Works Cited

1. Altman, Lawrence K. Chemotherapy before Surgery Aids Bladder Cancer Sufferers. New
York Times 15 May 2001: 1-2. Web. 30 Aug. 2015.
<http://www.nytimes.com/2001/05/15/us/chemotherapy-before-surgery-aids-bladdercancer-sufferers.html>.
This article proposes research on the effectiveness of preoperative chemotherapy,
specifically for patients suffering from bladder cancer. The study mentions the use of a
standard combination of chemo drugs that lead to an almost doubling effect on
patients post-op longevity. It suggests that chemotherapy administered in the weeks
before surgery may deter metastasis as opposed to chemo after surgery. Bladder cancer
patients are the newest experimental group exposed to this idea, following breast, colon,
esophageal, rectal and stomach cancer patients whose treatments have proven beneficial.
Many of these bladder cancer patients with presurgical chemo sessions can expect a
survival benefit measured in years rather than months, unlike other cancer studies.
This article is not particularly helpful in deepening ones understanding of chemotherapy
because of the lack of concrete evidence to back up the main claim. The end of the article
offers opposing evidence that counters the aforementioned information, showing how
controversial this approach is.
2. Cancer of the pancreas. Pamphlet by: National Cancer Institute. National Cancer Institute,
1992. 1+. Student Resources in Context. Web. 11 Oct. 2015.
The second half of this article discusses the more personal aspect to a patients treatment
after being diagnosed with pancreatic cancer. In terms of surgical care, it is completely
dependent on a pancreatic tumors location for the type of surgery to be selected.
Anything from a distal pancreatectomy to a total pancreatectomy is a possible path of
surgical resection that may completely remove a patients cancer. However, it is just as
possible for ones cancer to be nonremovable; in this case, the patient may still undergo
surgery to relieve symptoms like bile duct blockage by creating a bypass. The main
source of worry for patients who have a part of or their entire pancreas removed is their
diet. Because one of the pancreass main functions is to produce pancreatic jucies to aid
digestion, patients recovering from a pancreas surgery usually encounter issues with
eating solid foods or even consuming any form of nutrition in general.
By offering insight on both surgical and non-surgical treatments, this pamphlet provides
comprehensive information all aspects of a patients path to proper care. The back of this
source includes a reference page of all important terminologies that can be useful to fully
understanding the information provided.

3. Clinic Staff, Mayo. Diseases and Conditions of Surgical Oncology. MayoClinic.com. Mayo
Clinic, 22 08 2014. Web. 24 August 2015. <http://www.mayoclinic.org/diseasesconditions/cancer/in-depth/cancer-surgery/ART-20044171>
The Mayo Clinic Staff discusses the pre-op, op, and post-op essential information
regarding the most common procedures and paths patients undergo. The staff summarizes
the fundamental goal of surgical oncology as repairing by resecting part(s) of the patients
body to hopefully cure him or her of his or her cancer. There are many different
steps/goal for determining the need for surgery, one important one of which is Staging,
where the patients cancer is analyzed in terms of how advanced the tumor(s)s metastasis
is. Surgeons operating on cancer patients must not only resect the tumor, but also the
surrounding healthy tissue in order to ensure that all of the cancer is removed. Many
different surgical treatments, which would vary on the patients needs, luckily exist.
Some more common ones include cryosurgery, electrosurgery, laser surgery, Mohs
surgery, laparoscopic surgery, robotic surgery, and natural orifice surgery. Because
operations are subject to much risk, the patients post-op recovery maybe extended due to
severe pain, infection, organ function loss, bleeding, blood clotting, and altered waste
removal functions.
This article allows one to delve deeper in understanding that much attention must be
given to the patient. It can inform the reader that such a complex procedure can cause
apprehensiveness that may decrease quality of life during recovery.
4. Griffin, James F., Katherine E. Poruk, and Christopher L. Wolfgang. The Management of
Periampullary Cancers. 23 Nov. 2015. TS.
The book excerpt provides a surfeit of information regarding four different types of
periampullary cancer and the ways to treat them. Among these different types of cancer
are, in order of percentages of periampullary malignancies, pancreatic ductal (PDAC),
distal cholangiocarcinoma, ampullary adenocarcinoma, and adenocarcinoma. The
Ampulla of Vater, comprising of three things which converge: the distal common bile
duct, main pancreatic duct, and is stated as the most common primary source of
malignancy. PDAC is the common, malignant type of cancer that requires the now wellknown and well-perfected Whipple operation, which focuses on the resection of
duodenum and the anastomosis of the pancreatic duct and bile ducts. Both ampullary
adenocarcinoma and duodenal adenocarcinoma, though rare, have the best projected
prognoses, ranging between 34-68% and 45-71% respectively.
Although highly technical, the language of the text is very understandable, readable, and
relatable, as one could observe certain connections in a real-world operating room setting.
A modicum of appropriate statistics regarding things like prognoses supplement the
informational text.

