Pancreatic cancer is the fourth leading cause of death from cancer in the West, and is expected to be the second leading cause of lung cancer in 2030. Professor Alessandro Zerbi, Head of Pancreatic Surgery at Humanitas, spoke about pancreatic cancer and treatment options in an interview.

“When we talk about pancreatic cancer we have to keep in mind that we are not talking about a single disease, but about different conditions such as pancreatic adenocarcinoma, endocrine cancer and cystic cancer.


Pancreatic adenocarcinoma

Adenocarcinoma is the most dangerous form of adenocarcinoma because it is subtly presented, has rapid growth and tends to metastasize. Initially, the tumor tends to be asymptomatic, so diagnosis is not easy.

Early diagnosis is, however, fundamental and it is therefore important, especially in subjects with family history, to undergo screening tests in dedicated centers, to identify any injuries, even very small ones, and to monitor them over time.

Contrast CT allows the detection of tumors and the understanding of their evolution, while ecoendoscopy allows the creation of pancreatic images and biopsies to differentiate the type of tumors.


Endocrine tumors and cystic tumors

Endocrine cancer is more rare and is generally benign; its malignant forms are also generally not very aggressive. CT, MRI and eco-endoscopy are useful for diagnosing this form. In some cases, some laboratory tests measuring tumor markers may also be helpful.

Cystic tumors are more frequent than endocrine tumors; they are divided into serosis (benign) and mucousosis (which may evolve into malignant tumors). The diagnosis, also in this case, uses CT, MRI or eco-endoscopy.


Surgical intervention

The rapidity and aggressiveness of the spread of pancreatic cancer in neighboring tissues, its refractoriness to standard chemotherapy and its tendency to relapse make it one of the most difficult and challenging cancers to treat.

The choice of whether or not to have surgery varies from patient to patient. In some cases, chemotherapy or radiotherapy may be used. However, if, for example, the tumor looks like a well-localized carcinoma, you will generally decide to operate.

The surgical operation of tumor removal is not easy, both for the position of the pancreas (which is located deep and is close to veins and important arteries), and because it is a delicate organ, which produces digestive juices that tend to erode the surrounding tissues.

Depending on the case, surgery may be preceded or followed by chemotherapy or radiotherapy. “It should be noted that chemotherapeutic drugs are now more targeted and therefore have a better chance of success than in the past. The prognosis is better than it used to be and there are patients who heal,” stressed Professor Zerbi.


The importance of a multidisciplinary center

It is important that the patient is treated in centers with high specialization and clinical experience; in fact, several studies have shown how a multidisciplinary approach guarantees better diagnosis and more effective treatments.

Humanitas has a Centre for Pancreatic and Duodenal Diseases, in which various professionals work together to offer accurate diagnosis and thus better care for patients.