Talk:Pancreatic cancer/Archive 3

Needs sorting?
ref removal? Johnbod (talk) 11:40, 22 November 2015 (UTC)

Unexplained revert
My edits were reverted with the comment "some problems here". I'd appreciate knowing what those problems were. Lfstevens (talk) 17:27, 11 April 2016 (UTC)
 * Well there were lots of changes - one clear gibberish typo, one rather misleading change (to "body parts"), various changes of vocab in a somewhat over-technical direction, some things that made no difference at all. I did reinstate a couple of things that seemed worthwhile. Have you looked at the diff? Johnbod (talk) 18:53, 11 April 2016 (UTC)
 * I usually just fix typos that I encounter. I do ask that you be specific. "various changes" and "some things" are not really helpful. I did check the diff. Lfstevens (talk) 06:54, 12 April 2016 (UTC)
 * Well that certainly isn't what you did this time! Look at the 3rd red bit. I'm not going to go through every bit. Johnbod (talk) 12:51, 12 April 2016 (UTC)
 * I get it. You reverted because of the typo. The rest is just noise. Good to know. Lfstevens (talk) 20:14, 12 April 2016 (UTC)
 * No; you don't. Johnbod (talk) 04:46, 13 April 2016 (UTC)
 * Keep us guessing, yeah? Lfstevens (talk) 06:28, 13 April 2016 (UTC)

Comments

 * I'm not sure if this is important or not but in order to be consistent, the second paragraph of the introduction to the article briefly mentions the "signs and symptoms" and only mentions "yellow skin". However the Signs and Symptoms section mentions "yellow tint to the whites of the eyes or skin". Just looking for consistency. NikkiAB (talk) 01:42, 15 April 2016 (UTC)


 * Not sure why "it is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body. " was removed?
 * Symptoms start rather than appear. Signs appear.
 * Symptoms seem to "appear" very often in the most respectable sources: and
 * Appear means visual. IMO start is clearer. Doc James  (talk · contribs · email) 02:52, 14 November 2014 (UTC)


 * This is not important by why use all caps for "Cause, Mechanisms and Diagnosis"
 * no reason, Henry I think. Wiki CRUK John (talk) 15:20, 13 November 2014 (UTC)


 * Have arranged the lead to follow the layout of the body, thus put prevention with treatment rather than cause
 * Well whatever, but there is no logic there, and it goes against usual MEDRS sequences. Squeezing 10 or so sections into 4 paras will lead to crushing up whatever you do. Wiki CRUK John (talk) 15:20, 13 November 2014 (UTC)


 * Not sure what the issue is with these hidden tags " "
 * Nor am I - I didn't put them there & I expect FAC reviewers will complain. Aren't they to do with the translation project? Wiki CRUK John (talk) 15:20, 13 November 2014 (UTC)
 * We commonly use these at Wikiproject Med. Doc James  (talk · contribs · email) 02:52, 14 November 2014 (UTC)


 * Not sure why pancreatic adenocarcinoma needs bolding? IMO it doesn't
 * Really? It was bolded for the reason things are normally bolded, which is that they are the article title or a redirect - in this case the latter. This is a very basic MOS point which I notice medical articles often fail to observe. Wiki CRUK John (talk) 11:26, 13 November 2014 (UTC)
 * Hum yes medical articles typically do not bold. We can bold as you suggest.

Doc James (talk · contribs · email) 23:46, 12 November 2014 (UTC)
 * They are very often bolded (as at Lung cancer, Brain tumor etc), but not consistently. I'm not for bolding all redirects, but as you know this is the formal name for the disease in the great majority of "PC" cases, and unlike many of the much rarer types it has no other article of its own. Johnbod (talk) 03:36, 14 November 2014 (UTC)
 * I'm not very happy with the lead as it is, but will not change it for the moment. 15:20, 13 November 2014 (UTC)
 * What concerns do you have with it? Doc James  (talk · contribs · email) 02:52, 14 November 2014 (UTC)

Oxaliplatin
Here's a new paper on Oxaliplatin in the treatment of pancreatic cancer:
 * Novel patient-derived xenograft mouse model for pancreatic acinar cell carcinoma demonstrates single agent activity of oxaliplatin
 * Journal of Translational Medicine
 * 201614:129
 * DOI: 10.1186/s12967-016-0875-z© Hall et al. 2016
 * Published: 10 May 2016

Is it something that should be incorporated into the article? Here is a secondary source on it. Jonathunder (talk) 01:11, 28 May 2016 (UTC)
 * Too early. Just a primary research paper & a write-up of the press release. Doesn't appear to be approved for this yet. Johnbod (talk) 12:49, 30 May 2016 (UTC)

lead
as it is practically all referenced, I don't see why this (below) was left w/out one (I would have referenced it, but since its featured and will be Wikipedia:Today's featured article/June 16, 2016 I though it more appropriate to get opinions)?--Ozzie10aaaa (talk) 10:45, 30 May 2016 (UTC)
 * The most common, pancreatic adenocarcinoma, accounts for about 85% of cases, and the term "pancreatic cancer" is sometimes used to refer only to that type. These adenocarcinomas start within the part of the pancreas which makes digestive enzymes. Several other types of cancer, which collectively represent the majority of the non-adenocarcinomas, can also arise from these cells. One to two in every hundred cases of pancreatic cancer are neuroendocrine tumors, which arise from the hormone-producing cells of the pancreas. These are generally less aggressive than pancreatic adenocarcinoma.
 * The refs were there. They were just hidden and when stuff was moved around were not unhidden. Doc James  (talk · contribs · email) 11:36, 30 May 2016 (UTC)
 * thanks --Ozzie10aaaa (talk) 12:40, 30 May 2016 (UTC)

acinar cell carcinoma of the pancreas - query
In types, we have: "The next most common type, acinar cell carcinoma of the pancreas, arises in the clusters of cells that produce these enzymes, and represents 5% of exocrine pancreas cancers. Like the 'functioning' endocrine cancers described below, acinar cell carcinomas may cause over-production of certain molecules, in this case digestive enzymes, which may cause symptoms such as skin rashes and joint pain.

