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Pancreatic cancer is one of the most aggressive cancers and, unfortunately, its incidence is increasing sharply: more than 1,200 new diagnoses are formulated every day worldwide.
Even though we are talking about a very lethal tumor, the current research is not adequately funded, in fact it only accounts for 2% of all funds accumulated in Europe.
Specialists, researchers and patients are therefore in a forum organized jointly with the code Associazione Viola, which deals with different topics of the pathology: from the recognition of the first symptoms to the diagnostic-therapeutic pathways, from the nutritional problems to the evolution of the disease. research. The scenarios are finally promising: new biomarkers are being identified to allow for an earlier diagnosis, even in the early stages of the disease (three of them have been identified, higher in the blood of patients with pancreatic cancer as healthy subjects) and deepens the relationship between cancer and the immune system.
"This tumor is often considered a condemnation, but its natural history is changing – explains Alessandro Zerbi, head of pancreatic surgery at Humanitas and professor at Humanitas University – interesting perspectives open up thanks to the development of new chemotherapeutic treatments and their best combination. with surgical procedures, which are among the most complex and whose success depends greatly on the experience of those who perform them and the center where they are performed. All this combined with advances in research, which is increasingly focused on the biological peculiarities of pancreatic cancer.
Pancreatic cancer is a disease characterized by the appearance of abnormal cells in the pancreatic tissue. The pancreas is an organ located in the abdomen, behind the stomach, which produces both digestive enzymes and insulin. The pancreas has two types of tissues that perform different functions: the exocrine pancreas *, which secretes enzymes in the gastrointestinal tract, thereby helping to digest fats and proteins, and the endocrine pancreas *, which secretes glucagon * and insulin and pour them into the blood to control blood sugar (blood sugar). In more than 80% of cases, pancreatic neoplasms develop in the exocrine pancreas. About 75% of all exocrine pancreatic tumors originate in the head or neck of the pancreas, 15 to 20% in the body and 5 to 10% in the tail.
IS PANCREAS CANCER FREQUENT?
Pancreatic cancer is the seventh most common malignant tumor in Europe. In the European Union, pancreatic cancer affects 11.6 men per 100,000 every year, with a number of new cases ranging from 4.7 (Cyprus) to 17.2 (Hungary), and is responsible for 39, about 35,000 deaths male population. With regard to the female population, pancreatic cancer affects 8.1 women out of 100,000, with a number of new cases ranging from 2.1 (Cyprus) to 11.4 (Finland). Even in women, this tumor is responsible for 35,000 deaths each year. The frequency of newly diagnosed cases increases with age and most of them affect people over 65 years of age. As the disease often goes unnoticed for a long time, in most cases the diagnosis is made when the cancer has already spread to other organs. Pancreatic cancer is the fifth leading cause of cancer-related death.
WHAT ARE THE CAUSES OF PANCREATIC CANCER?
To date, the causes of pancreatic cancer development are not yet clear. Although it is thought that most pancreatic tumors (90%) are not badociated with any risk factors, some risk factors have been identified for other cases *. Risk factors increase the risk of developing cancer, but they are neither necessary nor sufficient to provoke it. Risk factors are not a cause in themselves. Some people with these risk factors will never develop pancreatic cancer, while others who have none of these risk factors may still develop it. To date, the main risk factors identified for the occurrence of pancreatic cancer are: – Genes: o It is known that certain genetic mutations * are related to pancreatic cancer.
The majority of pancreatic neoplasms show somatic mutations of the KRAS (80%), p53 (50%) and p16 genes badociated with tumor growth control. Other genes with alterations or mutations badociated with pancreatic cancer are CDKN2 (90%) and DPC4 / Smad4 (50%). BRCA2 is another gene whose mutation is responsible for the development of hereditary mammary and ovarian neoplastic syndromes. It has also been shown that BRCA2 is involved in the appearance of certain pancreatic tumors. o Genetically transmitted rare diseases such as hereditary pancreatitis, Peutz-Jeghers * syndrome, familial syndrome of multiple atypical naevi and melanoma (familial atypical multiple melanoma, FAMMM) *, hereditary cancer syndrome of the ovary and bad cancer Nonpolypotic hereditary colorectal cancer (hereditary non-polyposis colorectal cancer, HNPCC or Lynch syndrome) are badociated with a higher risk of developing pancreatic cancer. The term hereditary refers to the transmission of genetic traits from one family member to another from generation to generation. Having a first degree relative (parent or sibling) or second degree (uncle, aunt or cousin / a) who has suffered from pancreatic cancer increases the risk of developing the disease. It is estimated that between 5% and 10% of pancreatic tumors may have a family member. – Smoking cigarettes: 25% of patients with pancreatic cancer smoke or smoke cigarettes for many years.
The habit of smoking has a greater effect if the patient suffers from one of the aforementioned genetic syndromes. – Age: The risk of developing pancreatic cancer increases with age. Most pancreatic tumors are diagnosed in people aged 60 to 80 years. – Obesity: Available data suggest that the risk of pancreatic cancer increases slightly with the increase in body mbad index. The body mbad index is a parameter that expresses the relationship between weight and height and serves as an indicator of obesity or underweight. – Chronic pancreatitis: chronic pancreatitis, over several decades, increases the risk of occurrence of pancreatic adenocarcinoma *. The habit of smoking and genetic factors increase this risk.
HOW IS PANCREAS CANCER DIAGNOSED?
To date, no screening program1 can be recommended to the general population, as there is no ideal screening method for pancreatic tumors. Early pancreatic cancer and pre-cancerous lesions * that precede it do not cause symptoms. Therefore, early identification of pancreatic cancer is difficult and it is rare that this cancer is diagnosed while it is still in its infancy. However, it is recommended that patients with any of the aforementioned hereditary diseases routinely undergo endoscopic ultrasound (EUS), which allows for the identification of small lesions and magnetic resonance imaging (MRI) . The suspect diagnosis of pancreatic cancer can occur in the presence of several symptoms, the main ones being weight loss, jaundice and pain in the abdomen or back. Since these symptoms can be caused by many other diseases, it can be difficult to diagnose pancreatic cancer. Sometimes patients also have newly diagnosed diabetes or pancreatitis. The diagnosis of pancreatic cancer is based on the following tests: 1. Clinical examination. Below are some of the symptoms that can be detected in a patient with pancreatic cancer during the clinical examination. Jaundice is an important symptom, but it can also be caused by conditions other than pancreatic cancer. It is a yellowing of the skin and the white part of the eyes and is due to increased levels of bilirubin in the blood. It can be caused by obstruction of the main bile duct by the tumor, which in this case will probably be located in the head of the pancreas. The obstruction also causes accumulation of bile in the gallbladder, which can be enlarged. As the main bile duct is obstructed, bilirubin can not reach the intestine and the stools appear whitish. If bilirubin levels in the blood are high, bilirubin is eliminated from the body by urine in amounts above the norm and the urine becomes darker than usual. o Pain in the abdomen and back due to the pressure exerted by the tumor on adjacent structures, including nerves. This symptom appears especially when the tumor is located in the body or in the tail of the pancreas. Unexpected weight loss and loss of appetite are common symptoms. o Digestive disorders can occur if the tumor obstructs the pancreatic duct that joins the common bile duct, resulting in a lack of enzymes * for the digestion of fatty foods. This can cause nausea, vomiting and diarrhea.
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