5. Huang, John J. et al. Quality of Life and Outcomes After Pancreaticoduodenectomy. Annals
of Surgery 231.6 (2000): 890898. Print.
Containing much raw data, the source assesses the postoperative status and condition of
patients who underwent a pancreaticoduodenectomy (PD). Although there is a generally
accepted apprehension of PD because of the surgerys negative connotation, a few
hundred surveys sent out to surgery survivors over a span of 16 years indicate that PD is
a valid method of treatment for periampullary conditions. Assessed on three key
components that would properly evaluate patient quality of life (QOL), the study
surveyed the patients physical, psychological, and social QOL and symptoms of weight
loss, abdominal pain, fatigue, foul stools, and diabetes, because of the resection of a
large portion of patients pancreases. All in all, it can be inferred that PD is a valid
alternative to surgical treatment for not only pancreatic ductal adenocarcinoma, but also
other issues in that region, as indicated by the studys promising results.
This article is both heavily reliable and full of relevant material to research of pancreatic
cancers best option for surgical treatment, as it provides statistics that can be used as
supporting information.
6. Pancreatic cancer. World of Health. Gale, 2007. Student Resources in Context. Web. 10 Oct.
2015.
This article provides a brief but useful overview of pancreatic cancer, one of the worlds
most lethal killers. It neatly explains the role of the pancreas, the prognosis of pancreatic
cancer patients, and the guidelines for preventing, diagnosing, and treating pancreatic
cancer. The pancreas is a small gland embedded in the abdominal cavity behind the
stomach that has two primary functions of producing digestive juices and hormones. The
cause of pancreatic cancer is still unknown, although it can the cancer itself has been
observed to have predictable aggravating risk factors such as smoking and certain
meaty/fatty diets. Multiple tests and scans must be conducted to accurately diagnose this
cancer, among other cancers, despite them being somewhat too late in fully ensuring a
patients survival. Those diagnosed with pancreatic cancer and those deceased are in the
tens of thousands.
Explaining the foundations of pancreatic cancer in a holistic approach, this article was
quite beneficial for furthering ones background knowledge. With the technical terms and
few statistics, this article can serve as a quick reference source for evidence.
7. Pancreatico-duodenectomy (Whipple Procedure). The Toronto Video Atlas of Liver, Pancreas,
and Transplant Surgery. Toronto General Hospital, U of Toronto, n.d. Web. 15 Nov.
2015. <http://pie.med.utoronto.ca/TVASurg/TVASurg_content/surg/PP_whipple.html>.