Cystadenocarcinomas account for 1% of pancreatic cancers, and they have a better prognosis than the other exocrine types.[21]"

- This was originally one para, with one ref. I hope that means it was all covered by the ref, Tobias, but I no longer have access. Can anyone check, or add another ref? Thanks if so, Johnbod (talk) 01:20, 12 June 2016 (UTC)
 * Can you access this https://books.google.ca/books?id=CXjDBAAAQBAJ&pg=PA297#v=onepage&q&f=false Doc James  (talk · contribs · email) 01:25, 12 June 2016 (UTC)
 * Thanks, yes - the new 2014 edn, though this doesn't seem to say everything. Johnbod (talk) 02:44, 12 June 2016 (UTC)

Excellent article
Much appreciation goes out to those medical editors that worked so hard to bring this article up to featured status! Great job and thank you for all your work. Best Regards,
 * Barbara (WVS) (talk) 00:08, 15 June 2016 (UTC)

Notable cases
I was surprised that there was no mention of high profile cases such as Steve Jobs. For an example of a source covering such, please see Scientific American. In the see-also-section, there is a link to list of people diagnosed with pancreatic cancer but please note that we also have a larger category:Deaths from pancreatic cancer and also category:Pancreatic cancer survivors. Andrew D. (talk) 07:36, 16 June 2016 (UTC)
 * Personally I would, but I think the consensus is against this sorta thing from most medical editors. Folks feel free to confirm or deny this below....Cas Liber (talk · contribs) 07:56, 16 June 2016 (UTC)
 * See amyotrophic lateral sclerosis for an example where there are notable sufferers such as Stephen Hawking. Anyway, as Cas Liber is ok with it, I have made a small addition to address this point. Andrew D. (talk) 12:10, 16 June 2016 (UTC)
 * Yes we get this gossip in Wikipedia from time to time, it doesn't say anything about the disease. Perfectly fine for the Steve Jobs article to say what he died of. Jytdog (talk) 12:14, 16 June 2016 (UTC)
 * The article has (I think recently acquired) a "See also" link to List of people diagnosed with pancreatic cancer (as usual mainly List of Americans in the news diagnosed with pancreatic cancer since 1980). I think myself this is enough; certainly medical editors generally dislike such stuff. Apart from Jobs (who is something of a useful cautionary tale) and Grayson Gilbert, the articles rarely say which type of PC or treatment they had, which vastly reduces any utility in this. Johnbod (talk) 12:28, 16 June 2016 (UTC)
 * The category which I added to see also was more general, having a lot more names, but that was reverted along with the Scientific American stuff. One thing I noticed, while checking this topic out, is that it barely makes it into the first page of Google hits for the topic.  Taking such a stuffy view of the topic may hurt its readership. Andrew D. (talk) 13:05, 16 June 2016 (UTC)
 * This was exactly what my research while at CRUK addressed. The NHS (in the UK) and big cancer charities (CRUK, Macmillan, ACS etc), plus several PC specific ones, dominate page 1, and are on the whole more trusted by web-users before they have seen the pages. I'm not sure we can or should complain about this. But our fuller approach, all on one page, gives more detail and is appreciated by many. Johnbod (talk) 14:47, 17 June 2016 (UTC)
 * The good thing about this diagnosis is it is striaghtforward to confirm, unlike, say, autistic spectrum or bipolar disorder...Cas Liber (talk · contribs) 13:18, 16 June 2016 (UTC)
 * That is a good point; it is objective. And for Jobs the cautionary tale of his wasting time-he-didn't-have-to-lose with alt med is a useful public health message.   But here are a whole bunch of people who died of it. Once we do one we will end up with a whole laundrylist and I would rather our article not go there.  I know advocacy groups like this for its profile-raising and fund raising impact and people are kind of interested in this kind of thing.  It is just generally not... serious.Jytdog (talk) 18:14, 16 June 2016 (UTC)
 * John von Neumann appears in that list and, by coincidence, that subject was also on the main page recently. Note that his article explains that there is some uncertainty about the nature of his cancer.  My understanding is that this cancer is actually quite difficult to diagnose and manage.  And we don't seem to have anyone from antiquity in our lists or categories because, for many centuries, the pancreas was not well-understood at all.  But if you think it's better to suppress such information, people will go to other places to get it. Andrew D. (talk) 18:53, 16 June 2016 (UTC)
 * I hope you have actually looked at the article, Andrew! It is in most cases very difficult to diagnose in time, but then all too easy. The history of the recognition is in the history section. There are categories and see alsos still. Johnbod (talk) 19:47, 16 June 2016 (UTC)

Accelerating Advances in Treatment and Prognosis
Overall, this article is truly excellent and a worthy replacement of the previous article on pancreatic cancer. But it seems to me that the diagnosis and treatment information is about two years out-of-date.

