by Vera Martinella
This neoplasm still has the lowest survival rate among all oncological pathologies, but if the diagnosis occurs in the early stages the prospects improve greatly
«How much does 80 grams weigh?» It is a trick question that was chosen for the awareness campaign on pancreatic cancer, which is being celebrated World Day on November 16th. While 80 grams is certainly not a lot, few know that this is the average weight of the pancreas, a small organ located in the abdomen, behind the stomach, approximately 15-20 centimeters large. This scant 100 grams then takes on decidedly greater importance if we consider that it carries out two fundamental functions for our body: it produces hormones such as insulin and glucagon, which regulate the level of sugar in the blood, and secretes enzymes for the digestion of food. . Even more relevant is the weight of the pancreas if it becomes ill, especially if the pathology in question is cancer. The same one that marked the fate of illustrious people, such as the footballer Gianluca Vialli (we wrote about it here), the tenor Luciano Pavarotti, the actor Patrick Swayze and the co-founder of Apple Steve Jobs.
Watch out for these symptoms
Aggressive and still difficult to fight, pancreatic cancer unfortunately has the lowest survival rate of all oncological diseases: on average, 10-12% of patients are alive five years after diagnosis. A percentage far from the 88% of breast cancer, for example, or the 90% of prostate cancer. A sad record largely due to the late diagnosis: «In eight out of ten cases the neoplasm is discovered in an advanced stage, limiting the possibilities of treatment – explains Silvia Carrara, president of the Italian Association for Pancreas Study (Aisp) and gastroenterologist at the IRCCS Humanitas Clinical Institute of Milan -: many of the early symptoms are in fact non-specific and often also associated with other types of pathologies, but an early diagnosis can instead allow a good chance of survival”. What are the signs not to be overlooked? It is good to talk to a doctor, without delaying too much, in case of pain in the upper abdomen, jaundice (yellowish color of the skin and eyes) and itching, sudden loss of weight and appetite, digestive difficulties, change in intestinal habits ( loose, greasy stools), sudden onset of diabetes in an adult without specific risk factors, pain in the middle of the back.
Who risks more
On the occasion of World Day, they focus precisely on early diagnosis Nadia Valsecchi Foundation e Oltre la Ricerca ODV Association, organizations that for years have been involved in raising awareness among the population, supporting research on pancreatic cancer and assisting patients and their families in the diagnosis and treatment paths. The associations have in fact started a collaboration with Federfarma and the Italian Society of General Medicine (SIMG), to raise awareness among the population and institutions of the need to do more to identify a greater number of cases in the initial stage and activate surveillance paths in people at increased risk of pancreatic cancer. Smoking and extra pounds (especially obesity) increase the risk of getting sick, as do diabetes and chronic pancreatitis (a permanent state of inflammation among the most serious consequences of chronic alcohol abuse) and being carriers of a mutation in the BRCA genes. «To date, there are few structures that have activated active surveillance protocols for subjects at increased risk of developing the pathology or standardized Diagnostic-Therapeutic Assistance Pathways (PDTA) – says Federica Valsecchi, president of the Nadia Valsecchi Foundation -. There is a lack of resources and strategies dedicated to this by the National Health Service, just as the funds dedicated to scientific research on this pathology should be implemented at a European level.”
The usefulness of surveillance
More investments are needed to improve the hopes of those who fall ill, because something has started to move: although few and slow, there has also been progress in pancreatic cancer in recent years. «The life expectancy, which was mostly just a few months, for a growing number of patients who can now be operated on reaches up to three years – Silvia Carrara pointed out -. Today we know that some groups of people are more at risk of developing the disease due to family history (presence of multiple cases of pancreatic cancer in the family) or because they carry mutations in genes such as BRCA, CDKN2A and others also involved in the development of pancreatic cancer. pancreas. Recent studies also demonstrate that the presence of recent onset diabetes, or long-standing diabetes no longer well compensated with the therapy in use, is another important factor that must alert those who follow the patient to a scrupulous evaluation of the pancreas. The evidence of the studies published in the literature demonstrates that the identification of particular categories of subjects at risk and the surveillance conducted with the right means, and with the correct timing, can lead to early diagnoses and consequently to a higher percentage of cases operable and to a higher survival of the patients”. «It is necessary to develop strategies for taking care of patients in the area in order to guarantee equity of care and the “right to health” throughout the national territory – says Francesca Gabellini, president of Oltre la Ricerca ODV –. The mandatory duties of social solidarity enshrined in our Constitution are also implemented with the implementation of essential levels of assistance, which should be guaranteed everywhere according to uniform criteria through regulatory intervention by the State”.
Therapies in expert hands
Every year in Italy there are over 14,500 new cases of pancreatic cancer, the majority of which are in people between 60 and 80 years old. And the numbers are, unfortunately, increasing. For some time, however, specialists have underlined the importance of contacting a reference center in the diagnosis and treatment of pancreatic cancers because, as studies and statistics have shown, the surgeon’s experience makes the difference, as does the collaboration between various experts. «The path to the diagnosis and treatment of pancreatic cancer is very complex, and requires, in addition to adequate technological resources, the management of a multidisciplinary team that encompasses all the specialist skills that deal with the pancreas – specifies the president of Aisp, Carrara -. The creation of a standardized diagnosis and treatment path, and of network coordination between expert centers (called Hubs) and less expert ones (spokes) is essential to guarantee more adequate care for patients”. If the operation must be carried out only in centers with certain requirements, where more expert hands are concentrated, chemotherapy still remains an important weapon today and, essentially, the possibilities of definitive recovery depend on its ability to destroy the “invisible” disease.
Objective: early diagnosis
«The majority of patients with pancreatic cancer begin their diagnostic process by presenting the symptoms to their doctor – adds Claudio Cricelli, president of Simg –: the diffusion of suspicion is increasingly necessary to identify patients at risk who need further investigations and the application of strategies aimed at achieving early diagnoses”. Equally important, in order to gain precious time, can be the role of the over 19 thousand pharmacies present throughout the national territory: “Providing prevention and screening is part of the daily activities of the community pharmacy – concludes Marco Cossolo, President of national Federfarma -. This is why we wholeheartedly support the campaign “How much do 80 grams weigh?” . Every day the pharmacists welcome and listen to the people who turn to them with trust for guidance and advice on their health problems, thus carrying out the role of informants and trainers in close collaboration with the other healthcare professionals operating in the area. With the aim, also in collaboration with scientific societies and patient associations, of creating multidisciplinary and integrated paths that put the patient at the centre.”
November 16, 2023 (modified November 16, 2023 | 11:34)
© ALL RIGHTS RESERVED