This close-up video details the step-by-step procedure of the Whipple procedure,
mentioning the anatomy of the head of the pancreas, gallbladder, duodenum, and
stomach. However, the operation dives into the more specific parts of the patients
anatomy and surgical equipment, alluding to the jejunum, in addition to the duodenum as
the adjacent section of the small intestine, SMV (superior mesenteric vein) which is a
neighboring vein that is pertinent to the staging of a patient, and an electrocautery, a piece
of coagulating and cutting equipment also known as a monopolar or bovi. After the
initial incision, the pancreas is located to be transected at the neck, as the main cancer is
on the head. Afterwards, the duodenum, distal antrum, and a short segment of the
jejunum are excised. Then, the common hepatic duct is transected as a cholecystectomy
(removal of the bladder) en bloc (at the same time) follows. Nearing the end of the
surgery, the remaining sections will go through anastomosis (cross connecction of parts
of a system, in this case the GI tract/system) to conclude the procedure.
Extremely engaging and highly technical, this video is helpful not only because it poses
much new terminology in terms of anatomy, but also because narration accompanies it
and pauses the surgery at times to cross-dissolve into a cleaner-looking diagram of the
actual organs. The labels for the diagram and captions neatly foster learning for this
operation.
8. Pollack, Andrew. Trials Show Chemotherapy Helping after Lung Surgery. New York Times 6
June 2004: 1-3. Web. 30 Aug. 2015.
<http://www.nytimes.com/2004/06/06/health/06drug.html>.
This article offers detailed analysis of the chemotherapy drugs administered to
(specifically lung) cancer patients and of the effectiveness on post-operative longevity.
The studys members are aiming to ameliorate the standard of care by making post-op
drug treatments as regular as those for breast and colon cancer. The prognosis of those
with post-op chemo is expectedly hopeful as opposed to those living without
chemotherapy sessions after surgery. Particularly for patients who face the leading cause
of death among cancers, the risk of dying was reduced by half for those adhering to this
approach. This semi-comprehensive report details the multiple trial group sizes, drug
names, and prognosis as measured in years for a varied number of post-op lung cancer
chemotherapy treatments.
This article, though interesting, was not beneficial as it offered almost no information for
someone with a lower reading level and lesser background information. With specifics
regarding different drug names and statistics, it provides more trial specifications than
medical background knowledge.
9. Research UK, Cancer. Cancer Grading. Cancer Research UK. N.p., n.d. Web. 8 Sept. 2015.
<http://www.cancerresearchuk.org/about-cancer/what-is-cancer/cancer-grading>.

This article is a cursory insight to the technical assessment of normality of cancer cells. It
discusses medical professionals use of the word: grading or cancer grading, as how
abnormal a patients cells are contrasted to the normality of normal cells. A low grade
cancer may grow more slowly then a high grade cancer. The system starts from Grade 1
which describes the cancer as close to the characteristics of a normal cell to Grade 3
(although this can go higher) which describes cancer with a high propensity to grow,
looking highly abnormal as well. Differentiation characterizes tumor cells development;
well differentiated means these cells and tissue structures are truly similar to those of
normal ones, whereas poorly differentiated or undifferentiated refers to tumors which
look abnormal (some normal structures and tissue patterns are missing) and may spread
more easily. Cancer grading thus allows for a prognosis and a treatment plan.
Though brief in length, this article works well to establish technical terms of cancer
evaluation. It serves as good background information to have, especially if one were to
write a report on a patient or go on site to a medical setting.
10. - - -. Endoscopy. Cancer Research UK. N.p., n.d. Web. 16 Sept. 2015.
<http://www.cancerresearchuk.org/about-cancer/cancers-in-general/tests/endoscopy?
script=true>.
This article discusses the procedure of testing with an endoscopy, also providing general
information about the equipment itself. An endoscope is a long flexible tube with a tiny
camera and light on its tip. It serves to look within different parts of the body,
specifically the esophagus, stomach, duodenum, and/or colon with an endoscopy. The test
looks for abnormalities throughout the digestive tract, also checking for abnormalities in
cells, and may be used to perform a biopsy of any abnormal-looking tissue. The patient
undergoing the test may be sedated or awake, whether in clinic or in surgery. An
ultrasound may be attached to the tip of an endoscope, allowing it to build an image of
the esophagus, stomach, gallbladder, and/or bile duct from its sound waves and check for
swollen lymph nodes.
By examining a specific piece of equipments role, this article serves as a decent insight
into medical equipment and procedures which could be used during surgery related to
cancer testing. It clearly states the patients responsibilities throughout the endoscopy and
his or her preparation and care before, during, and after the test.
11. - - -. How Cancer Can Spread. Cancer Research UK. N.p., n.d. Web. 8 Sept. 2015.
<http://www.cancerresearchuk.org/about-cancer/what-is-cancer/how-cancer-can-spread>.
This article targets metastasis: bloodstream/lymphatic system-carried cancer cells and
micrometastases, specifically. It introduces the topic with a quick comparison between
primary, secondary, and multiple cancers and leads to the fact that cancer cells do not
stick together as well as normal cells, also adding that some may produce substances to

