Still very difficult to cure, pancreatic cancer – which struck Sven Goran Eriksson, the former Lazio coach who died today at the age of 76 – is the cancer with the lowest survival rate both one year after diagnosis (34% in men and 37.4% in women) and five years (11% in men and 12% in women). According to the most recent data, 14,500 new cases were estimated in Italy in 2022.
When it manifests
The pancreas produces some very important hormones, including insulin and glucagon (which regulate blood sugar levels). Several enzymes are also manufactured in the pancreas, such as trypsin. Transported by the pancreatic ducts to the intestine, these enzymes contribute to the digestion and absorption of certain types of nutrients. Pancreatic cancer – explain the experts at Airc, the Italian Association for Cancer Research – occurs when some cells, in most cases ductal cells, multiply out of control. Not only that. The tumor cells that grow in the pancreas spread very easily to nearby lymph nodes and other organs such as the liver and lungs, or they spread to the abdomen, giving rise to the so-called peritoneal carcinomatosis.
Who is most at risk?
The subjects most at risk are smokers between 50 and 80 years old of age. According to the report. Cancer numbers in Italy, edited by – among others – the Italian Association of Medical Oncology (Aiom) and the Italian Association of Tumor Registries (Airtum), completely eliminating smoking could potentially prevent 33% of deaths from pancreatic cancer in men and 13% in women. The risk of developing pancreatic cancer also increases in the presence of mutations in specific genes, such as those for a family history of breast and ovarian cancer, and also familial melanoma syndrome with multiple atypical moles, familial pancreatitis, Lynch syndrome and Peutz-Jeghers syndrome.
Other factors that can favor the development of the tumor are:alcohol and coffee abuse, sedentary lifestyle, obesity, presence in the family of cases of pancreatic or breast or colon cancer and occupational exposure to some industrial and agricultural solvents or derivatives of petroleum processing. Furthermore, being a fundamental organ for digestion, diet also plays an important role: a diet rich in fats and animal proteins seems to be associated with an increased risk. It is no coincidence that Eriksson himself had launched a special message last January through numerous interviews: “Take care of your life”.
Symptoms and how to recognize it
Early pancreatic cancer does not present any particular symptoms, and even when they are present, they are rather vague symptoms that can be misinterpreted by both patients and doctors. For these reasons, the diagnosis often arrives when the disease is already in an advanced stage. Among the most obvious symptoms: weight loss and loss of appetite, jaundice (yellowing of the eyes and skin), upper abdominal or back pain, weakness, nausea or vomiting. A percentage of patients ranging from 10 to 20% may also be affected by diabetes.
The diagnosis is made with a thorough examination by the doctor to identify the presence of any signs or symptoms of the disease and to collect information on the personal and family medical history. Then a computed tomography (CT) is performed to detect pancreatic tumors and their possible spread to the lymph nodes, liver and bile ducts, with an ultrasound of the abdomen and with positron emission tomography (PET) to identify the presence of any metastases, even small ones, and in some cases it is performed in combination with CT (PET/CT).
In the presence of jaundice, it is necessary to check whether the bile ducts are obstructed and whether this obstruction is due to a tumor. For this purpose, several tests can be used: endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography and magnetic resonance cholangiopancreatography. The latter is the least invasive of the three tests and allows for a good definition of the site of the obstruction; however, it does not allow for a biopsy to look for the presence of tumor cells, which is possible with both other tests. The sampling of tissue through the biopsy is a fundamental test to confirm the presence of a pancreatic tumor and also to determine its characteristics, so as to also guide subsequent treatment.
The treatments
Despite the progress of research and medicine, pancreatic cancer remains one of the most difficult neoplasms to treat and cure, especially because in many cases it is diagnosed at an advanced stage. However, in approximately 20% of patients (1 in 5) the disease is identified when it is still localized and it is therefore possible to proceed with the complete surgical removal of the tumor, not without risks. After surgery, it may be necessary to perform chemotherapy, the only weapon available, together with radiotherapy, for tumors that are not operable. In selected cases, chemotherapy may also be used before surgery, so-called neoadjuvant.
Some molecular-targeted drugs are already used in the treatment of some subtypes of pancreatic cancer: among these, tyrosine kinase inhibitors such as erlotinib. In the presence of mutations in the Brca1 and Brca2 genes, the Parp inhibitor olaparib could be helpful as maintenance therapy for some patients, but at the moment in Italy the drug cannot yet be prescribed under the National Health Service. Furthermore, trials are underway with immunotherapy drugs capable of enhancing the action of the immune system against the tumor. The therapies currently available in the clinic are often not curative, but some have been shown to extend life expectancy for several patients.
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