A number of agents are coming online and showing some success in treatment of pancratic adenocarcinomas, and success rates are improving. The use of two references, a 2010 paper and a 2015 WHO report (references 15 and 2, respectively) are quite pessimistic for reference by a new cancer patient entering competent care. In particular, one sentence "Surgery is the only treatment that can cure pancreatic adenocarcinoma,[5]" is too categorical in tone to be 100% accurate. In particular, I personally know of once case of stage IV pancreatic adenocarcinoma that had no surgical intervention other than a needle biopsy of a tumor on the surface of the liver for diagnosis, a stent to allow food to pass through the duodenum, and insertion of a portocath; treatment was initially using a patient-specific FOLFOX formulation that included a week's administration of fluorouracil repeated every two weeks for just over two months (very clearly not the FOLFOX4 or FOLFOX6 that is given in the FOLFOX article), that shrank all the tumors below visibility through CAT scans in the first two-month cycle. This was followed by a few months more of the patient-specific FOLFOX and then by a few months of orally-administered Xeloda. Full remission was verified through a PET scan about nine months after diagnosis and has continued for about four years, to date.

This article needs a subject matter expert to keep the list of approved treatments current. Another problem that is not as easy to solve is accurate survival rates with these treatments, which awaits data, studies, analysis, and peer review of results, a process that defies up-to-date numbers for emerging treatments. But this article should not tell new patients that they have little hope when that may not be true. — Preceding unsigned comment added by Motorfingers (talk • contribs) 21:05, 16 June 2016 (UTC)
 * Thanks! The article was essentially written in 2014/2015 and there is of course lots of ongoing research. I am putting together a section for the talk page here on potential updates for the article, now and in the future.  At Wikipedia the policy is to err on the side of conservatism and caution in terms of new research, if only to balance the hype and overselling of developing treatment that characterises most news media.  I believe that "Surgery is the only treatment that can cure pancreatic adenocarcinoma,[5]" still reflects the sources of the type we prefer (see WP:MEDRS).  Johnbod (talk) 14:40, 17 June 2016 (UTC)


 * Sorry I forgot to sign my discussion. The Talk paragraph that follows this one contains rough information that might fit into an "Emerging treatments" paragraph that explicitly defines the material reported there as not yet proven.  You didn't address my anecdotal case; it probably was driven by the extensive large metastases but otherwise good general health of the patient, allowing huge, extended administration does of fluorouracil, and the unexpectedly excellent response of the particular tumors, and thus too patient-specific for an encyclopedia article except possibly as an example of an outlier. -motorfingers- (talk) 14:46, 23 June 2016 (UTC)

Research
I asked Cancer Research UK to look it over in preparation for the main page day (36,152 views btw), and got comments including, from "CG", these:

Research - not sure if you want to out anything about current trial s into neo adjuvant which is still being researched see below: Several studies have shown that neo adjuvant treatment may be helpful for pancreatic cancer. But more research is needed to get a fuller picture of how well neo adjuvant treatment works, and what the best treatment is. The ESPAC-5F trial and the PRICKLE trial  are looking into this. Read more at

Radiotherapy is not routinely given in Europe but this study is looking at SIBRT: The SPARC trial is looking at different doses of SBRT to shrink pancreatic cancer before surgery. The people taking part have pancreatic cancer that could possibly be removed with surgery, but the operation may be difficult. For example, if the cancer is very close to the large blood vessels. The researchers want to find out the best and safest dose of SBRT, if giving it before surgery improves the chances of removing all the cancer, and to learn more about the side effects of SBRT. Read more at

Read more at http://www.cancerresearchuk.org/about-cancer/type/pancreatic-cancer/treatment/whats-new-in-pancreatic-cancer-research#XHf3suB5O4hyKxBJ.99

-I thought it was probably too early to include these, but would welcome other comments.

One thing that does seem likely to need change at some point is the bit on chemo, as the preliminary findings from the ESPAC-4 trial, comparing gemcitabine on its own with gemcitabine and capecitabine after surgery, look pretty positive for this "GEMCAP" combo - see EUROPAC. We might add a cautious sentence saying this may become an accepted regimen. Any thoughts? Johnbod (talk) 20:56, 17 June 2016 (UTC)


 * I'm not a SME but I can solicit a synopsis from a prominent oncologist, and filter the information through fact-finding and expansion from the community through online information which will allow adding references and permitting anonymity of the oncologist. If the Wikipedia community accepts such contributions, reply here and I will start the process.  With the material from Johnbod above and others as available, this should be a paragraph that we can update more often that a whole-article edit, and at least give the new patient reason to listen to his/her oncologist about options and prognoses.  Patient morale is a major factor in prognosis because it maps into treatment choices and also lifestyle choices that maintain general health.  I've seen pancreatic cancer patients with a good prognosis give up and go into hospice. -motorfingers- (talk) 14:55, 23 June 2016 (UTC)

Lancet Seminar
10.1016/S0140-6736(16)00141-0 JFW &#124; T@lk  13:49, 1 July 2016 (UTC)

Endocrine cancers
Curiously there is no mention of any of the endocrine cancers that may arise in the pancreas. These included insulinomas, gastrinomas, VIPomas, somatostatinomas and others. While individually rate they do may up a small but not insigificant proportion of pancreatic cancer. Would anyone care to comment? Virion123 (talk) 11:40, 7 August 2017 (UTC)
 * Apologies. These have been listed under the PanNET heading. Mind you this section could be improved to make this clearer.