help mobility, as mentioned in a previous article. These rapidly growing cells break
through normal cell tissue and the basement membrane as they grow, although spreading
occurs when these cancerous cells break off and enter closeby capillaries (very small
blood vessels) and/or small lymph vessels of the lymphatic system (network of tubes
and glands...that filters body fluid and fights infection). Cancerous cells breaking off
happens often, although many times they cannot leave a vessel to enter body tissue
successfully, thus failing to begin a new secondary cancer at some destination. Metastasis
often fails because of one or more of a few reasons: either the cells are killed off by white
blood cells or are eradicated by the surrounding fast flowing blood. An ideal condition for
metastasis to succeed is if the cells stick to platelets (blood cells that induce clotting),
which provides protection for movement.
Moderately lengthy, this article yields detailed information regarding cancer spread, or
metastasis. It explores the movements and behaviors of cancer cells aiming to start a
secondary cancer through the bodys blood circulation and lymphatic system.
12. - - -. How Cancers Grow. Cancer Research UK. N.p., 28 Oct. 2014. Web. 3 Sept. 2015.
<http://www.cancerresearchuk.org/about-cancer/what-is-cancer/how-cancers-grow>.
This article elaborates on the growth and spread habits of tumors. It introduces the topic
with a comparison between benign and malignant tumors, stating that benign tumors may
just as well cause discomfort as malignant tumors do, although malignant ones are
obviously of much more importance. Cancer cells are contained within the body tissue
from which they have developed is also named superficial cancer growth or carcinoma
in situ. These cells require the same (oxygenated) blood and nutrients that normal cells
need, and thus send signals/angiogenic factors to call for more blood vessels to deliver
such substances to the tumor, allowing it to continue its sustenance. Much research is
conducted on angiogenesis to hopefully make the connection between treatments and
stopping blood vessel growth. Also stated are the three ways cancer can locally spread to
surrounding tissues: pressure, enzymes, and a stimulating substance (to make them move
through tissue).
Accompanied with the video, this article provides crucial information regarding the
mobility and cancer cells. Not only does it offer good information, it is also very
readable.
13. - - -. How Cancer Starts. Cancer Research UK. N.p., 27 Oct. 2014. Web. 3 Sept. 2015.
<http://www.cancerresearchuk.org/about-cancer/what-is-cancer/how-cancer-starts>.
Describing the foundational background knowledge, this article briefly explains what one
needs to know about cancer and its behavior. Generally speaking, the article contrasts
normal cells to cancerous cells, where every cells genes instruct how the cell is to
behave. All cells need to multiply by dividing, although sometimes a change (that can

make the cell be out of control) of the genes called a mutation occurs, where the genes
either are damaged, lost, or copied twice. Mutations may take place mostly by chance,
whether the cause is literally chance, or if it is from other internal (intracellular) or
external (like UV sun-ray or cigarette smoke intake) factors. Such mutations may be what
damages the genes that makes their cells divide/grow too quickly: the definition of
cancerous cells.
Though brief, this article is of good use since a strong foundation of broad topics is
necessary to advancing. Also, the fact that this organization provides supplementary
video for their articles is even more beneficial to provide a visual understanding.
14. - - -. Stages of Cancer. Cancer Research UK. N.p., 29 Oct. 2014. Web. 15 Sept. 2015.
<http://www.cancerresearchuk.org/about-cancer/what-is-cancer/stages-of-cancer>.
This article is wholly concerned with the technicalities of a patients advancements in
cancer. It introduces that cancer staging is very useful to the treatment team in
determining the most suitable treatment a cancer patient could have, such as whether it be
localized (e.g. surgery, chemotherapy), systemic (e.g. chemotherapy, hormone therapy),
or adjuvant (e.g. chemo after surgery). To determine spread, doctors can examine lymph
nodes near the cancer, citing them as positive if cancer cells are detected there. There
are two different staging systems; one of which is named TNM (Tumor, Node,
Metastasis) where the tumor size, lymph nodes, and metastasis are taken into
consideration in separate categories, and the second is the number staging system, where
more comprehensive evaluations are taken in separate categories numbered Stage 1
through 4. There are possible additions to such systems however; the TNM system could
incorporate letters like p (pathological) and c (clinical) to show what phase the
cancers examination is at, whereas the number system could incorporate a Stage 0,
referring to carcinoma in situ, a group of abnormal cells that may develop into cancerous
cells.
This article is highly useful as it provides the lingo of medical professionals when
discussing a patients advancement in cancer. It promotes strong background information
that could allow one to progress onto other articles regarding the severity of a patients
cancer.
15. Sandone, Corinne. Encasement of Common Hepatic Artery (CHA). N.d. Johns Hopkins U.
JPG file.
This illustration clearly depicts a pancreatic ductal adenocarcinoma, as the vivid and
easy-to-see colors of the surrounding areas differ with the subject of the picturethe
tumor. This cancer is is depicted as a differentiable gray lump on the pancreas because of
such abnormal characteristics. Located on the head of the pancreas, this tumor can be
inferred as a Stage 3 locally advanced or higher degree of severity cancer. Since the

