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Pancreatic cancer is a type of cancer that starts in the tissues of the pancreas. Various types of tumours can develop, whether malignant or benign. In this case, it is uncommon for it to be detected at very early stages, as it does not cause symptoms.
Pancreatic cancer is the third most lethal cancer in Europe and is expected to become the second deadliest within a few years. Improving survival requires multidisciplinary management by highly trained specialists with extensive experience in this type of tumour.
Radical surgical techniques and selecting the most appropriate systemic chemotherapy treatment are essential to improving survival.
In more advanced cases, treatment must be personalised and tumour response after induction chemotherapy must be assessed, always seeking options for resectability or other systemic treatment alternatives.
Patients are usually asymptomatic until the disease reaches advanced stages. It may present with yellowing of the skin and eyes, dark urine, pale stools, pain in the upper abdomen, a burning sensation in the abdomen and upper back, frequent indigestion, foul-smelling and floating stools, fever, sweating and weight loss.
It usually appears from the age of 65, and incidence increases with age. It tends to occur more frequently in men.
It is more common in Black individuals and in Ashkenazi Jews. It is also more prevalent in people with obesity, patients with diabetes, smokers and those who consume alcohol.
There is a significantly higher risk in patients with two first-degree relatives who have had the disease.
It is also associated with certain syndromes that predispose to the development of multiple tumours.
Diagnosis begins with a physical examination and blood tests, which may show elevated tumour markers.
A thoracoabdominal CT scan is necessary to detect whether there is disease and whether it has spread to other regions. Conventional ultrasound or endoscopic ultrasound may also be performed, the latter enabling biopsy sampling to obtain a definitive diagnosis.
In some cases where there is biliary tract obstruction, an endoscopic retrograde cholangiography may be performed to drain the bile duct by placing a stent and to obtain biopsy samples.
If biopsy samples are available, molecular and germline analysis can be carried out to detect genetic mutations that may provide options for targeted treatment.
Treatment is decided by a multidisciplinary committee, which selects the appropriate therapy depending on the type of tumour and its extent.
Correct radiological staging and assessment of surgical potential are essential. Likewise, classification based on biological criteria may reclassify a patient who appears radiologically resectable as borderline, requiring an initial approach other than surgery. Identifying low-volume systemic metastatic disease in some cases is also essential to reach a more accurate and appropriate diagnosis.
At this initial stage, multidisciplinary evaluation is crucial, bringing together surgeons, oncologists, radiologists and pathologists specialised in pancreatic tumours.
The following tests are usually performed for diagnosis:
Multiphasic contrast-enhanced thoracoabdominal CT scan.
Biliopancreatic endoscopic ultrasound to obtain a biopsy (provided there are no metastases accessible for biopsy).
Endoscopic retrograde cholangiography to place a biliary stent in cases of bile duct obstruction, and determination of tumour markers in blood (CA 19-9 and CEA).
Additionally, an MRI scan or contrast-enhanced PET-CT may be required.
Prevention
We can reduce the risk of pancreatic cancer by leading a healthy lifestyle with regular exercise, balanced eating habits, limited consumption of red meat and animal fats, and by avoiding alcohol and tobacco use.
How to prevent the onset of pancreatic cancer
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