Pancreatic cancer
Classification and external resources
ICD-10	C25
ICD-9	157.9
OMIM	260350
DiseasesDB	9510
MedlinePlus	000236
eMedicine	med/1712
MeSH	D010190

Pancreatic cancer refers to a malignant neoplasm originating from transformed cells arising in tissues forming the pancreas. The most common type of pancreatic cancer, accounting for 95% of these tumors, is adenocarcinoma (tumors exhibiting glandular architecture on light microscopy) arising within the exocrine component of the pancreas. A minority arise from islet cells, and are classified as neuroendocrine tumors. The symptoms that lead to diagnosis depend on the location, the size, and the tissue type of the tumor. They may include abdominal pain and jaundice (if the tumor compresses the bile duct).

Pancreatic cancer is the fourth most common cause of cancer-related deaths across the globe.^[1] Pancreatic cancer often has a poor prognosis: for all stages combined, the 1- and 5-year relative survival rates are 25% and 6%, respectively;^[2] for local disease the 5-year survival is approximately 20%^[2][3] while the median survival for locally advanced and for metastatic disease, which collectively represent over 80% of individuals,^[3] is about 10 and 6 months respectively.^[4]

Signs and symptoms[link]

Early pancreatic cancer often does not cause symptoms,^[5] and the later symptoms are usually nonspecific and varied.^[5] Therefore, pancreatic cancer is often not diagnosed until it is advanced.^[5] Common symptoms include:

• Pain in the upper abdomen that typically radiates to the back^[5] (seen in carcinoma of the body or tail of the pancreas)
• Loss of appetite and/or nausea and vomiting^[5]
• Significant weight loss
• Painless jaundice (yellow tint to whites of eyes and/or yellowish skin in serious cases, possibly in combination with darkened urine)^[5] when a cancer of the head of the pancreas (75% of cases)^[6] obstructs the common bile duct as it runs through the pancreas. This may also cause pale-colored stool and steatorrhea. The jaundice may be associated with itching as the salt from excess bile can cause skin irritation.
• Trousseau sign, in which blood clots form spontaneously in the portal blood vessels, the deep veins of the extremities, or the superficial veins anywhere on the body, is sometimes associated with pancreatic cancer.
• Diabetes mellitus, or elevated blood sugar levels. Many patients with pancreatic cancer develop diabetes months to even years before they are diagnosed with pancreatic cancer, suggesting new onset diabetes in an elderly individual may be an early warning sign of pancreatic cancer.^[7]
• Clinical depression has been reported in association with pancreatic cancer, sometimes presenting before the cancer is diagnosed. However, the mechanism for this association is not known.^[8]
• Symptoms of pancreatic cancer metastasis. Typically, pancreatic cancer first metastasizes to regional lymph nodes, and later to the liver and, less commonly, to the lungs;^[9] it occasionally metastasizes to bone or brain.^[10]

Risk factors[link]

Risk factors for pancreatic cancer may include:^[5][11]

• Family history: 5–10% of pancreatic cancer patients have a family history of pancreatic cancer. The genes have not been identified. Pancreatic cancer has been associated with the following syndromes: autosomal recessive ataxia-telangiectasia and autosomal dominantly inherited mutations in the BRCA2 gene and PALB2 gene, Peutz-Jeghers syndrome due to mutations in the STK11 tumor suppressor gene, hereditary non-polyposis colon cancer (Lynch syndrome), familial adenomatous polyposis, and the familial atypical multiple mole melanoma-pancreatic cancer syndrome (FAMMM-PC) due to mutations in the CDKN2A tumor suppressor gene.^[12][13] There may also be a history of familial pancreatitis.^[12]
• Age. The risk of developing pancreatic cancer increases with age. Most cases occur after age 60, while cases before age 40 are uncommon.
• Smoking. Cigarette smoking has a risk ratio of 1.74 with regard to pancreatic cancer; a decade of nonsmoking after heavy smoking is associated with a risk ratio of 1.2.^[14]
• Diets low in vegetables and fruits^[15]
• Diets high in red meat. Processed meat consumption is positively associated with pancreatic cancer risk, and red meat consumption was associated with an increased risk of pancreatic cancer in men.^[16]
• Diets high in sugar-sweetened drinks (soft drinks).^[17] In particular, the common soft drink sweetener fructose has been linked to growth of pancreatic cancer cells.^[18]
• Obesity^[19]
• Diabetes mellitus is both risk factor for pancreatic cancer, and, as noted earlier, new onset diabetes can be an early sign of the disease.^{[clarification needed how much]}
• Chronic pancreatitis has been linked, but is not known to be causal. The risk of pancreatic cancer in individuals with familial pancreatitis is particularly high.
• Helicobacter pylori infection^[20][21]
• Gingivitis or periodontal disease^[22]

