my knowledge this phenomenon is encountered more often in primary biliary cirrhosis, where the itching is disproportional to the bilirubin.
  • The sources provided may be reliable for the average lay reader, but the relevant guideline WP:MEDRS sets a higher standard.

I think these concerns should be addressed before the paragraph in question is returned. JFW | T@lk 13:05, 2 February 2011 (UTC)[reply]

I've just come back from the hospital where my 63 year old dad suddenly has less than a year to live. I don't have the stomach for this right now but trust me if it literally kills me itching will be a side effect on this website permanently. — Preceding unsigned comment added by 82.2.1.93 (talk • contribs)

I'm very sorry to hear about your father. Please let us know when you are prepared to address my points above. JFW | T@lk 21:53, 2 February 2011 (UTC)[reply]

I'm afraid I do not recognise your concerns as valid. Furthermore there are other claims on this page solely supported by Pancreatic charity links that have not been removed. I'm appalled by your bloody mindedness. You guys cite wiki:RS. I give you 4 sources of which at least 2 meet the RS criteria. Then you cite something else as a criteria. I am sure if I trawled hard enough I'd be able to find some medical journal somewhere that declares that X test subjects out of a total of X reported itching prior to diagnoses.
I am trying to help people get diagnosed earlier when their cancer may be operable.
What exactly are you trying to do by removing a clearly valid sentence, that is clearly supported by 4 independent sources. Cancer Research UK, here in the UK is 100% reputable. Kings College is a brilliant hospital nationally renown and the BBC has integrity other media establishments could only wish for in a fleeting daydream. What you are doing is directly challenging what they have posted on their respective websites and challenging my own personal experience of watching my dad itch to the point of going mad prior to his diagnosis.
I find you undoing my slight changes narrow minded. You seem more concerned with the rules of wiki engagement that helping someone’s mother, father, brother or sister avoid this terrible affliction.
Shame on you. —Preceding unsigned comment added by 82.2.1.93 (talk) 00:18, 3 February 2011 (UTC)[reply]

I will not get drawn into your ad hominems, which distracts from the discussion. Your argument is not with me but with a Wikipedia content guideline and a number of editors who feel the same way. I am not seeking confrontation with you; I'd much rather we reach an agreement, ideally after you have addressed my concerns. JFW | T@lk 14:10, 3 February 2011 (UTC)[reply]

Incidentally I agree that we need to improve the sourcing of other parts of the article. The NCI page is not the kind of source we want to be using. JFW | T@lk 14:24, 3 February 2011 (UTC)[reply]

Why should I address your concerns when you clearly will not address mine citing "ad hominems" at me? You're being picky for the sake of it. If you applied the same RS requirements to the rest of the page you could cut a third of it out. What will make you happy? a medical journal and only a medical journal stating that itchiness is an indicator? Tell me exactly what you want now. Before I make an assumption and you change the goal posts for a second time. —Preceding unsigned comment added by 82.2.1.93 (talk) 19:33, 3 February 2011 (UTC)[reply]
Well, here's why you should. You want to add material to the article, and thus the burden is on you to provide sources, and you have supplied some, but some editors are not happy with those sources, my guess is that the basic objection is that these sources are not as good as others available. I agree with that in general, but it seems to me that a reliable newspaper is a good enough source to justify putting in something from it, if qualified, and that's the edit I made. But it was reverted, and now we have a small edit war here, and we should stop that right away. Talking about it here is better. In answer to you question, yes, a reference from a medical journal would be great, although we can consider other sources. But please take a look at WP:AGF, please do stop commenting on other editors and focus on the sources and content. I think a good place to start would be addressing this source, and what wording might be appropriate for that. But if there are any medical journal articles that address this, yes, please let's take a look at those. --Nuujinn (talk) 19:08, 5 February 2011 (UTC)[reply]
Please show me where I have an ad hominem argument in support of my position. JFW | T@lk 07:14, 8 February 2011 (UTC)[reply]