Virion123 (talk) 11:41, 7 August 2017 (UTC)

WP:MEDMOS
Typically we put the genetic mutations involved under pathophysiology. This is a medmos heading. Thus removed this Doc James  (talk · contribs · email) 16:11, 16 August 2017 (UTC)

Pathophysiology
I think the "Precancer" subheading under "Pathophysiology" helps the reader to understand, especially since the larger volume of text under "Pathophysiology" deals with precancerous states. Will put it back and hope you agree. Figgep (talk) 17:59, 28 September 2017 (UTC)

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Risk factors: herbicide use
I added a section for herbicide use under "risk factors" for pancreatic cancer and cited to a NIH summary of a study published in the International Journal of Cancer. A user named Zefr deleted my entry almost instantaneously, asserting that the research was only preliminary. I see no basis for that assertion, and no studies to the contrary. I am suspicious of the motives of "Zefr."

Zefr also suggested that my style of citation was incorrect, which it very well may be, and I would welcome help in understanding the proper method of citation.

I would like to add the risk factor section back in, and would welcome suggestions for language identifying the study as limited or preliminary perhaps, though I think it really should be included.

Thank you. Katy
 * Hello Katy. First, please sign and date-stamp your conversation by using the pencil icon in the upper left of the edit box. The section below was removed from the article because it is preliminary research unsubstantiated by WP:MEDRS-quality reviews; see MEDSCI and MEDASSESS for the level of evidence needed to support an encyclopedic medical statement. This study has not been confirmed in a review for its role in causing pancreatic cancer. It is a beginning finding from a limited cohort study, needing much additional work to verify the potential link to the herbicides; therefore, it is preliminary research. Please review the MEDRS guide and this tutorial for sourcing in medical articles. Further, you can use the Templates pick list in the upper left of the edit box to format a reference properly. This is explained in WP:CIT. --Zefr (talk) 16:05, 1 December 2017 (UTC)


 * Herbicide use: Exposure to the Pendimethalin and EPTC, pre-emergence herbicides used in the production of a wide variety of crops in the U.S., has been shown to triple the risk of developing pancreatic cancer. A study published in the International Journal of Cancer revealed a 300% increase among applicators in the top-half of lifetime use of Pendimethalin and a 256% increase among applicators in the top-half of lifetime use of EPTC.

Risk Factors: Specific types of food (as distinct from obesity)
The reference given for specific types of food not have any risk factor doesn't mention Specific types of food at all. It mentions Aspirin, so if you wanted to state what doesn't have a risk factor, you could replace this with Aspirin, although listing all the things not a risk factor could be anything, like the kitchen sink. So perhaps we should remove that text all together. --Zaurus (talk) 00:19, 8 February 2019 (UTC)
 * Aspirin is mentioned (in the paper but not in the text) as not being shown to be protective. The risk table lists a number of risks but, as you say, no types of food. I'm inclined to leave it - otherwise that ref should just be removed, letting the one at the end of the sentence reference the whole text. Johnbod (talk) 03:55, 8 February 2019 (UTC)
 * What was your issue with my edit? --Zaurus (talk) 02:27, 13 February 2019 (UTC)
 * Your wording implied that there was a long list of dietary factors increasing risk, from which the article was selecting a couple of examples ("such as"). As you probably know, this is not the case, and so the wording was misleading.  This article has received very thorough reviews, and like all articles on medical topics, the wording needs to be very precise and careful. Johnbod (talk) 13:31, 13 February 2019 (UTC)
 * How exactly? The current wording is like saying "the kitchen sink is not a risk". Listing what is not a risk does not belong in a section called Risk factors. I'm sure this wouldn't be the first time some ambiguous/erroneous language made it through the review process. --Zaurus (talk) 13:48, 13 February 2019 (UTC)
 * Well, I disagree there, and as far as I'm concerned the "ambiguous/erroneous language" came from your edit. There is so much press nonsense about foods raising cancer risk that it is important to say so when there is no evidence established for this - it's not like there hasn't been research into the subject. Johnbod (talk) 02:48, 14 February 2019 (UTC)
 * I was trying to address your off-topic point of "article has received very thorough reviews". To your other off topic point about nonsense in the press, perhaps you could create a separate section about that with sources. But from my perspective you've introduced two red-herrings to distract. I gave my argument, that defining what is not a risk is as useful as saying a kitchen sink is not a risk. Can you make an argument for keeping "Specific types of food (as distinct from obesity) have not been clearly shown to increase the risk of pancreatic cancer."? It actually sounds barely grammatical to me.
 * Also, what was ambiguous/erroneous about my wording?Zaurus (talk) 12:18, 14 February 2019 (UTC)
 * Yes, I told you I don't agree with that, and why. I also explained "what was ambiguous/erroneous about my wording" ("such as" implying there were others). Precision doesn't seem to be your thing, I have to say. Johnbod (talk) 13:42, 14 February 2019 (UTC)

This discussion belongs on the talk page. Not within the articles text.

There is a nice table that lists the risk factors for pancreatic cancer as "obesity" and does not list specific dietary factors.