pictured blood vessel, specifically the Common Hepatic Artery (CHA), seems to be
trapped, or encased by the tumor, it is evident that this picture represents a pancreatic
cancer case ineligible for surgical resection. Nearby arteries include the Superior
Mesenteric Artery (SMA), Celiac trunk, Splenic artery, and so on.
This simplified, in terms of structure isolation, yet still incredibly detailed illustration of a
pancreas tumor serves as a very useful reference because it shows both the pancreas and
the major blood vessels regarding the topic of interest.
16. Stewart, Bernard W., and Paul Kleihues, eds. World cancer report. Vol. 57. Lyon: IARC
press, 2003.
This report has a specific scope on lung cancer and provides numerous statistics for
cancer incidence, cause, pathology and genetics. It begins by introducing multiple figures
on lung cancer cases worldwide, dividing these cases by sex, environmental conditions,
and geography. It also takes demographics and socioeconomic status into account,
mentioning that lung cancer is the most common malignant disease worldwide with
greater incidence for those of lower socioeconomic statuses. Throughout the report, lung
cancer etiology is highly connected to smoking habits and peoples consumption of
tobacco. Helpful diagrams additionally depict the risk of lung cancer after one quits
smoking and the risk of different types of cancer during cigarette consumption.
Including many graphics, charts, tables, and data, this report is a practical resource to use
for reference. Also, because the articles focus is centralized in lung cancer, it supplies
detailed information in not just epidemiology, but yet cancer symptoms and detection
methods.
17. Surgery Team, The Pancreas. The Whipple Procedure and Other Pancreas Surgeries.
HopkinsMedicine.org. Johns Hopkins Medicine, based in Baltimore, Maryland -, n.d.
Web. 24 August 2015.
<http://www.hopkinsmedicine.org/kimmel_cancer_center/centers/pancreatic_cancer/treat
ments/whipple_procedure.html>
The Johns Hopkins article discusses more pancreas surgeries in greater depth, where
experimental surgeries still being researched are described. It explicitly states that a
patient will not benefit from surgical removal of his or her main tumor (among others if
existing) if the patients cancer has metastasized, which is very common, since the
diagnosis would have already been made too late. Among the existing Whipple
(pancreatoduodenectomy) and distal pancreatectomy operations exists the extreme
minimally-invasive option as opposed to the polar opposite extreme of a total
pancreatectomy, of which the patients entire pancreas is removed. In such conditions, the
patient must take supplemental enzymes and insulin for the rest of his or her life to
compensate for the loss of the vital organ. Aside from the actual surgery and recovery

themselves, margin checking is a substantial aspect to a patients healthy recovery. If the