Sorry to interrupt your discussion guys - I just wanted to let you know, that my uncle has only recently found that he is soon going to die of pancreatic cancer (too late for resection)... One of the symptoms, that made him go to the doctor was ITCHING. Therefore I'm absolutely convinced that itching is a good reason to perform diagnosis. Regards, Goldfinger 95.49.243.158 (talk) 22:28, 7 February 2011 (UTC)[reply]

Goldfinger fight for your uncle. Find first post here: http://community.macmillan.org.uk/groups/pancreatic-cancer/forum/p/25414/401807.aspx#401807 by tombaldry (that's me). fight. —Preceding unsigned comment added by 82.2.1.93 (talk) 00:38, 8 February 2011 (UTC)[reply]
Goldfinger, it is absolutely vital that we get the referencing right here, because we do not want everyone with an itch thinking they've got cancer, no? Did the doctor clinically detect jaundice, and request investigations as a result? I am prepared to accept a reliable medical source (please read that page) but no anecdotal reports. JFW | T@lk 07:14, 8 February 2011 (UTC)[reply]

Goldfinger, I'm sorry to hear about your uncle. My father died of pancreatic cancer a little over a year ago. However, it's not legitimate to use anecdotal evidence for a citation. If a medical claim is valid, then it can easily be supported by scientific literature. While it's true that pancreatic cancer is still under heavy study and we're always learning new things, we should not claim to know something that hasn't been proven. That's a slippery slope that may end up doing a lot of people a disservice if the information turns out to be false. 141.218.17.3 (talk) 17:21, 13 April 2011 (UTC)[reply]

Blood group a risk factor

I have just listened to a BBC Radio 4 programme Case Notes [4] (14:12-14:28 if you listen on the iPlayer) on pancreatitis and pancreatic cancer, and Professor John Neoptolemos of the Royal Liverpool Hospital stated that a risk factor for pancreatic cancer is having blood groups A, AB or B (20% of patients), and that Blood group O is a low risk. Can this be added to the article? 86.134.49.161 (talk) 17:45, 16 February 2011 (UTC)[reply]

There must be a source for this that meets WP:MEDRS. JFW | T@lk 19:35, 14 March 2011 (UTC)[reply]

There are scientific sources that show a statistically significant correlation.

1. Amundadottir L, Kraft P, Stolzenberg-Solomon RZ, et al. Genome-wide association study identifies variants in the ABO locus associated with susceptibility to pancreatic cancer. Nat Genet. 2009; 41:986–90. [PubMed: 19648918] Direct Link: http://jnci.oxfordjournals.org/content/101/6/424.full.pdf

2. Wolpin BM, Chan AT, Hartge P, et al. ABO blood group and the risk of pancreatic cancer. J Natl Cancer Inst. 2009; 101:424–31. [PubMed: 19276450]

However, note the limitations of the studies:

"Limitations: This study could not determine whether the ABO gene itself or genetic variations closely linked to this gene are the basis of the observed associations."

It's worth noting that out of a few recent comprehensive pancreatic cancer reviews, not everyone is taking their time to mention it. The details are still being churned out, so I'm not sure how prudent it would be to include this compared to arguably more relevant research that still needs to be implemented. There are far more damning genetic factors that need to be discussed in this article in greater detail. More on that later! Ns12123 (talk) 10:46, 13 April 2011 (UTC)[reply]

Separating out the diseases called pancreatic cancer

My understanding is that the most common form of the illness is found at one end of the organ and is the most deadly and a less common form found at the other end that has much better odds. Perhaps I missed this in my reading. If this is not present, the article should make this clear. I don't feel qualified to write about this. --Javaweb (talk) 07:02, 6 March 2011 (UTC)Javaweb[reply]

I think you are referring to ductal vs. (other) types of pancreatic cancer. --User:Ceyockey (talk to me) 13:04, 27 March 2011 (UTC)[reply]