Alcohol[link]

It is controversial whether alcohol consumption is a risk factor for pancreatic cancer. Overall, the association is consistently weak and the majority of studies have found no association.^{[23][24][25][26]} Although drinking alcohol excessively is a major cause of chronic pancreatitis, which in turn predisposes to pancreatic cancer, chronic pancreatitis associated with alcohol consumption is less frequently a precursor for pancreatic cancer than other types of chronic pancreatitis.^[27]

Some studies suggest a relationship,^[28] the risk increasing with increasing amount of alcohol intake.^[29][30] The risk is greatest in heavy drinkers,^[31][32][33] mostly on the order of four or more drinks per day.^[34] There appears to be no increased risk for people consuming up to 30g of alcohol a day,^[26][35][36] which is approximately 2 alcoholic beverages/day,^[36] so most people who take alcohol do so at a level that "is probably not a risk factor for pancreatic cancer".^[33] A pooled analysis concluded, "Our findings are consistent with a modest increase in risk of pancreatic cancer with consumption of 30 or more grams of alcohol per day".^[36]

Several studies caution that their findings could be due to confounding factors.^[32][37] Even if a link exists, it "could be due to the contents of some alcoholic beverages"^[38] other than the alcohol itself. One Dutch study even found that drinkers of white wine had lower risk.^[39]

Diagnosis[link]

Axial CT image with i.v. contrast. Macrocystic adenocarcinoma of the pancreatic head.

Most patients with pancreatic cancer experience pain, weight loss, or jaundice.^[40]

Pain is present in 80% to 85% of patients with locally advanced or advanced metastatic disease. The pain is usually felt in the upper abdomen as a dull ache that radiates straight through to the back. It may be intermittent and made worse by eating. Weight loss can be profound; it can be associated with anorexia, early satiety, diarrhoea, or steatorrhea. Jaundice is often accompanied by pruritus and dark urine. Painful jaundice is present in approximately one-half of patients with locally unresectable disease, while painless jaundice is present in approximately one-half of patients with a potentially resectable and curable lesion.

The initial presentation varies according to location of the cancer. Malignancies in the pancreatic body or tail usually present with pain and weight loss, while those in the head of the gland typically present with steatorrhea, weight loss, and jaundice. The recent onset of atypical diabetes mellitus, a history of recent but unexplained thrombophlebitis (Trousseau sign), or a previous attack of pancreatitis are sometimes noted. Courvoisier sign defines the presence of jaundice and a painlessly distended gallbladder as strongly indicative of pancreatic cancer, and may be used to distinguish pancreatic cancer from gallstones. Tiredness, irritability and difficulty eating because of pain also exist. Pancreatic cancer is often discovered during the course of the evaluation of aforementioned symptoms.

Liver function tests can show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, γ-glutamyl transpeptidase and alkaline phosphatase levels). CA19-9 (carbohydrate antigen 19.9) is a tumor marker that is frequently elevated in pancreatic cancer. However, it lacks sensitivity and specificity. When a cutoff above 37 U/mL is used, this marker has a sensitivity of 77% and specificity of 87% in discerning benign from malignant disease. CA 19-9 might be normal early in the course, and could be elevated because of benign causes of biliary obstruction.^[41] Imaging studies, such as computed tomography (CT scan) and endoscopic ultrasound (EUS) can be used to identify the location and form of the cancer.

Pathophysiology[link]

Micrograph of pancreatic ductal adenocarcinoma (the most common type of pancreatic cancer). H&E stain.

The definitive diagnosis is made by an endoscopic needle biopsy or surgical excision of the radiologically suspicious tissue. Endoscopic ultrasound is often used to visually guide the needle biopsy procedure.^[42]

Exocrine pancreas cancers[link]

Micrographs of normal pancreas, pancreatic intraepithelial neoplasia (precursors to pancreatic carcinoma) and pancreatic carcinoma. H&E stain.

