Tumour of the pancreas 

The most common form of pancreatic cancer is adenocarcinoma; it usually develops in the pancreatic head and originates in the ducts that carry the digestive enzymes.
It is a particularly aggressive and unfortunately very widespread form of cancer: 
Because of the rapid spread to organs such as lung and liver and the problematic nature of making an early diagnosis, pancreatic cancer is one of the most difficult to treat. 

Causes 
Pancreatic cancer occurs following the uncontrolled multiplication of cells that have undergone genetic alteration. The causes of this alteration are still unknown, but some factors are known to increase the risk of the onset of the disease include:

• overweight and obesity;
• chronic inflammation of the pancreas (pancreatitis);
• smoking (smokers have almost triple the risk of non-smokers);
• age (over 60 years of age the risk increases);
• family history for some types of cancer that may depend on genetic hereditary mutations (such as breast or colon cancer); 
• diet rich in animal proteins and fats.

Symptoms

As noted, the diagnosis of adenocarcinoma, the most common form of pancreatic cancer, is difficult to make during the early stages of the disease mainly because of the absence of easily-identifiable symptoms.
Only when the tumour blocks the bile ducts or reaches other organs is it possible to recognize the symptoms, which are mainly:

• lack of appetite
• weight loss
• weakness
• nausea and vomiting
• pain in the upper part of the abdomen and back
• jaundice 
• diabetes.

Diagnosis
The diagnosis of pancreatic cancer should be made by a medical specialist following tests such as CT, NMR, and echoendoscopy. In the case of jaundice, the yellowish coloration of the skin, other specific tests may be performed. The measurement of tumour markers is also useful for diagnosis. 
If a histological investigation of the lesion is necessary (an unclear radiological picture or the need for preoperative chemotherapy), patients are evaluated by means of echoendoscopy, that is, an ultrasound conducted through a special gastroscope, which also allows for biopsy sampling to be conducted.

Treatment
Based on radiological data, patients are considered to have: 

• Resectable neoplasm
• Locally advanced neoplasm
• Metastatic neoplasia

A resectable tumour is one that can be completely removed with clear margins around it. 
In the case of head/uncinate process and isthmus cancer, if the tumour has invaded the main visceral arteries, the neoplasm is considered locally advanced. In this case it is first necessary to reduce the infiltration of the vessels by means of chemotherapy and, subsequently, the possibility of a surgical intervention can be considered. 
In the case of metastatic neoplasia due to ductal adenocarcinoma, an intervention is almost always contraindicated, except in those patients with a good response to chemotherapy, at a young age, in good general condition, and after careful multidisciplinary re-evaluation. 

Other pancreatic tumours
 

CYSTIC NEOPLASMS OF THE PANCREAS
These are recently noticed heterogeneous lesions which are increasingly important from the statistical standpoint as a reason to carry out a resective intervention. They are almost always discovered randomly, usually during an ultrasound of the abdomen performed for unrelated symptoms, and require a morphological study that almost always occurs by means of Magnetic Resonance.
When benign, they will be monitored over time with radiological examinations. In the case of borderline or malignant lesions surgery is necessary. The decision regarding the type of treatment to be undertaken is based on clinical and radiological examinations. 

NEUROENDOCRINE NEOPLASMS
These are tumours of the other cell line prevalent in the pancreas, that is, those cellular elements responsible for the secretion of digestive hormones in the blood (especially glucagon, insulin, and gastrin). In 70% of all cases, neoplastic cells do not produce hormones. In this case, these tumours are called non-secretory neuroendocrine neoplasms.
They can sometimes be associated with diseases of other endocrine glands in familial syndromes (Von Hippel-Lindau disease).
They have some radiological characteristics, especially using CT, which often enable a diagnosis even without the need for a biopsy: they are, in fact, very vascularised tumours, so they show a lot of "colour" after the administration of contrast medium. They can also be diagnosed through nuclear medicine investigations, such as Octreoscan or PET with Gallium.
If the lesions are secretory, they must always be operated on.
Non-secretory lesions, if less than 2 cm, can be monitored with periodic radiological checks, but larger lesions are generally operated on. 
The prognosis of these lesions depends on the size of the primary tumour, the involvement of the lymph nodes, the presence of metastases, and the proliferative index (Ki 67, which measures the rate of cell proliferation). Metastatic lesions can also benefit from aggressive surgery: the indications for the intervention must be carefully discussed in the context of a multidisciplinary group that includes the surgeon, the oncologist, the radiation therapist, and the nuclear medicine physician.