The most common cancer in men over 40 – Greek expert tells you the early symptoms you should not ignore

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Dimitrios Dimitroulis, Professor of Surgery at the National and Kapodistrian University of Athens, talks to Ygeiamou about a common cancer that is the third leading cause of cancer-related death worldwide.

The pancreas is a very important organ in the back of the abdomen. It is responsible for two functions of the human body: digestion by secreting various enzymes that break down food and regulating blood sugar by secreting insulin.

Like all organs, it can be a focus for developing neoplasms with malignant characteristics. Pancreatic adenocarcinoma is more common in a percentage that reaches 90%, and for this reason, it is identified with the term "pancreatic cancer".

In recent years, the incidence of pancreatic cancer has increased, making it the third leading cause of cancer-related death worldwide.

In Greece, 7.43 new cases per 100,000 population are diagnosed annually, while in 2020 alone, 1,904 of our fellow human beings died of pancreatic cancer. It seems that people over the age of forty are affected, with a predominance in the male sex.

The etiology of the disease appears to be largely unknown as both hereditary and acquired factors are involved.

In addition to various genetic syndromes, acquired factors associated with pancreatic cancer are increased body weight, smoking (more than double the risk in smokers), long-term alcohol consumption, history of chronic pancreatitis, family history, and previous radiation therapy in the abdomen.

At this point, it is necessary to emphasise that in addition to the risk factors, special vigilance is required from all of us for early awareness of some early symptoms. One of the frequent early symptoms is newly diagnosed diabetes mellitus or sugar dysregulation in a known diabetic.

In addition, a change in the composition and number of bowel movements is an early symptom. Patients may experience episodes of unexplained diarrhea and changes in stool colour and quality, e.g. strong stench.

A constant and persistent pain in the abdomen, especially in the lumbar region, dyspeptic complaints, lack of appetite and weight loss without effort, depression, itching in our body and jaundice (yellow) tinge of the skin and the whites of our eyes are definite symptoms, which we must report to our doctor so they can be investigated.

The investigation includes a series of hematological (basic control and more specialised tests such as cancer and molecular markers) and imaging tests. The latter involves a simple ultrasound (U/S), computed tomography (CT) of the pancreas, magnetic resonance imaging (MRI), and magnetic cholangiopancreatography (MRCP).

In some cases, these imaging tests can be supplemented by positron emission tomography (PET), endoscopic ultrasound (EUS) and endoscopic palindromic cholangiopancreatography (ERCP) with biopsy or cytological washing for the histological identification of the lesion.

The clinical picture raises suspicion, and the laboratory and imaging investigation, in combination with the biopsy, establishes the diagnosis. And after the diagnosis, what?

Approximately 50% of pancreatic cancer patients have metastases at the time of diagnosis, and 30% have locally advanced disease, with the result that only about 20% of patients are candidates for immediate surgery at diagnosis.

For this reason, the therapeutic approach of these patients has changed in recent years, with chemotherapy playing an important role as it precedes surgery. In several cases, it reduces the size of the tumour and offers more chances for a successful surgery.

New chemotherapy drugs and modern oncological approaches are also improving outcomes in patients with metastatic disease. More targeted treatments and the role of immunotherapy and radiation are the subject of systematic research with several optimistic applications in clinical practice.

Surgical treatment is currently the cornerstone of pancreatic cancer treatment. The evolution of imaging techniques helps us plan the surgery precisely. The progress and development of surgical methods to perform complex surgical operations with vascular reconstructions in combination with appropriate and specialised anesthetic support help us to proceed with the surgical removal of tumours that in earlier times were considered inoperable.

At the same time, using new technologies during surgery allows us to treat locally advanced tumours.

Finally, clinical protocols in patients with metastatic disease provide the ability to identify which of these patients will benefit from surgery. And after a significant surgery, what?

After significant surgeries of this type, the cooperation of various specialties is required for the motor and nutritional rehabilitation of the patients and their optimal reintegration into their daily lives.

Pancreatic cancer is becoming quite common. Advances in science and technology arm us with new therapeutic approaches. Its early diagnosis and the referral of these patients to specialised centres can give optimistic messages for their present and future.

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