To consider for inclusion

These three articles are summarized in Scientific American and would be useful to consider for inclusion. The SciAm article is found at http://www.scientificamerican.com/article.cfm?id=how-old-is-your-cancer . . . but citing a SciAm article is not appropriate for this high quality article. Noted in the SciAm article is that "These technologies are not yet available commercially,..." --User:Ceyockey (talk to me) 14:37, 27 March 2011 (UTC)[reply]

Genetic analysis supporting window of opportunity for detection and treatment

Yachida, Shinichi; Jones, Siân; Bozic, Ivana; et al. (15 September 2010), "Distant metastasis occurs late during the genetic evolution of pancreatic cancer", Nature, vol. 467, no. 7319, Nature Publishing Group (published 27 October 2010), pp. 1114–1117, doi:10.1038/nature09515, ISSN 0028-0836, retrieved 27 March 2011 {{citation}}: Unknown parameter |description= ignored (help)CS1 maint: date and year (link)

--User:Ceyockey (talk to me) 13:48, 27 March 2011 (UTC)[reply]

Detection through transcriptome analysis

Zhang, Lei; Farrell, James J.; Zhou, Hui; Elashoff, David; Akin, David; Park, No–Hee; Chia, David; Wong, David T. (9 November 2009), "Salivary Transcriptomic Biomarkers for Detection of Resectable Pancreatic Cancer", Gastroenterology, vol. 138, no. 3, Elsevier (published 19 November 2009), pp. 949–957, doi:10.1053/j.gastro.2009.11.010, PMC 2831159, PMID 19931263, retrieved 27 March 2011 {{citation}}: Unknown parameter |display-author= ignored (help)CS1 maint: PMC format (link) CS1 maint: date and year (link)

--User:Ceyockey (talk to me) 14:01, 27 March 2011 (UTC)[reply]

Endoscopic optical method for pancreatic cancer staging

Turzhitsky, Vladimir; Liu, Yang; Hasabou, Nahla; Goldberg, Michael; Roy, Hemant K.; Backman, Vadim; Brand, Randall (2009), "Investigating population risk factors of pancreatic cancer by evaluation of optical markers in the duodenal mucosa", Disease Markers, vol. 25, no. 6, IOS Press (published 10 February 2009), pp. 313–321, ISSN 0278-0240, PMC 2730822, PMID 19208949, retrieved 27 March 2011 {{citation}}: Unknown parameter |display-author= ignored (help)CS1 maint: PMC format (link)

--User:Ceyockey (talk to me) 14:29, 27 March 2011 (UTC)[reply]

That looks like some solid literature. Regarding the salivary marker article and others like it, I believe this wikipedia article should have a dedicated research section that discusses current developments and progress in the field, rather than implementing new studies throughout the existing sections. This is particularly important when new research is merely a development that may lead to new treatments or diagnostic tools. To clarify, indisputable information should be separated from information that is currently being worked out, but both kinds of information should still be available, so long as it is scientific.

Thanks for posting these articles. It's always good to see an article from Nature. Research has to be top tier and groundbreaking to get published there. 141.218.17.3 (talk) 17:37, 13 April 2011 (UTC)[reply]

Concerns regarding cause

(moved to the bottom so others will see this) --Nuujinn (talk) 10:39, 10 April 2011 (UTC)[reply]

Risk factors should be certain before presenting them under a list of causes. If they're correlative and not yet proven to be causal, this should be annotated accordingly. This is especially important for people who may read this page and cannot make this distinction. I'd suggest that all information presented be, at minimum, in accordance with the American Cancer Society's presentation on the subject.