Cancer.org from 2014 says "Though evidence is still accumulating, consumption of red or processed meat, or meat cooked at very high temperatures, may slightly increase risk". So no conclusive evidence is supported. Doc James (talk · contribs · email) 18:53, 14 February 2019 (UTC)
 * Please read before commenting. ;-) a) The point about Aspirin was made on the talk page before being added to that edit summary. b) nobody is debating cooked meat. Zaurus (talk) 15:51, 16 February 2019 (UTC)
 * The issue here is whether, when considerable research has failed to demonstrate increased risk, this is worth mentioning. I say it is, Zaurus disagrees. Johnbod (talk) 16:20, 16 February 2019 (UTC)
 * Agree with Johnbod about mentioning that the evidence for specific foods is poor. Doc James  (talk · contribs · email) 16:44, 16 February 2019 (UTC)
 * Again off topic. The question is whether listing things that are not a risk is relevant. Zaurus (talk) 21:29, 16 February 2019 (UTC)
 * For certain ones that are notable, yes. Doc James  (talk · contribs · email) 21:45, 16 February 2019 (UTC)
 * Which ones? And as I suggested above, if they need to be mentioned, shouldn't there be a supporting ref? The refs you've supplied (by way of reverting edits) do not mentioned "non-risks" except for Aspirin. Zaurus (talk) 22:41, 16 February 2019 (UTC)

Role of galectins in pancreatic cancer
I am planning to add brief mention of the research in galectins in pancreatic cancer with several references. This is an active research area specific to pancreatic cancer pre-clinical models.
 * Please sign and timestamp your talk page edits. This edit is a problem for many reasons: 1) the research is at a very preliminary stage, with unknown significance as of 2019; 2) the journal Oncology Letters has a low impact factor (1.5) and is not a place where high-quality WP:MEDASSESS reviews appear; 3) the value of the research and future uses in therapy cannot be defined; WP:CRYSTAL. --Zefr (talk) 19:36, 1 May 2019 (UTC)

1) The research was properly described in my addition as pre-clinical but it is incorrect to characterize this as "very preliminary with unknown significance." It sounds like you are not aware of the large number of research papers regarding the role of galectins in pancreatic cancer.  Just because you, personally, are not familiar with this research does not mean it has unknown significance.

2) There are other papers on this topic that have a higher impact factor. If that remains the only problem, I can reference those papers.  I included this paper because it is a very current secondary review.

3) See #1 above.

It is a disservice to suppress this information. I find your reversion a bit over-zealous. I will try again, perhaps re-wording the edit next time. If that doesn't work I will submit to dispute resolution. Fpbear (talk) 19:46, 1 May 2019 (UTC)
 * A main purpose of the talk page discussion is to gain consensus among several other editors, WP:CON, which you do not have, so please don't start edit warring to make your edit stand. You can request individuals to review the edit and source, or post a discussion on WT:MED. --Zefr (talk) 20:33, 1 May 2019 (UTC)


 * Ok Zephyr, I can post it for pre-review and then we can see how to word this for consensus. Fpbear (talk) 20:45, 1 May 2019 (UTC) Editors: I posted my suggested addition to WT:MED. Fpbear (talk) 22:54, 1 May 2019 (UTC)
 * . You have not completed the consensus process here or at WT:MED; you need several editors to offer interpretations and revisions for a consensus opinion, yet you went ahead and reinserted your content with numerous duplicate sources; this is not how consensus is supposed to work. I edited the Preliminary research section to remove excessive content, speculation, and sources per WP:CITEKILL. Other editors may remove further content and sources. There are dozens of candidate mechanisms and drug compounds, and galectins are among them. Collectively, all this is early-stage research too preliminary for an encyclopedia; see this section in WP:WHYMEDRS. --Zefr (talk) 15:01, 2 May 2019 (UTC)
 * Two of the references that you removed are very important - the review paper in Oncology Letters, and the paper in the journal Nature. The editor on medpage talk agreed with me that these are strong references. This is NOT merely another molecular mechanism buried among other candidates, but rather the most promising new area of research in pancreatic cancer. There are drugs in clinical development (not mentioned) that inhibit galectins which are promising, yet you want to suppress even the fundamental research in this area with your edits.  You are making instant reversions without understanding the implications of hiding this information from the cancer community.Fpbear (talk) 15:24, 2 May 2019 (UTC)
 * This is your opinion which is WP:OR, so please wait until several other editors agree with you. You are relying on your own interpretations about importance and speculating about future success, WP:CRYSTAL. An encyclopedia expects much more advanced research. Please read WP:MEDASSESS and WP:WHYMEDRS to improve your understanding about encyclopedic sources. --Zefr (talk) 15:41, 2 May 2019 (UTC)
 * Actually, this research is well established as evidenced by the many review papers in top journals. It sounds like you are unfamiliar with this area of research so you are reacting with your WP:OR to revert these additions.  For now I have kept your revised text and added back the two important references because one of them is a comprehensive secondary review, and the other is a very important finding in the journal Nature.Fpbear (talk) 15:56, 2 May 2019 (UTC)