The most common form of pancreatic cancer (ductal adenocarcinoma) is typically characterized by moderately to poorly differentiated glandular structures on microscopic examination. Pancreatic cancer has an immunohistochemical profile that is similar to hepatobiliary cancers (e.g. cholangiocarcinoma) and some stomach cancers; thus, it may not always be possible to be certain that a tumour found in the pancreas arose from it.

Cross section of a human liver, taken at autopsy examination, showing multiple large pale tumor deposits. The tumor is an adenocarcinoma derived from a primary lesion in the body of the pancreas.

Pancreatic carcinoma is thought to arise from progressive tissue changes. Three types of precancerous lesion are recognised: pancreatic intraepithelial neoplasia - a microscopic lesions of the pancreas, intraductal papillary mucinous neoplasms and mucinous cystic neoplasms both of which are macroscopic lesions.^[43] The cellular origin of these lesions is debated.

The second most common type of exocrine pancreas cancer is mucinous.  ^[discuss] The prognosis is slightly better.   ^[discuss]

Other exocrine cancers include adenosquamous carcinomas, signet ring cell carcinomas, hepatoid carcinomas, colloid carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with osteoclast-like giant cells.^[44]

Pancreatic cystic neoplasms[link]

Pancreatic cystic neoplasms are a broad group of pancreas tumors that have varying malignant potential.^[discuss]

Pancreatic neuroendocrine tumors (PNET)[link]

Endocrine pancreatic tumors have been variously called islet cell tumors, pancreas endocrine tumors (PETs), and pancreatic neuroendocrine tumors (PNETs).^[45] The annual clinically recognized incidence is low, about five per one million person-years.^[44] However, autopsy studies incidentally identify PETs in up to 1.5%^[4] most of which would remain inert and asymptomatic.^[4]

The majority of PNETs are usually categorized as benign^[46][47][48] but the definition of malignancy in pancreas endocrine tumors has been ambiguous. A small subset of endocrine pancreatic tumors are incontrovertible pancreatic endocrine cancers, that make up about 1% of pancreas cancers.^[44][45] Low- to intermediate-grade neuroendocrine carcinomas of the pancreas may be called islet cell tumors. Some sources have also termed these pancreatic carcinoid,^[45] a practice that has sometimes been strongly condemned.^{[citation needed]} Definitional migration has caused some complexity of PNET classification,^[45] which has adversely affected what is known about the epidemiology and natural history of these tumors.^[45] It is probable that some of these tumors have been included in ICD-O-3 histology classifications 8240–8245, in that they were labeled pancreatic carcinoid tumours^[45][49] but most islet cell carcinomas have been coded as ICD-O-3 system 8150–8155.^[45]

The more aggressive endocrine pancreatic cancers are known as pancreatic neuroendocrine carcinomas (PNEC). Similarly, there has likely been a degree of admixture of PNEC and extrapulmonary small cell cancer.^{[citation needed]}

Prevention[link]

According to the American Cancer Society, there are no established guidelines for preventing pancreatic cancer, although cigarette smoking has been reported as responsible for 20–30% of pancreatic cancers.^[50]

The ACS recommends keeping a healthy weight, and increasing consumption of fruits, vegetables, and whole grains, while decreasing red meat intake, although there is no consistent evidence this will prevent or reduce pancreatic cancer specifically.^[51][52] In 2006, a large prospective cohort study of over 80,000 subjects failed to prove a definite association.^[53] The evidence in support of this lies mostly in small case-control studies.^[15]

A long-term study found that people who consumed in the range of 300 to 449 international units (IU) of vitamin D daily had a 43% lower risk of pancreatic cancer than those who took less than 150 IU per day;^[54][55] 150 IU is appreciably less than what was then, or is now, recommended.^[56] The World Health Organization (WHO) International Agency for Research on Cancer (IARC), concluded that there were insufficient studies in pancreatic cancer, and while it found evidence for an inverse association between vitamin D and colorectal cancer to be persuasive, it found evidence for a causal link to be limited, and also found that randomized controlled trials (RCTs) were inconclusive.^[57] Taking too much vitamin D may be harmful.^[56] Poor general diet, obesity, and relative physical inactivity can be risk factors in some cancers, so the role of vitamin D itself is not certain.^[58]