pancreas cancers surrounding tissue still shows signs of cancerous cells, much more
professional attention and insight is required. Experimental techniques to aid margincheckings efficiency/effectiveness include the use of radiotherapy during surgery, which
would assist the actual procedure by shrinking (or even potentially eradicating) the
tumor(s) to be resected.
This article provides an in-depth look at an aspect of surgical oncology one could observe
in the Johns Hopkins Hospital. It usefully delves deeper, with understandable
terminology, into the processes of some tumor-resection operations.
18. United States. Respected Periampullary Adenocarcinoma: 5-Year Survivors and Their 6- to
10-Year Follow-up. Washington: NCBI, 2006. PubMed US Library of Medicine National
Institutes of Health. Web. 16 Jan. 2016.
<http://www.ncbi.nlm.nih.gov/pubmed/17084719>.
Over a span of 29 years, a study was conducted to research the 10-year survival rate of
patients who underwent a pancreaticoduodenectomy (PD). Normally, surveys are
completed to document the 5-year survival rate of patients who had some surgical
treatment in general, although this study reports on a wider range to emphasize the longterm prognoses of patients who had a PD completed. There were 915 patients who had
PD for periampullary adenocarcinoma in this time span, and all of the patients where of a
median age of 65 years old. Conclusive results yield the statistics of a mere 23% 5-year
survival rate after having PD as treatment for periampullary cancer, which indicates that
the procedure is still in development. On the other hand, 65% of these 5-year survivors
survived an additional five years, proving that PD does indeed have a promising future in
its development.
This article provides much raw data about a consistently and well thought-out study
about the potential for the PD procedure, through descriptive statistics.
19. Weiss, Matthew John, and Christopher Lee Wolfgang, perf. Robotic Whipple Procedure at
Johns Hopkins Hospital. 2015. WMV file.
This video recording of a robotic pancreaticoduodenectomy (PD) shows footage of a the
minimally invasive approach to periampullary cancer surgery. With steps broken down in
the reconstruction phase of PD, it is somewhat easy to follow the steps of the procedure.
The robotic surgery is armed with a artificial first-person perspective camera which
engages viewers to see the three metal arms that work inside the patients body. With
equipment such as Liagsures and methods for anastomoses such as suturing for a
hepaticojejunostomy, the robotic surgery seems to relatably and similarly mimic a fullyopen incision PD. Additionally, it can also be observed when certain structures like the
ileum of the small intestine are cut.

This recording is extremely useful because it is real footage of a rarely observed method
of pancreatic cancer surgery.
20. Whipple Procedure Overview. DDC.MUSC.EDU. MUSC Health Digestive Disease
Center, n.d. Web. 24 August 2015.
<http://www.ddc.musc.edu/surgery/surgeries/chronicPanc/whipple.html>
This article poses special emphasis on the recovery/post-op stage of the pancreas
surgerys time span. Special treatment, which includes a one-night post-op ICU stay and
radiation/chemotherapy and so on, is administered to post-Whipple patients. Whipple
surgeries can be performed for chronic pancreatitis, small intestine cancer, and
cholangiocarcinoma, aside from the usual pancreatic cancer. Post-surgery precautions
include much restrictions concerning diet and activity, where smaller meals and reduced
physical exertion is highly favorable in aiding smooth recovery, especially if the patient is
discharged.
Interested in life after an intense Whipple operation, one can read this article with regard
to learning more about the recovery specifications of a discharged patient.
21. Wolfgang, Christopher. Personal interview. 9 Oct. 2015.
This first interview with Dr. Christopher Wolfgang yielded much of his personal
information regarding his interest in and training for surgery and the field of medicine.
Dr. Wolfgang did not initially want to become a surgeon as a small child, but all that
changed when he watched a handful of surgeries as a teenager, although he did admit he
almost fainted because of the uneasiness he felt in the Operating Room (OR) at the time.
As his interest for pursuing a career in the biological sciences burgeoned as a medical
student, he claims to constantly carry a suture driver around with him and consistently
play with it even while watching TV to eventually make it feel like an extension of [his]
hand. Additionally, he has been operating for about 17 years. His evident dedication to
surgery pursues even until today and throughout the bitter, unfortunate end of a case,
where he assures the deceased patients awaiting family members that he and his team
confidently did all they could to save the patients life.
This interview serves as a highly useful source of information as the personal ambitions
and experiences of a currently successful surgeon have been documented.
22. - - -. Personal interview. 18 Dec. 2015.
This second interview with Dr. Wolfgang exposed many insights, details, and statistics
about the signs and symptoms of pancreatic cancer. He stated that the most common
signs of periampullary pancreatic cancer are painless jaundice and digestive issues. Not
only did he provide this information, but he also explained some technical aspects of