I think it is very easy to overemphasise new research findings. A good secondary source will place new findings in context, and how they might affect diagnostics and therapeutics in the future. If there is a secondary source that says that galectin signalling is hugely likely to lead to such developments, such a source can be cited to that effect. I would support 1-2 sentences at most at this stage. JFW &#124; T@lk  16:57, 2 May 2019 (UTC)
 * Indeed, there are secondary sources that describe how targeting galectin is a very promising therapeutic approach (for example the Munkley reference). This is backed up by a number of primary sources in top journals (e.g. the Nature reference) regarding the critical role of galectin in pancreatic cancer.Fpbear (talk) 17:30, 2 May 2019 (UTC)
 * I do not understand why you removed the secondary source reference (Munkley). This is perplexing because in your writing above, you state that "A good secondary source will place new findings in context, and how they might affect diagnostics and therapeutics in the future" which I completely agree with.  Then shortly after writing this, you removed the secondary reference!  Did you do this by accident?  This is a very good review paper that compiles research that was published in other top journals.  Although this particular review paper is not itself in journal with a very high impact factor, please recognize that pancreatic cancer is a specialized field of oncology, so the reviews in this field are often found in specialized publications.Fpbear (talk) 17:30, 2 May 2019 (UTC)

Please sign your posts. Could you clarify what the Munkley reference adds to the source that is already cited? Also, please do not separately approach me on my talk page. JFW &#124; T@lk  17:28, 2 May 2019 (UTC)
 * The Munkley reference has a more comprehensive review of how aberrant glycosylation is involved in pancreatic cancer, with a more comprehensive picture of the rationale for targetin galectins specifically in pancreatic cancer. The existing reference is much more general, and the two references would complement each other.  Fpbear (talk) 17:37, 2 May 2019 (UTC)

The Munkley reference is essential because it frames the context that weaves together this rapidly expanding area of pancreatic cancer research. I do not understand, what is the harm of including a second reference? Why hide this from readers? Fpbear (talk) 07:27, 3 May 2019 (UTC)


 * I am really sorry you are encountering so much resistance to your suggestions to include material on this aspect of pancreatic cancer research. I do however think that you have a very specific focus on this issue and this makes it harder to engage with you on what a perfect article on pancreatic cancer looks like. The average reader is very unlikely to be particularly interested in current laboratory research, because the translation of such results to practice generally takes at least a decade and many lines of research are subsequently abandoned due to lack of progress or reproducibility.
 * Could I encourage you to focus your efforts in updating the relevant basic science articles relating to this subject? If this is genuinely a "rapidly expanding area of pancreatic cancer research" there will very soon be more data, stronger sources, and probably more of a justification to expand our discussion of the relevant content within this article.
 * As for your plea that "another reference won't hurt" and that we are somehow "hiding this from readers", I do hope my points above have adequately illustrated my stance here. JFW &#124; T@lk  09:16, 3 May 2019 (UTC)
 * The research into how the immune system evades immunotherapy (aPD-1) has been going on for more than a decade. The research is now zeroing in on galectins (specifically: Galectin-1, Galectin-3, and Galectin-9 in pancreatic cancer). There are galectin inhibitors in clinical trials for melanoma, head & neck cancer, and non-small cell lung cancer.  A trial run by the same team that helped with the 2018 Nobel Prize in Medicine for immunotherapy recently found that galectin-3 inhibition increased overall survival and which also reduced myeloid derived suppressor cells in humans (since galectin-3 inhibition reduces MDSC). So it would not be far-fetched to imagine that these clinical trials might be expanded to include pancreatic cancer within the next 5 years. Here is an example of a different publication catching onto this area of research (before Wiki) https://www.pancan.org/news/new-strategy-allow-immune-attack-pancreatic-tumors/. Thank you for the discussion Jfdwolff, I'll leave it up to the editors what to do with this information.Fpbear (talk) 18:02, 3 May 2019 (UTC)
 * - your enthusiasm for galectins in a drug development program is admirable, but you may benefit by taking a dose of reality on the potential success of such research. Among all drugs in development as anti-disease therapies across disciplines, the probability of success for eventually achieving drug approval is only 10%, and for cancer, it's 3%. The reality of drug development - no matter how promising the results of early-stage lab studies or even Phase II trials - is that 90% fail, and 97% of anti-cancer candidates fail. As pointed out above, the content and further primary sources you wish to add are unencyclopedic per WP:CRYSTAL. --Zefr (talk) 03:58, 4 May 2019 (UTC)


 * I can see now where we are looking at this from different perspectives. I interpret the word "Research" to mean that which is being investigated.  The research into galectins role in pancreatic cancer is growing at an accelerated pace in top journals (e.g. Nature), and that is why it is worthy of mention. On the other hand you seem to interpret "Research" as meaning something that has been projected to succeed in Phase 3 clinical trials (ahead of time).  I do not think it is the role of wiki editors to make a projection whether a topic under investigation is going to succeed in clinical trials or not.  Instead, the Research section of the article would just summarize what is active in the research community.  While we would not want to include research that is too early (embryonic concepts), this particular area of glycobiology is pretty far along, already in human clinical trials for other cancers, and with papers appearing in top journals as it applies pancreatic cancer.Fpbear (talk) 04:43, 4 May 2019 (UTC)
 * When galectin drug candidates pass the hurdle of not failing in Phase II trials, that would be the time to mention a success-in-progress under Research. There are dozens of cancer drug candidates in lab studies or preliminary clinical trials. An encyclopedia based on well-established facts doesn't cover them all because 97% will fail. You are confusing content for a term paper, book chapter or journal article for what is encyclopedic, WP:NOTJOURNAL #6. --Zefr (talk) 13:31, 4 May 2019 (UTC)