B vitamins, such as B₁₂, B₆, and folate, can reduce the risk of pancreatic cancer when consumed in food, but not when ingested in vitamin tablet form.^[59][60]

Screening[link]

People who may have a high risk of pancreatic cancer due to a family history can be followed, but there is no consensus on what constitutes optimal monitoring. Several small studies have shown promising preliminary results for new biomarkers, but further validation on a larger scale is needed. People with pancreatic cancer themselves, or family members, may wish to participate in the activities at a research facility, or identify a pancreas tumor registry.

Treatment[link]

Exocrine pancreas cancer[link]

Surgery[link]

Treatment of pancreatic cancer depends on the stage of the cancer.^[61] Although only localized cancer is considered suitable for surgery with curative intent at present, only ~20% of cases present with localised disease at diagnosis.^[62] Surgery can also be performed for palliation, if the malignancy is invading or compressing the duodenum or colon. In such cases, bypass surgery might overcome the obstruction and improve quality of life but is not intended as a cure.^[42]

The Whipple procedure is the most common attempted curative surgical treatment for cancers involving the head of the pancreas. This procedure involves removing the pancreatic head and the curve of the duodenum together (pancreato-duodenectomy), making a bypass for food from stomach to jejunum (gastro-jejunostomy) and attaching a loop of jejunum to the cystic duct to drain bile (cholecysto-jejunostomy). It can be performed only if the patient is likely to survive major surgery and if the cancer is localized without invading local structures or metastasizing. It can, therefore, be performed in only the minority of cases.

Cancers of the tail of the pancreas can be resected using a procedure known as a distal pancreatectomy.^[61] Recently, localized cancers of the pancreas have been resected using minimally invasive (laparoscopic) approaches.^[63]

After surgery, adjuvant chemotherapy with gemcitabine has been shown in several large randomized studies to significantly increase the 5-year survival (from approximately 10 to 20%), and should be offered if the patient is fit after surgery (Oettle et al. JAMA 2007, Neoptolemos et al. NEJM 2004, Oettle et al. ASCO proc 2007).

Radiation[link]

Principles of radiation therapy in pancreas adenocarcinoma are reviewed extensively in guidelines by the NCCN.^[64] Radiation can be considered in several situations. One situation is the addition of radiation therapy after potentially curative surgery. Groups in the US have been more apt to use adjuvant radiation therapy than groups in Europe.^[65]

Chemotherapy[link]

In patients not suitable for resection with curative intent, palliative chemotherapy may be used to improve quality of life and gain a modest survival benefit. Gemcitabine was approved by the United States Food and Drug Administration in 1998, after a clinical trial reported improvements in quality of life and a 5-week improvement in median survival duration in patients with advanced pancreatic cancer. This marked the first FDA approval of a chemotherapy drug primarily for a nonsurvival clinical trial endpoint. Gemcitabine is administered intravenously on a weekly basis.

A Canadian-led Phase III randomised controlled trial, reported in 2005, involved 569 patients with advanced pancreatic cancer, led the US FDA in 2005 to license erlotinib (Tarceva) in combination with gemcitabine as a palliative regimen for pancreatic cancer. This trial compared the outcome of gemcitabine/erlotinib to gemcitabine/placebo, and demonstrated improved survival rates, improved tumor response and improved progression-free survival rates.^[66][67] Other trials are now investigating the effect of the above combination in the adjuvant (post surgery) and neoadjuvant (pre-surgery) settings.

Addition of oxaliplatin to Gemcitabine (Gem/Ox) was shown to confer benefit in small trials, but is not yet standard therapy.^[68]

Pancreatic neuroendocrine tumors (PNET)[link]

The majority of these tumors are histologically benign. Treatment of pancreatic endocrine tumors, including the less common malignant tumors, may include:

• Watchful waiting: incidentally identified small tumors, for example on a computed tomography (CT) scan performed for other purposes, may conceptually not always need intervention, but criteria for watchful waiting are unclear.

• Surgery: tumors within the pancreas only (localized tumors), or with limited metastases, may be removed. For localized tumors, the surgical procedure is much less extensive than the types of surgery used to treat pancreatic adenocarcinoma.

