A silent tumor, hard to defeat. Which manifests itself with tiredness, pain that radiates from the abdomen towards the back and yellowing of the eyes and skin. A difficult opponent to take down, even with a tackle. He tried Gianluca Vialli, when from 2017 he began a forced coexistence with the disease, pancreatic adenocarcinoma. But unfortunately that form of tumor, which attacked the pancreas, won his challenge. A battle that the former footballer of Sampdoria, Juventus and Chelsea, then added value of Roberto Mancini’s national team who made us rejoice in 2021 with the victory of the European Championships, fought head-on until the end. Pancreatic cancer is one of the most insidious oncological diseases, a disease that is growing in incidence and for which there is still little certainty about its cure.
Giorgio Ercolani, director of Surgery and Advanced Oncological Therapies of Forlì and full professor of Surgery at the University of Bologna, you are one of the leading experts in hepato-biliary-pancreatic oncological surgery. How many cases do you treat annually in the Forlì area?
“We treat about 120-140 cases in our area and perform about 50-60 pancreatic resections a year in Forlì (i.e. removal of part or all of the gland, ed). Only 30-35% of patients with pancreatic adenocarcinoma are operable at the time of diagnosis”.
The average age?
“The peak incidence is between the sixth and seventh decade”.
What are the symptoms with which it manifests itself?
“Pancreatic tumors localized in the head frequently begin with jaundice (due to hyperbilirubinemia), alteration of biochemical indices in particular those of cholestasis (gamma-Gt, total and direct bilirubin), hyperchromic urine and acolic stools. Those localized in the pancreatic body or tail, unfortunately, they often begin with pain and weight loss when the tumor has already reached a moderate size. And often in these cases it is no longer operable”.
What is it caused by?
“There is no trigger factor. There are some risk factors such as smoking and alcohol. There are some pancreatic lesions considered pre-cancerous such as pancreatic mucinous cysts, IPMN (intraductal papillary mucinous neoplasms, ed.) and some risk factors genetic factors such as the mutation for BRCA (genes with an onco-suppressive action present in every human being, ed.). These patients should be screened. Patients with diabetes must also undergo an adequate clinical-instrumental follow-up”.
Is it a growing type of cancer?
“Unfortunately yes, partly linked to lifestyle especially in the western world and above all linked to the increase in average life and therefore to the aging of the population”.
Why, unlike other tumours, is pancreatic cancer the most lethal?
“There are several reasons. Unfortunately, in some cases it presents with symptoms already in an advanced stage; the possibility of screening in the population at risk is not yet ubiquitously feasible and furthermore, compared to other tumors, we do not yet have effective chemotherapy in most cases”.
What is the role of surgery against this tumor?
“The only chance of a cure is the possibility of resective surgery associated with chemotherapy treatments performed either before or after surgery depending on the case”.
So is chemotherapy administered before surgery also for the pancreas?
“Absolutely, and recently the trend to precede surgery with chemotherapy is becoming more and more common due to the better results that can be expected from this approach.”
What are the survival expectations?
“In general, we are talking about 15-20% at 5 years. In patients with favorable prognostic factors (such as small size, absence of lymph node metastases and execution of R0 curative interventions) these percentages can rise to 30-35 %”.
Last November, a meeting was held in Forlì in the Municipality, aimed at specialists in the sector and at the Community. What are the needs that are currently not recognized, or not yet satisfied, by the care network?
“First of all, we need to disseminate the culture of prevention and screening in subjects at risk. And we healthcare professionals too must improve our ability to disseminate the necessary information, including the presence of a reference center where we try in a collegial and multidisciplinary way to treat all patients with pancreatic cancer or disease.
What can institutions do?
“They should solicit the identification of reference Centers for the treatment of this pathology (which due to the small numbers cannot be everywhere. In Italy 60-70% of pancreatic resections that are performed in Centers that do less than 15 per year) as it is known in the scientific field that the treatment of patients with pancreatic cancer in highly specialized centers where all the necessary “professional” skills are present (surgeons, oncologists, gastroenterologists, pathologists, interventional radiologists, radiotherapists and others) it is the only way to improve results in terms of distant survival by reducing mortality and promoting clinical research”.
Prevention and early diagnosis are essential. What message do you want to convey to our readers?
“One of the objectives of the November conference on World Pancreatic Cancer Day was to raise public awareness of screening for subjects at risk (such as carriers of pancreatic lesions such as cysts or Ipmn, those who have had family members affected by this neoplasm or who have BRCA mutations, or diabetics) as early diagnosis at the moment is still the most important factor to improve life expectancy in affected patients.Another message is that in our territory we have set up a multidisciplinary group of professionals dedicated to the diagnosis and treatment of pancreatic diseases inspired by the Pancreas Unit of the San Raffaele in Milan (one of the leading centers at an international level) which has followed us along this path”.