In recent years the medical community has witnessed an alarming trend: an increase in pancreatic cancer cases at younger ages. Pancreatic cancer was once considered a disease that mainly affects adults over 70. The worrying thing is that pancreatic cancer is now being diagnosed more and more often in people under 50 and unfortunately it is on the rise.

“This epidemiological change highlights the urgent need for increased awareness, early detection and innovative diagnostic approaches.
Statistics show that pancreatic adenocarcinoma is already the third leading cause of death from cancer in the Western world. Unfortunately, pancreatic cancer is “notorious” for its aggressive nature and despite our therapeutic interventions, it has a very poor prognosis,” says Mr. Dimitrios Panagiotakopoulos MD, MRCP(UK) Gastroenterologist – Director of the 4th Gastroenterology Clinic, Head of the Endoscopic Ultrasound Department at Metropolitan General.

What are the symptoms of pancreatic cancer?

With symptoms often vague and non-specific, pancreatic cancer escapes detection until it reaches an advanced stage, making treatment difficult and with poor outcomes. However, early diagnosis remains the cornerstone of effective management and improved survival rates.

Symptoms that should be evaluated immediately by a specialist are:

• Painless jaundice: That is, the yellowing of the eyes that is usually accompanied by dark urine and discoloration of the stool.
• The pain: Pancreatic cancer can cause pain, which unfortunately is a symptom of advanced disease. The pain is typically in the epigastrium with a reflection in the back and occurs mainly at night waking the patient.
• The unexplained weight loss: It is due to anorexia but also hyper-catabolism (cancer cachexia) caused by pancreatic adenocarcinoma.
• Changes in mood: Mainly the depression that usually precedes the diagnosis by months.
• Diabetes mellitus: New-onset diabetes or sudden worsening of existing diabetes.

Ways to diagnose pancreatic cancer

“The doctor who suspects a possible pathology in the pancreas must proceed with a further check which usually includes a CT scan of the upper abdomen with the use of contrast. MRI also with contrast complements the screening. In the event that a tumor is found in the pancreas, the patient must be referred to a special center that deals with diseases of the pancreas. The diagnosis and staging of the tumor is done with the help of endoscopic ultrasound (EUS), which is usually accompanied by the taking of biopsy material through a needle (Fine Needle Biopsy – FNB)”, he explains.

The role of endoscopic ultrasound in the diagnosis of pancreatic cancer

An essential tool in the arsenal against pancreatic cancer and especially early diagnosis is endoscopic ultrasound (Endoscopic Ultrasound – EUS). It is a special endoscope that has an ultrasound head attached to its end. The examination is performed under intoxication (sedation), lasts about 30 minutes and is painless for the patient. This advanced endoscopic imaging technique allows the specialized gastroenterologist to examine the pancreas and adjacent tissues and organs (the liver, vessels, lymph nodes, etc.) with high-resolution images. The accuracy of endoscopic ultrasound is greater than CT or MRI because it allows clinicians to detect abnormalities as small as a few millimeters.

“The endoscopic ultrasound not only helps in the diagnosis of pancreatic cancer, but also facilitates the staging of the disease, guiding treatment decisions and prognostic assessments. Endoscopic ultrasound allows, in addition to the morphological characterization of the tumor, to obtain material for biopsy and histological identification. Something that in the past was done either with a surgical approach or with a biopsy under a CT scanner. The method of obtaining biopsies is called EUS – FNB (fine needle biopsy) and with the experience of both the specialized gastroenterologist and the cytologist or pathologist, the accuracy in diagnosis exceeds 90-95%”, emphasizes the expert.

In conclusion

“In conclusion, the increase in pancreatic cancer incidence in younger demographic groups requires our undivided attention and concerted action. Through increased awareness, information, improved access to diagnostic modalities such as endoscopic ultrasound (EUS), and screening initiatives, we can improve outcomes and ultimately reverse the tide of this devastating disease. New techniques are emerging on the horizon for diagnosis, liquid biopsies may give us the opportunity to rise to the challenge and fight for a future where pancreatic cancer is no longer a formidable enemy, but an adversary that can be defeated.” , concludes Mr. Panagiotakopoulos.

*Specialized endoscopic ultrasound department at Metropolitan General

The Metropolitan General is one of the first centers in Greece to apply the endoscopic ultrasound technique and will soon close twenty years of operation. The latest techniques are applied at a diagnostic level regarding pancreatic diseases, such as elastography, the use of contrast agents and needle biopsy (EUS-FNB). The endoscopic ultrasound department offers high quality and reliable results with rates exceeding 90-95%. Recognized collaborators in the field of cytology, imaging, pancreatic surgery and oncology offer the necessary multidisciplinary approach to such a complex problem as pancreatic adenocarcinoma.