• Hormone therapy: if the tumor is not amenable to surgical removal and is causing symptoms by secreting functional hormones, a synthetic hormone analog medication, octreotide, may lessen the symptoms, and sometimes also slows tumor growth.

• Radiation therapy: occasionally used if there is pain due to anatomic extension, such as metastasis to bone.

• Radiolabeled hormone: some PNETs absorb a hormone called norepinephrine and these may respond to nuclear medicine medication, radiolabeled MIBG therapy (or, experamentally, other hormones), given intravenously.

• Radiofrequency ablation (RFA), cryoablation, hepatic artery embolization

• Chemotherapy and targeted medication for PNETs receive Wikipedia discussion in the relevant section of that article.

Prognosis[link]

Age-standardized death from pancreatic cancer per 100,000 inhabitants in 2004.^[69]

  no data

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Exocrine pancreatic cancer (adenocarcinoma and less common variants) typically has a poor prognosis, partly because the cancer usually causes no symptoms early on, leading to locally advanced or metastatic disease at time of diagnosis.

Pancreatic cancer may occasionally result in diabetes. Insulin production is hampered, and it has been suggested the cancer can also prompt the onset of diabetes and vice versa.^[70] It can be associated with pain, fatigue, weight loss, jaundice, and weakness. Additional symptoms are discussed above.

For pancreatic cancer:

• For all stages combined, the 1-year relative survival rate is 25%, and the 5-year survival is estimated as less than 5% ^[71] to 6%.^[2]
• For local disease, the 5-year survival is approximately 20%.^[2][3]
• For locally advanced and for metastatic disease, which collectively represent over 80%^[3] to 85-90%^[12] of individuals, the median survival is about 10 and 6 months, respectively.^[4] Without active treatment, metastatic pancreatic cancer has a median survival of 3–5 months;^[12] complete remission is rare.^[12]

Outcomes with pancreatic endocrine tumors, many of which are benign and completely without clinical symptoms, are much better, as are outcomes with symptomatic benign tumors; even with actual pancreatic endocrine cancers, outcomes are rather better, but variable.^[45][72]

In 2010, an estimated 43,000 people in the US were diagnosed with pancreas cancer^[2] and almost 37,000 died from the disease;^[2] pancreatic cancer has one of the highest fatality rates of all cancers, and is the fourth-highest cancer killer among both men and women worldwide.^[73] Although it accounts for only 2.5% of new cases, pancreatic cancer is responsible for 6% of cancer deaths each year.^[74]

See also[link]

• Category:Deaths from pancreatic cancer
• Category:Pancreatic cancer survivors
• Gastrointestinal cancer
• Pancreatic Cancer Action Network (organization in the US)
• Pancreatic Cancer Action (organization in the UK)

References[link]

External links[link]

Wikimedia Commons has media related to: Pancreatic cancer

• Pancreatic cancer at the Open Directory Project

Randy Pausch
Randy Pausch
Born	(1960-10-23)October 23, 1960 Baltimore, Maryland, US
Died	July 25, 2008(2008-07-25) (aged 47) Chesapeake, Virginia, United States Pancreatic cancer
Nationality	American
Fields	Computer science Human Computer Interaction
Institutions	Carnegie Mellon University University of Virginia
Alma mater	Brown University Carnegie Mellon University
Doctoral advisor	Alfred Spector
Known for	Creator of Alice software project Cofounder of CMU's Entertainment Technology Center Virtual Reality Research with Disney Imagineers Inspirational speeches regarding life #1 best-selling book Battle with cancer
Notable awards	Karl V. Karlstrom Outstanding Educator Award ACM Special Interest Group on Computer Science Education Award for Outstanding Contributions to Computer Science Education Fellow of the ACM Time's Time 100[1]
Spouse	Jai Glasgow

Randolph Frederick "Randy" Pausch^[2] (October 23, 1960 – July 25, 2008) was an American professor of computer science and human-computer interaction and design at Carnegie Mellon University (CMU) in Pittsburgh, Pennsylvania.

