Genetic Susceptibility and High Risk Groups for Pancreatic Cancer
Cancer develops because of a series of unfortunate events. The order of events defines a progression from normal cells through premalignant lesions to malignancy. A limited number of possible forms of progression are possible and initiation of this progre
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John P. Neoptolemos, Raul Urrutia, James L. Abbruzzese, Markus W. Bu¨chler (Eds.)
Pancreatic Cancer
With 253 Figures and 95 Tables
John P. Neoptolemos University of Liverpool Liverpool UK Raul Urrutia Mayo Clinic Rochester, MN USA James L. Abbruzzese The University of Texas M. D. Anderson Cancer Center Houston, TX USA Markus W. Bu¨chler University of Heidelberg Heidelberg Germany
Library of Congress Control Number: 2009937021
ISBN: 978-0-387-77497-8 This publication is available also as: Electronic publication under ISBN: 978-0-387-77498-5 and Print and electronic bundle under ISBN: 978-0-387-77499-2 ß Springer Science+Business Media, LLC 2010 (USA) All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. springer.com Printed on acid free paper
SPIN: 12037278 2109SPi– 5 4 3 2 1 0
This work is dedicated to our wives Linda, Gwen, Marie, and Hedi and to our patients and their relatives.
Foreword
For those of us immersed in cancer research, the last decade has been a fruitful one, with many significant achievements and real clinical advances. One needs to look only at the declining mortality rates in many malignancies such as breast and prostate cancer to appreciate that new discoveries have a positive impact on our patients. In some arenas, the advances have been transforming. For example, imatinib mesylate and successor drugs that target an enzyme called BCR/ABL in chronic myelogenous leukemia have turned this previously uniformly fatal disease into an easily manageable condition. Similarly, the work of the legendary Judah Folkman on the importance of the angiogenesis in malignancy spawned a number of agents that can interfere with the angiogenic pathway either by neutralizing ligands or inhibiting receptors. As a result, patients with breast, colon, kidney, lung, and other cancers are living longer and feeling better. Agents that target EGFR and HER2, among others, have also strengthened our therapeutic arsenal. However, in reflecting on pancreatic cancers, especially pancreatic ductal adenocarcinoma, one is immediately struck by how little progress we have made. Incidence rates continue to rise because of an aging population, and patients still present primarily with locally advanced or metastatic disease because cost-effective early detection tools are not available. Our treatments, while clearly improved, have not yet had a major impact on