 * I'm with JFW and Zefr on this - we should err on the side of caution in describing developments in research, especially in cancer. Johnbod (talk) 15:39, 4 May 2019 (UTC)
 * Here are a couple additional references:

The review paper in the journal Cell states that "targeting galectin-1 seems to be a promising therapeutic strategy." Wiki editors can decide what to do with this. Fpbear (talk) 22:09, 4 May 2019 (UTC)

adding oral health/ periodontitis as a risk factor
Good day, Suggested addition under "Risk factors", last line of the first section above "Alcohol":

- Periodontal disease has been shown to be associated with a moderate increase risk {PMID: 24855008)

Let me know if it is OK with you for the style. Best Jacques ScienceGlee (talk) 21:49, 24 June 2019 (UTC)

Experiences and Care needs
"Pancreatic cancer is associated with a decreased quality of life. The early identification and palliation of symptoms is therefore an important aspect of patient care. There is evidence to suggest that the severity of these symptoms can predict prognosis and survival."

Were does this ref say this? Or am I looking at the wrong spot? Doc James (talk · contribs · email) 13:30, 5 November 2019 (UTC)

Updated incidence and mortality 2018
Incidence and mortality and 5-year prevalence to indicate 2018 numbers
 * Incidence: 458 918
 * Mortality: 432 242
 * 5-year period prevalence: 282 574
 * 6th most common cause of death globally.

--Astroketh (talk) 09:25, 8 November 2019 (UTC)
 * The table with mortality figures in the Outcomes section is twenty years old. Do we not have more recent data available? -Ad Orientem (talk) 03:17, 30 December 2019 (UTC)
 * The ref is dated 2014. Obviously (I hope) a table of 5-year survival rates based on diagnoses up to 1998 is not yet "twenty years old"! On a quick look, the same source has newer figures, but very differently presented, & I don't feel safe updating these myself. Perhaps an expert could do it? Unsurprisingly, they are still pretty poor. Johnbod (talk) 03:38, 30 December 2019 (UTC)

Survival on diagnosis
I removed "Life expectancy 4-6 months; " -from the infobox. It certainly doesn't belong there, presented like that. UK figures btw, & iffy source. If anyone has better-sourced data for average survival, or 12 month survival, upon diagnosis, that would be welcome in the main text. Johnbod (talk) 23:13, 21 February 2020 (UTC)

Lancet seminar
10.1016/S0140-6736(20)30974-0 JFW &#124; T@lk  14:50, 1 July 2020 (UTC)

Pancreatic cancer and ethnicity
The article mentions African-Americans have a higher incidence of pancreatic cancer, but it doesn't make clear whether this is because of increased biological susceptibility or because of sociological reasons. 2601:600:A37F:F111:A556:5019:ABC3:190D (talk) 00:43, 30 August 2020 (UTC)
 * Or lifestyle, perhaps the most likely. Johnbod (talk) 01:40, 30 August 2020 (UTC)

Distribution → Epidemiology
I suggest to rename «Distribution» section. Any objections? AXO NOV (talk) ⚑ 11:03, 20 March 2021 (UTC)
 * No objection; epidemiology is the preferred section heading per WP:MEDMOS, though distribution has less of a jargon feel to it. I'm afraid though I respectfully disagree with the new "Pathology" section you added, with information on the role of gut microbiota on the pathogenesis of the disease. There is already a Histopathology section in this featured article. Moreover, "Pathology" as a heading is not ideal for the information you contribute; it doesn't need a new section anyway, it fits in "Risk factors", if it is eventually included. (Allow me some time to check out your references and have an opinion if this information from primary sources is useful for the article.) Finally, I am not passing any judgement on your edit summary, being a non-native English speaker myself I understand how written comments may not make justice to one's intentions; it's impossible to rewrite it anyway. NikosGouliaros (talk) 14:09, 20 March 2021 (UTC)
 * Please refer to a separate section discussing recent changes here. I also appreciate your efforts in assessing sources. They don't seem to be very speculative and number of people involved is impressing. I wish you read «The fungal mycobiome promotes pancreatic oncogenesis via activation of MBL» in full. Please take a note that the study mostly concerns animals, not humans. -- AXO NOV  (talk) ⚑ 19:09, 20 March 2021 (UTC)
 * Objection - I prefer "distribution" as more easily understood. Johnbod (talk) 20:02, 20 March 2021 (UTC)

Pathology and Cancerogenic fungus

 * What's your justification? Primary Sources aren't completely disallowed and I believe that you are driven mostly by misapplication of cited guideline (WP:MEDRS). You can also clarify why you invoked WP:ENGVAR?
 * I know that the is primary-sourced but I believe they are eligible as long we clearly state that this is a single study and conclusions are rather NOT well-established facts. Considering that microbiota is long suspected to be involved in whole range of cancerous growths (there is even a whole article devoted for that: Carcinogenic bacteria) you cannot blame me for bringing an indiscriminate piece of information.--  AXO NOV  (talk) ⚑ 19:08, 20 March 2021 (UTC)


 * I see no other fitting the best but I see no problem placing it under any other section either. I believe that Pathology is the most suitable here as risk factors aren't primary cause and histopathology concerns diagnosis of the tumor on the tissue level. It doesn't mean investigation into possible root-cause or primary pathogenic factor. Feel free to move it around if you wish. I stand just for mentioning the fact finding of possible relationship for the sake of curiosity of potential researchers here. --  AXO NOV  (talk) ⚑ 19:08, 20 March 2021 (UTC)