Pausch learned that he had pancreatic cancer in September 2006, and in August 2007 he was given a terminal diagnosis: "3 to 6 months of good health left". He gave an upbeat lecture titled "The Last Lecture: Really Achieving Your Childhood Dreams" on September 18, 2007, at Carnegie Mellon, which became a popular YouTube video and led to other media appearances. He then co-authored a book called The Last Lecture on the same theme, which became a New York Times best-seller.

Pausch died of complications from pancreatic cancer on July 25, 2008.

Early life[link]

Pausch was born in Baltimore, Maryland, and grew up in Columbia, Maryland.^[2] After graduating from Oakland Mills High School in Columbia, Pausch received his bachelor's degree in computer science from Brown University in May 1982 and his Ph.D. in computer science from Carnegie Mellon University in August 1988.^{[3][not in citation given]} While completing his doctoral studies, Pausch was briefly employed at Xerox Palo Alto Research Center and Adobe Systems.^[4]

Computer science career[link]

Pausch was an assistant and associate professor in the Department of Computer Science at the University of Virginia's School of Engineering and Applied Science from 1988 until 1997. While there, he completed sabbaticals at Walt Disney Imagineering and Electronic Arts (EA). In 1997, Pausch became Associate Professor of Computer Science, Human-Computer Interaction and Design, at Carnegie Mellon University. He was a co-founder in 1998, along with Don Marinelli, of CMU's Entertainment Technology Center (ETC), and he started the Building Virtual Worlds^[5] course at CMU and taught it for 10 years. He consulted with Google on user interface design and also consulted with PARC, Imagineering, and Media Metrix.^[4] Pausch is also the founder of the Alice software project.^[6] He received the National Science Foundation Presidential Young Investigator Award and was a Lilly Foundation Teaching Fellow.^[7] Pausch was the author or co-author of five books and over 70 articles.

Pausch received two awards from ACM in 2007 for his achievements in computing education: the Karl V. Karlstrom Outstanding Educator Award and the ACM Special Interest Group on Computer Science Education Award for Outstanding Contributions to Computer Science Education.^[8] He was also inducted as a Fellow of the ACM in 2007.

Cancer and death[link]

Pausch was diagnosed with pancreatic cancer^[9][10] and underwent a Whipple procedure (pancreaticoduodenectomy) on September 19, 2006, in an unsuccessful attempt to halt his pancreatic cancer.^[11] He was told in August 2007 to expect a remaining three to six months of good health. He soon moved his family to Chesapeake, Virginia, a suburb near Norfolk, to be close to his wife's family. On March 13, 2008, Pausch advocated for greater federal funding for pancreatic cancer before the United States Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.^[12] In the week prior to this, he had been hospitalized in order to have needle aspiration of pleural effusion in his right lung.^[13]

On May 2, 2008, a positron emission tomography (PET) scan showed that he had very tiny (5 millimetres (0.20 in) or less) metastases in his lungs and some lymph nodes in his chest. He also had some metastases in his peritoneal and retroperitoneal cavities. On June 26, 2008, Pausch indicated that he was considering stopping further chemotherapy because of the potential adverse side effects. He was, however, considering some immuno-therapy-based approaches.^[14] On July 24, on behalf of Pausch, a friend anonymously posted a message on Pausch's webpage stating that a biopsy had indicated that the cancer had progressed further than what was expected from recent PET scans and that Pausch had "taken a step down" and was "much sicker than he had been". The friend also stated that Pausch had then enrolled in a hospice program designed to provide palliative care to those at the end of life.^[14]

Wikinews has related news: "Last Lecture" Professor Randy Pausch dies at age 47

Pausch died from pancreatic cancer at his family's home in Chesapeake, Virginia on July 25, 2008, at the age of 47. He is survived by his wife, Jai, and their three children, Dylan, Logan, and Chloe.^[15]

[edit] Really Achieving Your Childhood Dreams

Pausch delivered his "Last Lecture", titled Really Achieving Your Childhood Dreams, at CMU on September 18, 2007.^[16] He gave an abridged version of his speech on the Oprah show in October 2007.^[17][18] The talk was modeled after an ongoing series of lectures where top academics are asked to think deeply about what matters to them, and then give a hypothetical "final talk", with a topic such as "what wisdom would you try to impart to the world if you knew it was your last chance?" Before speaking, Pausch received a long standing ovation from a large crowd of over 400 colleagues and students. When he motioned them to sit down, saying, "Make me earn it," someone in the audience shouted back, "You did!"^[9][19]

