It is a cancer that affects the pancreas, an organ located in the abdomen, behind the stomach, which is part of the digestive system. This organ is also part of the endocrine system, which secretes hormones into the blood, thus controlling several functions of the human body such as growth, reproduction, sleep or hunger.

There are several types of pancreatic cancer, including:

• Pancreatic adenocarcinoma : It is the most common type of pancreatic cancer, accounting for approximately 90% of cases. It is formed in the cells that line the pancreatic ducts.
• Pancreatic neuroendocrine tumor : This type of cancer starts in cells that produce hormones. In some cases, this type of cancer is responsible for hormone secretion (insulinoma, glucagonoma...)
• Papillary mucinous intracanal tumors of the pancreas (TIPMP) : these are rare tumors characterized by a proliferation of the ductal epithelium which secretes more or less abundant quantities of mucus causing dilation of the pancreatic ducts.

Pancreatic cancer may be associated with several biomarkers and genetic mutations including:

• KRAS gene mutation : This mutation is the most common in pancreatic cancer (present in approximately 95% of cases of pancreatic adenocarcinoma). The KRAS gene mutation is an early event in the development of this cancer and is associated with aggressive tumor progression.
• TP53 and CDKN2A gene mutation : These mutations are generally associated with disease progression and poor response to treatment.
• BRCA 1/2 gene mutation : Mutations in the BRCA1 and BRCA2 genes are associated with an increased risk of pancreatic cancer. These mutations can also influence the response to targeted treatments related to DNA repair. ‍
• SMAD4 gene mutation : This mutation is present in about half of cases of pancreatic carcinoma. She is generally at an increased risk of advanced tumor progression and has a poor prognosis.

The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

Three parameters must be taken into account:

• The T describes the size and extent of the primary tumor
• The N indicates whether the cancer faces a regional lymph node extension
• The M indicates whether the cancer has spread to other parts of the body, called metastasis

Different stages of development of pancreatic cancer exist depending on how well the cancer cells are spreading. The stages vary from 0 (cancer limited to the epithelium that has not yet touched deeper areas of the pancreas and has no metastasis or extension to the lymph nodes) to IV (metastatic cancer that is, cancer that is, cancer that has spread to distant organs such as the lung or liver).

There are several treatments available for pancreatic cancer. Treatment involves multidisciplinary care that depends on the stage of the disease, the cancerous tumor and the overall health condition of the patient.

Surgery is the only cure for pancreatic cancer and involves surgically removing the tumor. This procedure is generally performed for patients with small tumors (less than 2.5 cm), which represents approximately 20% of patients.

Depending on the size and location of the tumor, different operations should be considered:

• Partial pancreatectomy: only part of the pancreas is removed
• Total pancreatectomy: removal of the entire organ
• Whipple procedure (also called pancreatoduodenectomy): removal of the head of the pancreas, duodenum (first segment of the small intestine) as well as part of the stomach and gallbladder

Chemotherapy is a treatment that uses powerful drugs to destroy cancer cells by stopping them from multiplying or spreading in the body. Chemotherapy medications can be given intravenously (into a vein), orally (as tablets or capsules), or by subcutaneous injection (under the skin).

Chemotherapy may be used alone or in combination with other treatments such as surgery or radiation therapy, depending on the type and stage of the cancer, as well as the patient's overall health. While chemotherapy can be very effective in destroying cancer cells, it can also damage healthy cells, leading to side effects such as hair loss, fatigue, nausea and vomiting, and suppression of the immune system.

In the case of pancreatic cancer, among the chemotherapy therapies used, we find in particular:

• The combination of leucovorin, fluorouracil, irinotecan and oxaliplatin (FOLFIRINOX)
• Gemcitabine (GEMZAR)
• NAB-paclitaxel (ABRAXANE) which is often used in combination with Gemcitabine.

Radiation therapy consists in using radiation (also called rays or radiation) to destroy cancer cells by blocking their ability to multiply. We are talking about a locoregional treatment of cancers.

In the case of pancreatic cancer, radiation therapy is difficult to use because of the location of the organ.

Targeted therapy is a drug treatment that specifically targets genetic or molecular abnormalities or alterations present in cancer cells or other diseased cells.

Unlike conventional treatments such as chemotherapy that act on all cells in the body, targeted therapies work more selectively, by blocking or inhibiting specific proteins involved in the growth and proliferation of cancer cells or in other diseases.

Targeted therapies are often used in combination with other treatments such as chemotherapy or radiation therapy. They are being used more and more in the treatment of cancer.

In the case of pancreatic cancer, among the targeted therapies used, we find for example:

In case of a BRCA1/2 mutation:

• Anti-PARP treatment (ex: Olaparib, Rucaparib etc...)

Treatment of neuro-endocrine tumors

• Sunitinib (SUTENT)
• Everolimus (AFINITOR)