 * I think as well as WP:MEDRS, WP:EXCEPTIONAL, WP:WEIGHT and maybe WP:FRINGE apply here. If the ideas in the proposed content are not part of the fabric of the secondary literature, how can we be sure we are properly reflecting accepted knowledge as we are meant to be doing? Alexbrn (talk) 19:15, 20 March 2021 (UTC)
 * No relation to WP:MEDRS. WP:FRINGE and WP:EXCEPTIONAL are even ridiculous to mention here as the amended doesn't have to do with anything exceptional: the development of cancer is often attributed to infections and it's well established fact.  Are you going to ignore it?--  AXO NOV  (talk) ⚑ 20:51, 20 March 2021 (UTC)
 * Yes, and the relationship between fungus and cancer is also a well-known locus of quackery (see Tullio Simoncini e.g.). But this is beside the point, we need secondary sources for weight and reliability, and that's the way it works here. You are attempting to change the guidelines, I see. Well then.Alexbrn (talk) 20:56, 20 March 2021 (UTC)
 * Thanks for letting me know. That's notable case. Thankfully, I didn't claim anything close to that, nor cited researchers did. It would be too bold if not dumb. The only thing I regret mentioned is humans: the concerned studies were done only on mice. What is important in this case is that researchers described biological pathways in great details. To be precise, they discovered mediation of cancerous growth via mannose-binding lectin (MBL). That's why I consider it worth noting. It's inconclusive for humans though so should be mentioned as such. -- AXO NOV  (talk) ⚑ 21:26, 20 March 2021 (UTC)
 * The research might be wrong. Much is. Your statement "I consider it worth noting" should reveal to you how you are engaging in WP:OR, which is prohibited by policy. Why should Wikipedia be a text to imply the importance of some research, that has otherwise been ignored by reliable sources? Alexbrn (talk) 01:02, 21 March 2021 (UTC)
 * Agreed. once it turns up in secondary sources, fine. That's the way we do things. Johnbod (talk) 20:03, 20 March 2021 (UTC)


 * No need for secondary sources for statements above. The guidelines perfectly allow primary ones. Seems no reasonable objections. -- AXO NOV  (talk) ⚑ 20:51, 20 March 2021 (UTC)
 * You think? In WP:MEDRS, "all biomedical information must be based on reliable, third-party published secondary sources, and must accurately reflect current knowledge" seems pretty clear. Johnbod (talk) 21:12, 20 March 2021 (UTC)


 * I may be wrong, who knows, let's see! AXO NOV  (talk) ⚑ 21:36, 20 March 2021 (UTC)
 * @Alexander Davronov, instead of trying to change the guideline, why don't you just read these 38 sources that seem to cite your primary source and see what they have to say about it? If most of them approve of the research, and if they're in good journals (try https://www.scopus.com/sources if you're not familiar with some of them), then you could re-write this from purely secondary review articles. WhatamIdoing (talk) 05:40, 21 March 2021 (UTC)
 * Thanks for letting me know. I'm already working on it. -- AXO NOV  (talk) ⚑ 20:56, 21 March 2021 (UTC)


 * It seems that Alexander_Davronov is placing the same sort of thing over on Malassezia, the article on the fungus involved. I believe that many of the same MEDRS issues apply there. More eyes would be appreciated. - MrOllie (talk) 21:21, 23 March 2021 (UTC)

See also section, add Europac wikilink?
Hi, after seeing edit notice, I'm presenting here. Would it be Okay to add Europac to See also section? Maybe like * Europac - European Registry of Hereditary Pancreatic Diseases, or similar. JoeNMLC (talk) 18:16, 22 October 2021 (UTC)
 * Ok, Johnbod (talk) 03:33, 23 October 2021 (UTC)
 * ✅ - JoeNMLC (talk) 13:42, 23 October 2021 (UTC)

Outcomes
The table in the outcomes section is based on data that is almost 25 years old. Is that the most recent available? -Ad Orientem (talk) 00:00, 17 April 2022 (UTC)
 * Ok, I'm going to explain this (again) very slowly. To get a "5 year survival" rate for diagnoses up to 1998, you have to wait five years, and see how many people are still alive in 2003. That's what it means. The access date on the ref is 2014, & it was no doubt then the most recent data available. Probably there are later figures available now (but frankly they won't have shifted much). Johnbod (talk) 02:50, 17 April 2022 (UTC)
 * Gotcha. Thanks. -Ad Orientem (talk) 02:52, 17 April 2022 (UTC)
 * Actually they now have figures based on diagnoses to 2017, so bang up to date. I'll update the table soon. Johnbod (talk) 02:53, 17 April 2022 (UTC)
 * Oops, these are the relative survival rates, different & less useful frankly. Johnbod (talk) 02:56, 17 April 2022 (UTC)
 * I think I got the gist. If you get diagnosed with this, in all but the rarest cases you should make sure your affairs are in order and start shopping for a plot. -Ad Orientem (talk) 03:01, 17 April 2022 (UTC)
 * It depends which type, and early diagnosis is absolutely crucial, but most cases are only diagnosed rather late. Johnbod (talk) 03:12, 17 April 2022 (UTC)