Tuesday, November 7, Professor Alessandro Zerbi, Head of Pancreatic Surgery at Humanitas, was the protagonist of the live Facebook stream dedicated to pancreatic cancer. Many topics were covered: pancreatic cancer and other cancers, family history and screening programs, surgery and the role of research.

A great many questions came up and not all of them could be answered. We will resume some of them in this article, with the contribution of Professor Zerbi.


Pancreatic cancer

Having had a spinal cord carcinoma of the thyroid, is there a high probability of pancreatic cancer?

There may be an increased risk of having an endocrine tumor of the pancreas (not a carcinoma) in multiple endocrine neoplasms (MEN).


Is it possible not to see a tumor at the head of the pancreas by CT or magnetic resonance imaging?

It is very difficult not to see it with these investigations, except in exceptional cases I would say where it could be excluded.


Are there any new experiments for adenocarcinoma of the pancreas or will they start shortly? If so, what are the requirements for acceptance? Is there an immunological cure for this type of cancer?

Experimental studies to evaluate the effectiveness of new drugs are activated with a certain frequency. The requirements for access vary from time to time, depending on the type of drug: usually they are “biological” criteria, i.e. linked to specific characteristics of the tumor that must be evaluated with appropriate laboratory tests. Immunological treatments are being studied, but none have yet entered clinical practice.


In 2015 I had a diagnosis of 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 treated for the results of a micro-adenoma of the pituitary gland (always MEN1) and for an essential diagnostic thrombocythemia in 2000. From the data of medical literature, what should I expect for the near future? Does the pancreatic cancer caused by MEN1 have different characteristics?

Pancreatic cancer in MEN 1 is an endocrine cancer (therefore not a carcinoma) that usually has a mild, “almost” benign behavior. We can expect a slow and progressive growth of the nodules: when they are small (let’s say under 2-3 cm) we can observe them and not operate on them. If they generate symptoms or grow further, surgery should be considered.


Compared to the tumor at the tail of the pancreas, which at the time of diagnosis already has hepatic signs, what are the conditions for which it is possible to envisage (and recommend) surgery?

Pancreatic cancers (understood as carcinomas) with liver metastases usually have no indication for surgery, because the removal of the primary tumor alone cannot change the prognosis, and should be treated with chemotherapy. However, if there is a good response to chemotherapy, with disappearance or persistence of only 1-2 metastases, surgery may be considered in special cases.


I am 42 years old and a pancreatic cancer was diagnosed this spring due to severe lower right abdominal pain still present. I still have frequent nausea and strong fatigue, lack of appetite and / or sudden changes in appetite: are they related to the neoplasm of the pancreas?

It is likely that these symptoms, although quite non-specific, are attributable to pancreatic cancer.


What diet do you recommend for pancreatic cancer sufferers aged 77? Can ice cream be eaten?

There is no contraindication to eating ice cream, there are no specific dietary restrictions in those with pancreatic cancer, except limiting the intake of foods rich in animal fats and alcohol.



I have a slowly growing pancreatic cyst, is it dangerous?

It depends on the characteristics of the cyst; it is impossible to generalize. However, the dimensions alone are not a sufficient element of danger.


How long does a mucous membrane degenerate? 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 on the basis of the characteristics of the cysts. Not all mucous cysts degenerate, and those that degenerate do so with very variable timescales. If cysts located in the head are to be removed surgically, they require more complex surgery than cysts located in the tail.


I am 53 years old and have a problem with the dilation of the gallbladder, production of sludge, gallstones, and two pancreatitis diagnoses after ERCP. What is the risk of having a more serious pathology?

This is a problem related to biliary calculi, it has nothing to do with pancreatic cancer.



I have an acute pancreatitis; I have been diagnosed with cysts on the duct for a year, should I keep them under control?

I would say yes, also because these cysts could be both the consequence and the cause of pancreatitis. The relationship between cysts and the pancreatic duct should be well assessed.


I had pancreatitis as a result from medications, what should I do? Since then I have also had a kidney problem.

It depends on the medicine and the outcomes that the pancreatitis has left. The kidney problem seems unlikely to be caused by pancreatitis.


Are there any new treatments for chronic genetic/family pancreatitis? Question for my 14 year old daughter.

There is no specific treatment. However, there is progress in the measures to be taken to control the symptoms that chronic pancreatitis may cause from time to time. It is important to stress the need for lengthy checks, especially when the child is an adult, because of the possible risk of degeneration of this disease.