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Pancreatic Cancer

Exocrine pancreatic cancer is now the seventh most common cancer in Europe. In Italy, approximately 14,800 new cases (6,800 men and 8,000 women) were estimated in 2023, with incidence steadily rising in both sexes. Mortality is equally alarming: in 2022 nearly 15,000 deaths were recorded, making pancreatic cancer the fourth leading cause of cancer death. Even more concerning, only 11% of men and 12% of women survive beyond five years after diagnosis, and projections indicate that by 2030 pancreatic cancer could become the second leading cause of cancer death in Western countries. 

The risk of developing this disease increases with age—most cases are diagnosed after age 65—and depends on various factors: cigarette smoking, obesity, a diet low in fruits and vegetables and high in saturated fats, occupational exposure to chemicals, and in some cases conditions such as newly diagnosed type 2 diabetes or chronic pancreatitis. In 5–10% of patients, a genetic predisposition underlies the disease, expressed in known familial syndromes (for example, Peutz-Jeghers syndrome, BRCA-2 mutations, or Lynch syndrome). 

DIAGNOSTIC PATHWAY AND TREATMENT STRATEGY 

FIRST CONSULTATION:  

Patients may access our center in several ways: referral from a general practitioner, external providers, internal outpatient clinics or endoscopy units, and even complex surgical departments. Under the National Health Service, the patient must be physically present for the consultation. During the first visit, we review the patient’s overall health and comorbidities and examine any existing diagnostic reports. Occasionally, it is necessary to request and re-examine the tumor tissue used for the initial diagnosis. Both newly diagnosed patients and those already undergoing treatment elsewhere—seeking a specialized consultation—attend this first visit. 

DIAGNOSTIC WORKUP:  

Diagnosis and staging go hand in hand with assessing whether the tumor can be surgically removed, with particular attention to vascular involvement in localized disease. A multidisciplinary approach is essential in this context. We start with an evaluation of the patient’s general condition and basic imaging and laboratory tests, such as chest/abdominal CT scans and bloodwork. The CT scan helps determine tumor size and extent, its relationship to adjacent organs and vessels, presence of metastases, and possible complications (e.g., pulmonary embolism). If not already performed, an endoscopic ultrasound of the pancreas is ordered to visualize the lesion directly and, when indicated, obtain a biopsy sample. All cases are discussed within our Pancreas Unit multidisciplinary team. This collegial meeting establishes the optimal diagnostic path—considering additional tests like abdominal MRI or PET-FDG scans—and immediately outlines a personalized treatment plan. 

TREATMENT  

For each patient, we develop an individualized care plan based on the latest scientific standards. Whenever available, patients are always considered for participation in experimental clinical trials. Thanks to our active clinical research program, we often can offer innovative therapies, including treatments targeted to the tumor’s genetic features, immunotherapies, and approaches based on new mechanisms of action or novel strategies.  

Patients receiving systemic treatment also benefit from continuous monitoring via Pain Therapy, Supportive Care, and Clinical Nutrition services, ensuring effective control of both disease-related symptoms and treatment side effects. Finally, the treatment journey relies on a multidisciplinary, team-based approach, with ongoing evaluation of potential locoregional and/or palliative therapies to complement systemic treatment. 

TREATMENT OF LOCALIZED DISEASE 

RESECTABLE DISEASE: About 5–20% of patients with pancreatic cancer present with surgically resectable disease. In these cases, radical surgery—removal of the tumor—is the guideline-recommended treatment. The surgical procedure depends on the tumor’s location (head, body, or tail), its size, and the feasibility of achieving disease-free resection margins. 

BORDERLINE RESECTABLE DISEASE: In patients with localized pancreatic cancer but unfavorable prognostic factors (for example, local extension, partial vascular involvement, or elevated CA19-9 levels), the treatment approach is discussed collegially and often includes preoperative therapy. 

UNRESECTABLE LOCAL DISEASE: In cases of locally advanced, non-resectable pancreatic cancer, exclusive chemotherapy or chemoradiotherapy is indicated (to be evaluated by the multidisciplinary team in selected cases), using regimens similar to those for advanced or metastatic disease. If significant disease reduction is achieved, reassessment for potential surgical resection may follow. 

POSTOPERATIVE ADJUVANT THERAPY: After surgery, based on the patient’s clinical condition and tumor stage, adjuvant therapy may be offered to reduce the risk of recurrence. This usually consists of cyclic administration of one or more drugs chosen according to the patient’s overall health and comorbidities. Common regimens include fluoropyrimidine-based and/or gemcitabine-based chemotherapy. Combined chemoradiation is reserved for cases deemed appropriate by the multidisciplinary group. 

FOLLOW-UP PROTOCOL AND OUTPATIENT CONTROLS: After postoperative treatment, patients undergo scheduled clinical and instrumental checks—including chest/abdominal CT scans and blood tests with tumor markers—every 4–6 months for the first 2–3 years. Thereafter, the frequency may be extended to annual assessments up to five years. 

TREATMENT OF METASTATIC DISEASE  

Patients with metastatic pancreatic cancer are evaluated for first-line chemotherapy, aiming to prolong survival and manage tumor-related symptoms. Systemic treatment may involve one or more chemotherapy agents (typically fluoropyrimidines- or gemcitabine-based regimes), selected based on the patient’s overall clinical status. Treatment duration and any regimen modifications are determined by tolerability, efficacy, and the patient’s health condition. Given the aggressive nature of pancreatic cancer and the general clinical status of patients who progress after first-line therapy, relatively few are eligible for second- or third-line treatments. Consequently, decisions regarding subsequent lines of therapy must be made after thorough clinical evaluation, weighing the risk/benefit profile and treatment tolerability.  

Whenever possible, participation in experimental clinical trials is always preferred. 

Carcinoma del pancreas 

Gastrointestinal Oncology
Clinical Area, Simple Structure

Oncologic Surgery 1 – Hepato-Gastro-Pancreatic and Liver Transplantation 
Clinical Area, Complex Structure

Research in Nutrition and Metabolomics
Departmental Simple Structure

Cure Palliative, Terapia del Dolore e Riabilitazione
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Diagnostic and Interventional Radiology Unit
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Anatomia patologica 2
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Pathological Anatomy 1
Complex Structure

Medical Genetics
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Clinical Psychology
Clinical Area, Departmental Simple Structure

Last update: 09/10/2025

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