Adenocarcinoma of the Pancreas

Pancreatic cancer is more common in men than women and affects people between the ages of 60 and 80.

Risk factor's

The main risk factors are:

  • tobacco smoke: it is the main risk factor and is directly proportional to the number of cigarettes smoked per day. The risk of getting sick from a smoker is about 2-3 times greater than that of a non-smoker;
  • overweight: a sedentary lifestyle, the distribution of body fat (especially abdominal fat) and the intake of high-calorie foods and beverages are related to the risk of developing pancreatic cancer;
  • occupational factors : some categories of workers are more exposed to the risk of developing pancreatic cancer (especially if they are in frequent contact with metals, fabrics, leather, coal, chemical solvents);
  • chronic pancreatitis seems to lead to an increased risk of developing pancreatic cancer;
  • patients who have undergone a previous gastrectomy or cholecystectomy appear to be at increased risk of developing pancreatic cancer.
  • Hereditary Genetic Factors : Less than 10% of pancreatic cancer cases are attributable to hereditary genetic factors.
  • diabetes: has been associated with pancreatic cancer, although this relationship is still unclear;
  • alcohol: the association between alcohol abuse and the development of pancreatic cancer has not been proven by scientific studies, at least until now.
  • Symptoms
  • In the initial stage of the disease, pancreatic cancer is asymptomatic. In about half of the patients, it can manifest as:
  • jaundice: it manifests itself with a yellowing of the skin due to an obstruction of the bile ducts, with the consequent accumulation of bile in the gallbladder and its passage into the blood;
  • abdominal pain;
  • weightloss.


In the presence of suspicious symptoms, the diagnostic tests are:

  • CT (Computerized Tomography) allows excellent visualization of the bile ducts and pancreas, and is also capable of identifying possible liver metastases;
  • MRI (Magnetic Resonance Imaging);
  • ERCP (Endoscopic Retrograde Cholangiopancreatography): A flexible endoscope (a thin tube with a lighted end) is inserted through the mouth into the stomach and small intestine. A small catheter is then inserted into the endoscope and then into the pancreatic and bile ducts. In this way it is possible to visualize even more clearly the internal organs that you want to investigate;
  • PET (Positron Emission Tomography): it is the best diagnostic technique to detect local recurrences (the tumor returns to form after having been treated, in the same place) but it is not currently considered a standard follow-up method;
  • Pancreatic biopsy : A small sample of pancreatic tissue is taken, which is suspected to contain cancer cells. The sample is then analyzed under a microscope to determine the presence of the tumor and, if positive, to define the stage of the tumor. The sampling is done through extremely fine needles, introduced during an ERCP or during an ultrasound endoscopy.


Depending on the stage of the tumor, that is, where in the pancreas it is, how big it is, and whether it has spread to other organs or lymph nodes, surgery, chemotherapy, or radiation therapy is used.


When possible, the first approach is always surgical.

Depending on the extent of the tumor, the goal of surgery may be to completely remove it (radical surgery) or to relieve symptoms of the disease (palliative surgery). This choice depends on the extent of the tumor and partly also on the general conditions of the patient.

Radical surgery: it is defined as such when the objective of the intervention is to remove all the tissues in which the tumor is present. Depending on its prevalence, there are two options for radical surgery:

  • Pancreatectomy : consists in the resection of the portion of the pancreas where the tumor is located. If the head of the pancreas is removed, it is called a proximal or cephalic pancreatectomy; when the body or tail of the pancreas is removed, it is called a distal or corporocaudal pancreatectomy. In addition to the portion of the pancreas involved in the tumor, it is also necessary to remove other organs close to the pancreas, for example, during a proximal pancreatectomy, the duodenum (the initial part of the small intestine) must also be resected;
  • Total pancreatectomy: the entire pancreas is removed as well as other neighboring organs that are compromised.

Palliative surgery: it is used when the extension of the tumor does not allow a radical intervention, but even so the symptoms of the disease are alleviated. In case of jaundice and intestinal obstruction, it is possible to opt for the creation of a biliodigestive by-pass, a gastrojejunoanastomosis (a direct connection is created between the stomach and an intestinal loop), the placement of a stent (a small plastic tube or metal inserted into the bile duct or intestine to prevent it from closing) endoscopically or percutaneously.

To control intestinal obstruction: in some cases it is possible to intervene with the placement of expandable metallic stents.

Severe pain is relieved by the administration of opioids. Among these, the most widely used drug is morphine.


Anticancer drugs may be given before surgery to shrink the tumor (primary or neoadjuvant chemotherapy) or after surgery (adjuvant chemotherapy). Since the treatment of pancreatic cancer is surgical, the role of chemotherapy is exclusively palliative.


It can also be neoadjuvant or adjuvant (e.g., prescribed before and after surgery, respectively) and, like chemotherapy, offered as palliative treatment. It can be useful in locally advanced forms, when the tumor is inoperable. After a few cycles of chemotherapy, if the disease does not progress, radiotherapy can improve the survival of these patients.


Staging is important to define the extension of the tumor and consists of three parameters: T (tumor dimensions), N (involvement of neighboring or distant lymph nodes), M (presence or absence of metastases, that is, secondary locations of the disease, in organs other than the primary one). This classification not only has a surgical purpose, but also serves to delimit the treatment to which each patient will undergo.


Overall, one-, three-, and five-year survival is 15.9%, 5.4%, and 4.1%, respectively. However, the percentage varies according to the size and spread of the tumor, and the consequent possibility of surgical intervention: for stage I, patient survival at 5 years is 20-40%, for stage II it is 15- 25%, for stage III 10-15% and for stage IV 0-8%.

Another factor on which the prognosis depends is age: the five-year prognosis, in fact, is better in patients between 15 and 44 years of age (13%), compared to that of patients over 55 years of age, for whom it is the same. at 5%. These data are similar in both sexes.


The chance of pancreatic cancer coming back even after radical surgery is very high. Currently, the only possibility of prolonging the survival of patients affected by this pathology is close follow-up, that is, a series of clinical and radiological controls in order to timely identify a relapse. The purpose of follow-up visits and tests to be performed after treatment should be discussed on an individual patient basis with their physician.