reading CT scans, such as the fact that vascular involvement is seen as the absence of fat
between a tumor and a neighboring blood vessel. In these images, the color black
indicates fat, while white depicts vessels and gray illustrates cancers. Additional to this
knowledge, he pointed out the difference between resectable and unresectable cancers in
the other CT scans.
This interview was very valuable in that a researcher could attain professional
information regarding the narrow topic of pancreatic cancer surgical treatment.
23. Wolfgang, Christopher L., et al. Recent Progress in Pancreatic Cancer. CA: A Cancer
Journal for Clinicians 63.5 (2013): 319-25. Print.
The first quarter of this article examines the recent progresses made in pancreatic cancer,
commonly referred to as ductal adenocarcinoma, specifically with genetic advances and
the multidisciplinary team approach to patient care. The article first explores the risk
factors and possible signs that are proven to be associated with pancreatic cancer, stating
that the most common risk factor is a patients cigarette smoking habit. Signs of newonset diabetes, increased body mass index (BMI), alcohol intake, and pancreatitis may
indicate a higher risk for pancreatic cancer. Hereditary signs such as hereditary
pancreatitis may significantly increase a patients risk for developing pancreatic cancer,
especially if he or she is at least 70 years of age. The article then describes the
characteristics of some solid tumors, stating that invasive ductal adenocarcinoma tumors
are usually solid and firm and have a penchant for invading nerves and spreading along
perineural spaces.
The benefit of this first part of the article is that it provides multiple tables of information
related to statistics of pancreas cancer risk or even the Pathology of the Major
Neoplasms of the Pancreas which details a handful of different tumor types. Although
somewhat technical at times, this article introduces useful high-level terminology and
insight to signs and risks of developing ductal adenocarcinoma.
24. - - -. Recent Progress in Pancreatic Cancer. CA: A Cancer Journal for Clinicians 63.5
(2013): 326-32. Print.
The second quarter of this journal discusses the molecular biology, signs and symptoms,
cancer staging (using the well-known TNM and AJCC stages), and treatment for
localized diseases (Stages I/II and III borderline resectable) for pancreatic cancer, referred
in the text as ductal adenocarcinoma. The article indicates that a cancer is inherited
(germline) and acquired (somatic), and that when a patient inherits and acquires cancer,
his or her genes are somatically altered, or mutated. Certain genes, specifically SMAD4,
when mutated can cause malicious effects to the cancer patient such as a poor prognosis
and metastatic cancer. Recurring signs some patients obtain because of cancer are
diabetes mellitus, chronic pancreatitis, and the most commondepression, suggesting

that cancer does indeed trigger an onset of depression. Patients with ductal
adenocarcinoma of Stages I and II are normally considered for potentially curative
resection, or surgery. Whereas, patients with cancer, usually staged as Stage III
borderline resectable, may be considered for curative surgery. However, patients with
locally advanced cancer, such as Stage III or Stage IV (metastatic) cannot be treated with
surgery and must resort to chemotherapy, chemoradiotherapy, systemic therapy, and/or
end-of-life care. The reason some patients may be treated with surgery at their respective
stages is dependent on the tumors location and interaction according to the nearby
vessels and arteries, which tumors extend to reach a humans blood system to provide
nutrition for itself.
As a technical yet understandable piece, this journal report serves as a useful tool for
further investigation because of the numerous connections one can make from the content
itself, or the supplementary CT scans, tables, and flowcharts.
25. Wolfgang, Christopher L., and Paul K. Neumann. Pancreatic Cancer: Surgical Techniques.
2 Nov. 2015. File last modified on 9 Nov. 2015. Microsoft Powerpoint Presentation file.
A powerpoint presentation, this source provides numerous CT scans detailing resectable
and unresectable cancers, where Stage I and II cancers have a higher probability of being
resected, Stage III cancers may be either locally advanced, or unresectable, or borderline
resectable, and Stage IV cancers are unresectable. Stage III cancers require the most
investigation for which patients are qualified for curative, surgical therapy, since they
have the highest tendency to be either for or against surgical removal. Stage IV, more
simply, requires systemic therapy which could include therapies like chemoradiotherapy.
Multiple diagrams with follow-up explanations are also included to explain the surgical
procedures of some stated operations like the pancreaticoduodenectomy and distal
pancreatectomy. The slides are highly relatable in the sense that connections can be made
across other sources, such as the inference that the site where the pancreatic duct, bile
duct, and duodenum converge is, anatomically named, the Ampulla of Vater, the common
site for periampullary malignancies.
Extensive and easy-to-follow, this powerpoint presentation serves as a highly useful
guide in determining a patients qualifications for surgical removal of the most two major
periampullary cancers, PDAC and duodenal adenocarcinoma.