Early diagnosis, personalised therapies and new targeted drugs are marking a paradigm shift for one of the cancers with the poorest prognosis.
Pancreatic cancer remains one of the most complex tumours to diagnose and treat, but progress in recent years is opening up a more hopeful outlook for patients. This is explained by Dr Enrique de Madaria, a specialist in Digestive Diseases at Quirónsalud Torrevieja Hospital and Quirónsalud Alicante, who emphasises that the combination of new imaging techniques, emerging biomarkers and targeted therapies “is beginning to change a disease that for a long time seemed immovable”.
Pancreatic cancer develops when cells in the pancreas start to grow uncontrollably, generally in the part responsible for producing digestive enzymes. The most common type is pancreatic adenocarcinoma.
One of the greatest challenges is achieving earlier diagnosis. Because the pancreas lies deep within the abdomen, early tumours rarely cause clear symptoms. “When signs such as abdominal pain, weight loss or jaundice appear, the disease is often already advanced,” Dr De Madaria points out. At present, nearly 80% of cases are detected when surgery is no longer possible — despite being the only treatment that can potentially cure the disease.
New tools for the early diagnosis of pancreatic cancer
Although there is still no effective screening programme for the general population, technological progress is enabling the detection of increasingly small suspicious lesions thanks to tools such as high-resolution MRI scans, endoscopic ultrasound, and advanced image-analysis systems based on artificial intelligence. “This is where we are seeing a qualitative leap: technology is sharpening our ability to identify incipient tumours and, in some cases, to get ahead of symptoms,” the specialist explains.
At the same time, new biomarkers are being investigated that could revolutionise early detection, including fragments of circulating tumour DNA, specific metabolites, and even signals detectable in saliva and stool samples — a line of research still in the experimental phase but especially promising.
A treatment approach that requires a multidisciplinary team
Managing pancreatic cancer calls for close coordination between gastroenterologists, surgeons, oncologists, radiologists and nutritionists. Specialists review each case in tumour boards to decide on the best therapeutic plan.
Surgery remains the only potentially curative treatment, but only a small proportion of patients are eligible for it at the time of diagnosis. In some cases that are initially inoperable, new chemotherapy regimens can shrink the tumour and make later surgery possible.
Advances in the treatment of pancreatic cancer
In recent years, medical treatment for pancreatic cancer has evolved significantly, leading to clear improvements in survival.
However, the most important breakthrough comes from personalised medicine. Some tumours harbour mutations that allow the use of targeted therapies.
“We are witnessing a paradigm shift,” says Dr De Madaria. “For decades, KRAS — the main mutation in pancreatic cancer — seemed untouchable, but drugs are now starting to emerge that can act on specific mutations such as KRAS G12C or G12D. The first trials are promising.”
In addition, therapies capable of acting against several KRAS variants are already in development, which could benefit a far larger proportion of patients. Research is also exploring combinations with immunotherapy and other targeted treatments, with increasingly robust preliminary results.
Although pancreatic cancer remains a major challenge, the pace of progress is faster than ever. “For the first time, we are seeing research deliver not only knowledge but real tools that can transform prognosis,” concludes Dr Enrique de Madaria. “Collaboration between centres and participation in clinical trials have been key to opening new doors for our patients.”
