On November 7, Professor Alessandro Zerbi, Head of Pancreatic Surgery in Humanitas, was the protagonist of the direct Facebook dedicated to pancreatic tumours were many topics were addressed. Pancreatic cancer and other cancers, familiarity and surveillance programs, surgery and the role of research.

A lot of questions were received but not all of them were answered. Professor Zerbi answers some of them.

Tumours of the Pancreas

Having had a medullary thyroid carcinoma, is there a high probability of pancreatic cancer?
There may be an increased risk of having endocrine pancreatic cancer (not carcinoma) in multiple endocrine neoplasms (MEN).

Is it possible to not see a tumour in the head of the pancreas via tac or magnetic resonance?
It is very difficult not to see it with these examinations. However, in exceptional cases, I would say that it can be ruled out.

Are there any new trials for pancreatic adenocarcinoma? If so, what are the requirements in order to gain access? Is there an immunological cure for this type of a tumour?
Experimental studies to evaluate the efficacy of new drugs are activated with a certain frequency. The requirements for gaining access vary from time to time, depending on the type of drug. Usually, the criteria are “biological”, ie linked to specific characteristics of a tumour that must be evaluated with appropriate laboratory analysis. Immunological treatments are being studied, but none has yet entered clinical practice.

In 2015 I was diagnosed with pancreatic cancer (5 nodules) in the MEN1 syndrome. I am asymptomatic and I am not following any therapy. Currently, I enjoy a good quality of life even if I am looking for the results of a micro pituitary adenoma (always MEN1) and for an essential diagnostic thrombocythemia in 2000. From the medical literature data, what have I to wait for the near future? Does pancreatic cancer caused by MEN1 have characteristics different from others?
Tumor of the pancreas in the field of MEN 1 is an endocrine tumour (therefore not a carcinoma) that usually has a rather aggressive behaviour, of a “near” kind. It is reasonable to expect a slow and progressive growth of the nodules. As long as they remain small (say under 2-3 cm), you can observe them and do not operate them. If they give symptoms or grow further, surgery should be considered.

With respect to the pancreatic tail tumour, which at the time of diagnosis already presents hepatic secondarisms, what are the conditions for which it is possible to envisage (and recommend) surgery?
Usually, pancreatic tumours (understood as carcinomas) with liver metastases have no indication for surgery, because the removal of only the primary tumour is not able to change the prognosis, and should be treated with chemotherapy. However, if there is a good response to the chemotherapeutic treatment, with disappearance or persistence of only 1-2 metastases, the surgical intervention may be considered in particular cases.

I am 42 years old and pancreatic cancer diagnosed this spring due to the strong pains in the lower right abdomen still present. I still have frequent nausea and heavy fatigue, lack of appetite and/or sudden “fierce” appetite. Can they be connected to the pancreatic neoplasia?
It is likely that these symptoms, even if quite unspecific, are due to pancreatic cancer.

Diet

What diet do you recommend for a 77-year-old pancreatic cancer patient? Can ice cream be eaten?
No contraindication to eating ice cream, there are no specific dietary restrictions in those with pancreatic cancer, except to limit the intake of foods rich in animal fats and alcohol.

Cysts

I have a pancreas cyst that grows slowly, is it dangerous?
It depends on the characteristics of the cyst. It is impossible to generalize. However, the dimensions alone are not just a sufficient element of danger.

A mucinous cyst in which time degenerates? If it is positioned on the head of the pancreas, is it more difficult to reach than the tail?
The case must be assessed individually, based on the characteristics of the cyst. Not all mucinous cysts degenerate, and those that degenerate do so with very variable timing. The cysts located in the head, if they were to be surgically removed, require a more complex surgical procedure than those located in the tail.

I am 53 years old and I have a dilation problem of the common bile duct, sludge production, gallbladder, two pancreatitides after ERCP. What is the risk of having a more serious pathology?
This is a problem related to gallstones, has nothing to do with pancreatic cancer.

Pancreatitis

I have acute pancreatitis, I have been diagnosed with cysts on the duct for a year, do I have to keep them under control?
I would say yes because these cysts could be the consequence of pancreatitis. The relationships between the cysts and the pancreatic duct should be well evaluated.

I have had medicinal pancreatitis, how should I behave? Since then I also have a kidney problem.
It depends on the medicine and the outcomes that caused pancreatitis. The kidney problem seems unlikely to depend on pancreatitis.

I have a 14-year-old daughter with chronic genetic/familial pancreatitis. Are there new treatments for it?
There are no specific treatments. However, there is progress in the measures to be taken to control the symptoms that chronic pancreatitis causes from time to time. It is important to stress the need for protracted controls over time, especially when the daughter gets adult, due to the possible risk of degeneration of this disease.