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  • Introduction In recent years the mortality

    2019-08-16

    Introduction In recent years, the mortality rate of all cancer has decreased significantly, save for one. Pancreatic cancer remains elusive to treatment, and is the fourth leading cause of cancer-related death in the world [1]. First described in 1761 by Giovanni Battista Morgagni, an Italian pathologist, pancreatic cancer will continue to become the number two cancer-related cause of death unless a remarkable breakthrough is achieved [2]. Although successful surgery of the pancreas is possible, diagnosis at an early stage is less likely. Even with the tumor removed, the median survival after surgery is only 17–23 months [3]. A major factor for the untreatable condition lies in the resistance of pancreatic cancer to chemotherapy [4]. Nab paclitaxelin, a potent drug used for the treatment of various cancers, in combination with gemcitabine, a chemotherapeutic agent, has improved the survival rate of cancer patients [5]. However, there is a dire need for techniques for early detection, along with understanding of tumor biology and discovery of novel therapeutics.
    Anatomy of the pancreas Located in the abdominal cavity, the pancreas is an endocrine organ 15 cm long and 70–100 grams in weight. It is roughly divided into four main sections: head, neck, body, and tail. The head lies near the duodenum. The neck, located anterior to the portal vein, connects the head and body. The body, which lies behind the pylorus, continues from the neck and terminates in the tail, which extends toward the splenic hilum. The anatomy of the pancreas is depicted in Fig. 1.
    Pancreatic cancer Pancreatic cancer is the general term for tumor formed in the epithelial Minocycline HCl of glandular structures, referred to as adenocarcinoma, in the pancreatic ductal cells. Pancreatic ductal adenocarcinoma (PDAC) is the most common form of pancreatic cancer, representing 85% of all reported cases [6]. Although the exact causes are unknown, family history and genetics, smoking, obesity, and diabetes are the most likely factors that contribute to the risk of PDAC [7]. Individuals between the ages 60–80 are more prone to this form of cancer, while reports of patients below this age is infrequent [8].
    Pancreatic cancer cell line Cell lines are the most appropriate resource for in vitro investigation in cancer research. Generally obtained from subjects with cancer, neoplastic changes in cell line will vary according to the patient sample. The important characteristics of cell lines are the information of the donor and the site from where it is derived. Table 2 gives a brief description of the commonly used pancreatic cancer cell lines.
    Current management The benefit of early detection of pancreatic cancer lies in surgical resection of tumor. Lesion on the head of the pancreas are removed via pancreaticoduodenectomy, while lesions on the body or tail may be removed through distal pancreatectomy [58]. However total removal of the pancreas is avoided unless tumor on the pancreas is extraordinarily large because of postoperative complications. It has been observed that 1–4% mortality rate was conserved in high volume centers after surgical treatment. Standard treatment protocol includes chemotherapy with gemcitabine or 5-fluorouracil [59]. Gemcitabine is a pyrimidine antimetabolite which is currently used as the first-line of treatment for pancreatic cancer due to its tolerance and low side effects [60]. 5-flurouracil is the drug used as second-line treatment used when an individual isn’t suited for gemcitabine [61]. In the case of advanced cancer, application of gemcitabine-based combination chemotherapy is established. However, the median survival rate for this therapy lies at a low 9 months. In over 10% of patients with advanced stage pancreatic cancer, progression-free survival went up to two years. In recent years, targeting molecular pathways as a potential therapy has revolutionized cancer treatment. However, the use of small molecule inhibitors and monoclonal antibodies end up inhibiting active cell surface molecules. Clinical trials have also ended in disappointment due to the increased resistance of the disease.