During the lecture, Pausch was upbeat and humorous, alternating between wisecracks, insights on computer science and engineering education, advice on building multi-disciplinary collaborations, working in groups and interacting with other people, offering inspirational life lessons, and performing push-ups on stage. He also commented on the irony that the "Last Lecture" series had recently been renamed as "Journeys", saying, "I thought, damn, I finally nailed the venue and they renamed it."^[15] After Pausch finished his lecture, Steve Seabolt, on behalf of Electronic Arts—which is now collaborating with CMU in the development of Alice 3.0^[20]—pledged to honor Pausch by creating a memorial scholarship for women in computer science, in recognition of Pausch's support and mentoring of women in CS and engineering.^[9]

CMU president Jared Cohon spoke emotionally of Pausch's humanity and called his contributions to the university and to education "remarkable and stunning".^[21] He then announced that CMU will celebrate Pausch's impact on the world by building and naming after Pausch a raised pedestrian bridge^[22] to connect CMU's new Computer Science building and the Center for the Arts, symbolizing the way Pausch linked those two disciplines. Brown University professor Andries van Dam followed Pausch's last lecture with a tearful and impassioned speech praising him for his courage and leadership, calling him a role model.^[21][23][24]

The Randy Pausch Memorial Footbridge was dedicated on October 30, 2009, with Jai, Dylan, Logan and Chloe Pausch cutting the ribbon.

[edit] The Last Lecture

The Disney-owned publisher Hyperion paid $6.7 million for the rights to publish a book about Pausch called The Last Lecture, co-authored by Pausch and Wall Street Journal reporter Jeffrey Zaslow.^[25] The book became a New York Times best-seller on April 28, 2008.^[26] The Last Lecture expands on Pausch's speech. The book's first printing had 400,000 copies, and it has been translated into 46 languages. It has spent more than 85 weeks on The New York Times bestseller list, and there are now more than 4.5 million copies in print in the U.S. alone. Despite speculation that the book would be made into a movie, Pausch had denied these rumors, stating that "there's a reason to do the book, but if it's telling the story of the lecture in the medium of film, we already have that."^[27]

Media coverage[link]

Pausch was named "Person of the Week" on ABC's World News with Charles Gibson on September 21, 2007.^[28] His "Last Lecture" attracted wide attention from the international media,^[29] became an Internet hit, and was viewed over a million times in the first month after its delivery.^[30] On October 22, 2007, Pausch appeared on The Oprah Winfrey Show where he discussed his situation and summarized his "Last Lecture".^[18] On October 6, 2007, Pausch joined the Pittsburgh Steelers for the day during their regular practice, after the organization learned that one of his childhood dreams mentioned in his "Last Lecture" was to play in the NFL.^[31] On April 9, 2008, the ABC network aired an hour long Diane Sawyer feature on Pausch titled "The Last Lecture: A Love Story For Your Life".^[32][33] On July 29, 2008, ABC aired a follow up to the Last Lecture special, remembering Pausch and his famous lecture.^[34]

Other lectures and appearances[link]

Pausch gave a lecture about time management^[35] on November 27, 2007 at the University of Virginia, to an audience of over 850 people.^[36] In March 2008, Pausch appeared in a public service announcement video^[37] and testified before Congress in support of cancer research.^[38] On May 18, 2008, Pausch made a surprise return appearance at Carnegie Mellon, giving a speech at the commencement ceremony,^[39] as well as attending the School of Computer Science's diploma ceremony,^[40] and on May 19 Pausch appeared on the Good Morning America show.^[41] His lecture, "Really Achieving Your Childhood Dreams", was nominated at the 2007 YouTube Video Awards.^[42][43]

A devoted Star Trek fan, Pausch was invited by film director J. J. Abrams to film a role in Star Trek. Abrams heard of Pausch's condition and sent a personal e-mail inviting Pausch to the set. Pausch accepted and traveled to Los Angeles, California to shoot his scene. In addition to appearing in the film, he also has a line of dialogue at the beginning of the film ("Captain, we have visual.") and donated the $217.06 paycheck to charity.^[44][45]

Honors[link]