Citations given should always be scientific when making a scientific claim. A lot of the sources given are, indeed, scientific, but some are not. Even if a source links to a scientific article in a scientific journal, members should still take their time to review the original article and cite that instead. It's no secret that news organizations often misrepresent or misinterpret the conclusions of a scientific study. This should be taken into account. The experimental design of studies should also be considered, given that some experiments on other animals are done to create a model on how something may affect humans. Often, further research is necessary and articles will often make a note of this.

A specific issue I found was "In particular, the common soft drink sweetener fructose has been linked to growth of pancreatic cancer cells." The source given is from Reuters. Clicking on the source just leads you to the main page of the Toronto Star. In any case, unless there is a definitive study that proves this, it should be removed. Generally, it's no secret that cancer cells use a lot of resources to ensure rapid growth, but this concept, in itself, is not a cause of tumor formation. And when considering risks for pancreatic cancer, we need to be considering factors that may cause the transformation of pancreatic cells into tumor forming cells (be it exocrine or endocrine in origin).

If I made a mistake, please let me know. Thank you to everyone that has taken their time to work on this page.

Ns12123 (talk) 17:44, 9 April 2011 (UTC)[reply]

The article says:
"In particular, the common soft drink sweetener fructose has been linked to growth of pancreatic cancer cells"
The source says:
The industry has also argued that sugar is sugar.
Heaney said his team found otherwise. They grew pancreatic cancer cells in lab dishes and fed them both glucose and fructose.
Tumour cells thrive on sugar but they used the fructose to proliferate. “Importantly, fructose and glucose metabolism are quite different,” Heaney’s team wrote.
“I think this paper has a lot of public health implications. Hopefully, at the federal level there will be some effort to step back on the amount of high fructose corn syrup in our diets,” Heaney said in a statement.
It seems to me that the statement in the article is supported by the source. --Nuujinn (talk) 01:24, 10 April 2011 (UTC)[reply]

The citation still leads to the main page of Toronto Star when you click the link. I'm referring to the 14th source. The language used in your article, I believe, means that the pancreatic tumor cells in the study were using the fructose to grow more efficiently. I don't see any implications in what you quoted that they mean to say that fructose has a correlative link to tumor formation itself. Even so, I've found supporting literature that also indicates that fructose helps pancreatic cancer cells to grow.

Please let me know if your article found a correlative link between fructose and the transformation of normal pancreatic cells into tumor cells. If not, then we may still mention these results under a different section, but it would not be fitting under potential causes, unless other evidence is provided, of course.

Ns12123 (talk) 04:45, 10 April 2011 (UTC)[reply]

First off, it is our article, not my article.
Reference 14, "Cancer cells slurp up fructose, U.S. study says". Reuters. 2010-08-02. Retrieved 2010-08-02, is what I quoted from above. You flagged the statement I quoted above with (citation given is invalid). Perhaps I'm being dense, but the citation from a reliable source and supports the statement that pancreatic cancer cells use fructose to "proliferate", a fair synonym, if vague, for growth. If you want to argue that we need clearer wording or that we don't need a newspaper source when we have better ones, or that this particular statement is too strong or has undue weight, or that it is contradicted by other sources that's all fine, and if you want to replace this source with better ones, that's fine, too. But the citation provided supports the statement as it stands, and that's why I removed the flag you provided. --Nuujinn (talk) 10:39, 10 April 2011 (UTC)[reply]

I think you're misunderstanding my intent. Can you please go on the page and click the link for the source? It does not lead me to the article that it should. It leads me to the main page of Toronto Star. No harm was meant by saying "your article". I meant it merely in the context of addressing the article you were referring to. I shouldn't have used that language.

As far as the issue itself about fructose and cancer cell proliferation, please note that there's a distinct difference in transforming a normal cell into a tumor forming cell, and contributing to a tumor forming cell's growth after it has been transformed. The article (from what you quoted, as the link seems to be broken) may be implying the latter. If so, then fructose does not belong under causes, unless a different source is provided.

I'm not fighting to include my original edit. I shouldn't have done it that way. Again, please don't misunderstand my intent.

