Health and Culture Quarterly • ONCOLOGY
PROF. Massimo FALCONI, DIRECTOR OF THE PANCREAS CENTRE
DR. Gianpaolo BALZANO, PANCREATIC SURGEON
DR. Michele RENI, ONCOLOGIST
IRCCS OSPEDALE SAN RAFFAELE (MI)
“That girl has guts”, “he is a man with a good heart”, “he definitely has thick skin”: the English language has many sayings that involve organs in our bodies. But of all the others, the pancreas is left out: perhaps it is because its function is obscure to many people. And yet the diseases that affect this organ are constantly on the increase: in only the last ten years, diagnoses of pancreatic cancer in Italy have doubled (reaching 13,700 in 2017). Unfortunately, the prognosis for this neoplasia, the most widespread and aggressive form of which is adenocarcinoma, remains unfavourable: only eight patients out of a hundred are still alive five years from diagnosis. “This occurs because pancreatic cancer is often silent – when it shows symptoms, it has already attacked the surrounding organs and/or obstructed the bile ducts”, begins Professor Massimo Falconi, director of the Pancreas Centre at IRCCS Ospedale San Raffaele, part of the Gruppo San Donato. “Within this field, the objectives to be pursued are undoubtedly early diagnosis and treatment of the disease within high volume centres, i.e. they are involved in treating a lot of cases, and have access to dedicated multidisciplinary teams, consisting of oncologists, surgeons, radiologists, endoscopists, radiotherapists and anaesthetists”, the expert continues.
However, there are signals to which attention can be paid, and which can raise suspicions of pancreatic cancer. “Without giving rise to pointless fear, we need to pay particular attention to the sudden onset of diabetes in an adult, to the occurrence of jaundice (Editor’s note: yellowish colouring of the skin), to persistent pain in the area of the stomach or back, and to any substantial and undue loss of weight” Professor Falconi warns. Suspected neoplasia should be confirmed with diagnostic examinations. “These include abdominal echography, and secondly, CT scan with contrast – for viewing the cancer, its extent, and its connection with the surrounding vessels – and echo-endoscopy, a complex examination that is carried out using a probe that reaches the stomach, and which can enable material to be sampled for laboratory analysis”, adds Professor Falconi.
SURGERY OR CHEMOTHERAPY?
Treatment for pancreatic cancer is based mainly on surgery and chemotherapy. “As the neoplasia often develops silently, it is resectable (Editor’s note: It can be removed surgically) in only 20% of cases. In addition, surgical interventions within the pancreas are very complex, and often hampered by complications. In most cases, therefore, initial chemotherapy is opted for, which aims to reduce the volume of lesion to the point where it is resectable”, Falconi explains. A recently published Italian study, co-ordinated by clinicians and researchers from San Raffaele, and published in the prestigious scientific journal The Lancet – Gastroenterology & Hepatology, challenged the use of surgery as treatment of first choice in patients considered to be operable, clearly highlighting the role of neoadjuvant chemotherapy (Editor’s note: Carried out before the surgical removal of diseased tissue) in persons with operable pancreatic adenocarcinoma.
“Although surgery is a valid weapon, recovery from the disease can be compromised by the presence of micro-metastases, i.e. metastases that are too small to be identified”, explains Doctor Gianpaolo Balzano, a pancreatic surgeon at IRCCS Ospedale San Raffaele and co-author of the study. “The only effective treatment for combating micro-metastases is chemotherapy. However, when we apply the standard treatment and operate on the patient, the start of the chemotherapy is delayed by a few days, to allow the patient to recover from the intervention. In addition, many patients are not able to start it at all, due to possible complications and difficulties with post-operative recovery”, adds Doctor Michele Reni, an oncologist at San Raffaele, and primary author of the study.
By: Chiara Cozzolino
Translation: TDR Translation Company
Editing: Violetta Valeeva & Victor Cojocaru