• The Pittsburgh City Council declared November 19, 2007 to be "Dr. Randy Pausch Day".^[46]
• In May 2008, Pausch was listed by Time as one of the World's Top-100 Most Influential People.^[1]
• Randy was named Pittsburgher of the Year 2008.^[47]
• On May 30, 2008, Randy received a letter from then President George W. Bush thanking him for his commitment to the Nation's youth.^[48]
• On February 4, 2009, The Walt Disney Company dedicated a tribute plaque at Walt Disney World near the "Mad Tea Party" attraction with a quote by Randy that reads "Be good at something; It makes you valuable ... Have something to bring to the table, because that will make you more welcome."^[49]
• The Walt Disney Company also created the Disney Memorial Pausch Fellowship at Carnegie Mellon University, which will support two graduate students.^[50]
• Per Jared Cohon's announcement on the day of the Last Lecture, a raised pedestrian bridge at CMU that connects the Gates Computer Science building and the Purnell Center for the Arts is named after Pausch, symbolizing the way he linked the two disciplines.^[22]

Other publications[link]

• Adding input and output to the transactional model (Research paper, CMU), 1988
• Dann, Wanda P.; Cooper, Stephen; Pausch, Randy (2005-07-25). Learning to Program with Alice. Prentice Hall. ISBN 0-13-187289-3. http://www.aliceprogramming.net/. 
• Pausch, Randy (2008-08-07). Time Management. ISBN 0-9820556-3-3. 

References[link]

External links[link]

• Quotations related to Randy Pausch at Wikiquote
• Randy Pausch's Home Page at Carnegie Mellon University
• News about Randy Pausch at the University of Virginia
• Randy Pausch's Publications on Google Scholar
• Randy Pausch at the Internet Movie Database

Videos

• The last lecture of Randy Pausch at Youtube
• The last lecture of Randy Pausch at iTunes U
• "Time Management" by Randy Pausch, November 2007 at Google Video (presentation slides)
• Randy Pausch addressing the CMU 2008 graduating class
• Randy Pausch on Good Morning America, May 19, 2008
• An Interview with Steve Seabolt about Randy Pausch - video audio (mp3) with John Ortberg at Menlo Park Presbyterian Church on September 12, 2008
• Randy Pausch's five second Star Trek cameo

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The Cure
The Cure performing in Singapore in 2007. Left to right: Porl Thompson, Jason Cooper (back), Robert Smith, Simon Gallup.
Background information
Origin	Crawley, England
Genres	Gothic rock,[1][2] alternative rock, New Wave, post-punk
Years active	1976–present
Labels	Fiction, Suretone, Geffen, Polydor, Elektra, Asylum, Sire
Associated acts	Malice, Easy Cure, The Glove, Siouxsie and the Banshees
Website	www.thecure.com
Members
Robert Smith Simon Gallup Roger O'Donnell Jason Cooper Reeves Gabrels
Past members
Lol Tolhurst Michael Dempsey Matthieu Hartley Andy Anderson Phil Thornalley Boris Williams Porl Thompson Perry Bamonte

The Cure are an English alternative rock band formed in Crawley, West Sussex in 1976. The band has experienced several line-up changes, with frontman, vocalist, guitarist and principal songwriter Robert Smith being the only constant member. The Cure first began releasing music in the late 1970s with its debut album Three Imaginary Boys (1979); this, along with several early singles, placed the band as part of the post-punk and New Wave movements that had sprung up in the wake of the punk rock revolution in the United Kingdom. During the early 1980s, the band's increasingly dark and tormented music helped form the gothic rock genre.^[1][2][3]

After the release of Pornography (1982), the band's future was uncertain and Smith was keen to move past the gloomy reputation his band had acquired. With the 1982 single "Let's Go to Bed" Smith began to place a pop sensibility into the band's music (as well as a unique stage look). The Cure's popularity increased as the decade wore on, especially in the United States where the songs "Just Like Heaven", "Lovesong" and "Friday I'm in Love" entered the Billboard Hot 100 chart. By the start of the 1990s, The Cure were one of the most popular alternative rock bands in the world. The band is estimated to have sold 27 million albums as of 2004.^[4] The Cure have released thirteen studio albums, 10 EPs and over thirty singles during the course of their career. Since 2010, they have been working on a fourteenth studio album.^[5]