Ns12123 (talk) 13:25, 10 April 2011 (UTC)[reply]

Ok, I just went back and clicked reference 14, this url, and it takes me to healthzone.ca with the reuters piece from which the quotes I provided above originate. I'm not sure why you're being led elsewhere. Since you seem to be having problems accessing the source, perhaps addressing the quotes as provided would help. I'm not particularly fond of the source, and additional qualifications in the assertion may be required, but the raw statement is supported I think--it represents the research as supporting the notion that in the lab, fructose facilitates proliferation of cells. Perhaps the assertion should be removed, it seems a "thin" insertion perhaps providing undue weight. --Nuujinn (talk) 15:54, 10 April 2011 (UTC)[reply]

I just tried the link in Firefox and it worked fine. My problem, apparently, was using the link through Google Chrome, which still results in linking me to the main page itself and not the article. I'm not sure why that is.

Ok, now that I've looked at the article, I wanted to discuss a few comments made by one of the researchers:

“These findings show that cancer cells can readily metabolize fructose to increase proliferation,” Dr. Anthony Heaney of UCLA’s Jonsson Cancer Center and colleagues wrote.

“They have major significance for cancer patients given dietary refined fructose consumption, and indicate that efforts to reduce refined fructose intake or inhibit fructose-mediated actions may disrupt cancer growth.”

This article is discussing how fructose, in the experiment, lead to faster growth of pancreatic tumor cells. Note that these cells have already been transformed from normal cells. The study, at least from what I gather, is not saying that fructose causes a normal pancreatic cell to transform into a tumor cell. From what I understand the intent is of the "Causes" section, we should be focusing on the underlying cause of cancer formation and not what causes the cancer cells to spread once they've already been transformed. It may be prudent to include this data in another section. There are other sound scientific studies that also found that fructose may help pancreatic tumor cells grow more rapidly, so I believe the conclusion is sound in this regard. It's just my understanding that we're conflating the underlying cause of the cancer itself with its actual spread.

Now, if this is the case, where may we put this? I would suggest that it should fall under treatment considerations, regarding the diet of pancreatic cancer patients. For those that already have pancreatic cancer, removing fructose from one's diet may help prevent proliferation.

Please let me know what you think and thank you for continuing to participate in this discussion.

Ns12123 (talk) 16:43, 10 April 2011 (UTC)[reply]

UPDATE:

There are a few recent studies on this issue. Here's one of the observations from one of the studies I came across:

"Of the three sugars assessed (lactose, fructose, and sucrose), only the milk sugar lactose was associated with pancreatic cancer risk (OR = 2.0, 95% CI: 1.5, 2.7 comparing extreme quartiles)." (Source: June M. Chan, Furong Wang, and Elizabeth A. Holly. Sweets, sweetened beverages, and risk of pancreatic cancer in a large population-based case–control study. Cancer Causes Control. 2009 August; 20(6): 835–846. Published online 2009 March 11. doi: 10.1007/s10552-009-9323-1. PMC 2694313. Obtained from: http://www.ncbi.nlm.nih.gov.libproxy.library.wmich.edu/pmc. Accessed on 10 April 2011.)

This source has a lot of data on the subject and I encourage you to look it over, particularly the discussion section. Let me know what you think.

PS: Please forgive my formatting issues in these posts. I'm still getting used to this. Ns12123 (talk) 17:42, 10 April 2011 (UTC)[reply]

Lancet

doi:10.1016/S0140-6736(10)62307-0 (in print) - seminar on pancreatic cancer. This might help update the article. JFW | T@lk 07:18, 27 June 2011 (UTC)[reply]

Data

In the beginning section it says "Men are 30% more likely to get pancreatic cancer. Persons of African descent are more likely to develop pancreatic cancer." Both statements need a source, for all we know some random person inserted those statistics. Stopde (talk) 11:03, 17 June 2013 (UTC)[reply]

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