The main symptom of pancreatic cancer is stomach pain

The Auditorium of Galicia is hosting until today the 56th Congress of the European Pancreatic Club, which brings together doctors and scientists who are experts in the pancreas from around the world in Santiago, where advances in research that have occurred in the pathologies that affect this organ are being presented. It is chaired by Dr. Enrique Dominguezhead of the Digestive System service of the Santiago de Compostela and Barbanza Health Area.

—What are the most common pathologies affecting the pancreas seen in consultation?

—The pancreas is a very special organ. The most frequent reason for hospital admission in the Digestive System Department is acute pancreatitis. In addition, one of the tumors with the worst prognosis is that of the pancreas. We have the dubious characteristic of having very frequent and very serious diseases. Then there is another type of disease such as chronic inflammation (chronic pancreatitis), which is related to alcohol and tobacco consumption, even if it is not excessive.

—What is acute pancreatitis?

—A picture of acute and intense abdominal pain that forces you to go to the emergency room. Inflammation can occur in any organ, but the pancreas has a very special characteristic: it is loaded with digestive enzymes. This makes acute pancreatitis, in some cases, a serious disease. It can even be fatal. Luckily, most of them evolve well. In our environment, it is the most frequent cause of hospital admission in the Digestive System Service and the most frequent origin, by far, is gallstones. They account for about 350 cases per year.

—How does our lifestyle affect the pancreas?

—The pancreas has two great enemies: alcohol and tobacco. The more we drink and the more we smoke, the greater the damage we are subjecting to the pancreas. But people who have an alcohol consumption that we can consider socially normal and who are not heavy smokers, have a high risk of developing chronic inflammation of the pancreas. A totally different condition from acute pancreatitis because what it does is produce stomach pain. If we want to take care of the pancreas, the ideal is zero alcohol and tobacco.

—Normal alcohol consumption on the street is not normal for the medical community.

-No. Especially if we talk about the pancreas. In other organs it may be different, each one has its sensitivity. We must also take into account the genetic predisposition of each person, but we do not know it. In our CHUS Pancreas Unit we have more than a thousand patients with chronic pancreatitis under follow-up. Many of them have developed the disease with alcohol consumption considered normal. If you ask the patient, he tells you he only has a glass of wine with meals and little else. They are also not big smokers; They tell you about five cigarettes a day. But the combination is still bad.

—What if alcohol is not consumed daily, but on the weekend?

—What we call a weekend drinker, a very harmful profile too. Any alcohol intake, even if it is occasional, is toxic to the pancreas. In fact, it is not uncommon for a subject, after having had dinner and several liquors, to develop acute pancreatitis; simply due to high alcohol consumption at a given time.

—Pancreatic cancer is not the most diagnosed, but it is the most lethal.

The situation in Galicia is similar to that of Spain and that of Spain is similar to that of the rest of Europe. With very few differences between countries, it is the fourth cause of death from cancer in the Western world. Despite being the eighth or tenth in frequency, it is the fourth with the worst prognosis.

—What are the current problems when talking about pancreatic cancer?

—The problem is twofold. On the one hand, the number of cases continues to increase. There are many tumors that are decreasing in incidence; It does not happen with the pancreas. It is expected that by 2030, it will be the second cause of death from cancer. We cannot say that it is always fatal, but it is a disease with a worse prognosis than the vast majority of tumors. The second point, the increase in incidence in young people. Twenty years ago it occurred in older people, now there are thirty-year-old people with pancreatic cancer.

—What is the age measurement at the time of diagnosis?

—Obviously, it is still more frequent in older people. But on average, we can be talking about around 60 years old. What really draws our attention is finding a very young person who can have a tumor of these characteristics. That used to be something that was not seen and now it is. In fact, many of the clinical guidelines that develop algorithms for the treatment of this type of patient always put age as a cut-off point. Now it will have to change, because the fact of being young does not imply that you cannot have this type of tumor; although logically the probability is much lower than in the elderly population.

—Are there risk factors that can lead to suffering from a tumor in the pancreas?

—It is very difficult to know, in cancer in general and in pancreatic cancer in particular. There are many different types of cancer and the effect of each one individually is small, and some cannot be modified, such as genetics. We can say that smoking has a very clear association, but there are studies that have shown that a sedentary lifestyle and an unhealthy diet can also have an association.

—And when it comes to addressing it, what treatments are available?

—There are good prospects for the future, but it is very complex to treat. The pancreas is protected by fibrotic tissue, which makes it very difficult for the usual chemotherapy drugs to reach the tumor in sufficient concentrations to be as effective as in other types of tumors. On the other hand, it has a very special biology that varies from one subject to another. The key is early diagnosis; finding the tumor at a stage where it is operable.

However, if we do not diagnose the tumor in time to be able to perform surgery, we still have options. Giving chemotherapy before surgery to reduce the size of the tumor and then performing surgery on the patient. This is one of the usual treatments we use. What’s more, even if the tumor is even larger, that is, if we do not expect a direct response from chemotherapy, we are currently beginning to use different, advanced and local therapies. In Santiago we are the first center in Galicia to have started to use them. An example is the direct application of radioactive substances, such as phosphorus 32, to the tumor.

—What symptoms can lead to this early diagnosis?

—The main one is the pain. The problem is that it occurs in the upper part of the abdomen. The key is to suspect that the pain that seems to be in the stomach is not. It usually has nothing to do with food. Just like the unintentional weight loss, without dieting and in a short time. Patients who were not diabetic and who develop this pathology. If they also lose weight, it is suspicious because a type 2 diabetes patient is usually overweight. It doesn’t have to be cancer, but it makes us suspect that something is happening with the pancreas. And when the tumor infiltrates the bile duct, jaundice occurs; that is, the patient turns yellow. It all depends on the location of the tumor.