Early Detection of Pancreatic Cancer

Pancreatic cancer is diagnosed primarily through the use of computed tomography (CT) scans, endoscopy, laparoscopy, biopsy and exploratory surgery.   Unfortunately, these tests are ineffective at detecting smaller lesions, pre-cancers or early stage cancers, which may be more possible to cure.   When diagnosed early, surgical resection offers the best chance for long term control of pancreatic cancer, yet the majority of patients diagnosed are not eligible for surgery.   Tests sensitive enough to detect pancreatic cancer in the earliest stages before symptoms develop are therefore urgently needed.   For individuals who are at increased risk due to family history and chronic or hereditary pancreatitis, effective early screening methods are especially important.  

A blood test, because of ease of use and cost effectiveness, is the ideal early detection method.  In prostate cancer, the PSA test identifies a specific substance or biomarker in the blood that, at certain levels, is highly indicative of cancer.   At institutions across the country, researchers are actively looking for pancreatic cancer biomarkers that can be used in a diagnostic test similar to the PSA test.   Researchers use a variety of methods to find these markers and they are beginning to yield promising results.

Current Research
Using genetic analysis, scientists are looking for specific genes and changes within genes that are associated with pancreatic cancer.   Preliminary studies have revealed that a significant number of genes are abnormally active in pancreatic cancer cells.   Some of this increased gene expression can be detected in both tumor biopsy samples and in digestive fluids secreted by the pancreas called pancreatic juice.  Researchers predict that they will someday be able to isolate these genes in blood samples as well.

Proteomics is a new and exciting area of research that involves analyzing samples of biological fluids for patterns of protein expression unique to a specific disease.  For example, a small study done at Johns Hopkins analyzed pancreatic juice taken from patients undergoing pancreatic surgery for either pancreatic cancer or other non-cancerous diseases.  Protein from each sample was analyzed.  The samples from the cancer patients contained elevated levels of a protein that was not detected in the non-cancer group.

A diagnostic test involving any biomarker must be able to distinguish between a person with pancreatic cancer and unaffected individual with near 100% accuracy.  It is doubtful that one marker alone will be specific enough to reliably diagnose all types of pancreatic cancer.  It is more likely that a group, or panel, of many markers will be combined to create an accurate test.

Existing Options
Until a reliable early detection test is developed, there needs to be a screening protocol for high-risk individuals.  Although many doctors agree that having two or more close family members with pancreatic cancer puts a person at high risk for the disease, there is no consensus as to when, how often and with what methods these individuals should be screened. 

Because of the lack of knowledge surrounding early screenings, doctors stress the importance of taking part in investigational studies targeted specifically at populations at high risk for pancreatic cancer.   A few institutions already have programs in place and others are in the process of developing them.   Please contact a Patient and Liaison Services (PALS) Associate at 877-272-6226 or pals@pancan.org for more information about current early detection studies.

Many of these studies involve monitoring high-risk persons using scans such as endoscopic ultrasound (EUS), computed tomography (CT) and/or endoscopic retrograde cholangiopancreatography (ERCP).  Participants may also undergo novel imaging procedures, be tested for genes associated with hereditary pancreatic cancer and have biological fluids, such as blood and pancreatic juice, collected and analyzed.  Besides the advantage of having screenings performed by knowledgeable doctors and possibly benefiting from cutting edge diagnostic tests, study participants will undoubtedly help advance the science of early detection.  Over the next few years, these studies should provide a wealth of information regarding who is at risk, what genes are most involved in developing pancreatic cancer and the best methods for early diagnosis and treatment.    

With continued research, improved technology and increased funding, researchers predict that significant advances in the early detection of pancreatic cancer will be made in the next few years.  

If you have questions about early detection of pancreatic cancer, please contact a Patient and Liaison Services (PALS) Associate toll-free at 877-272-6226 or email pals@pancan.org .

The Pancreatic Cancer Action Network thanks the following doctors for their important contributions to this column:

Randy Brand, MD, Evanston Northwestern Healthcare          
James Disario, MD, University of Utah  
Michael Goggins, MD, Johns Hopkins University
Samir Hanash, MD, PhD, University of Michigan
Gloria Petersen, PhD, Mayo Clinic
Craig Logsdon, PhD, MD Anderson Cancer Center
David Tuveson, MD, PhD, University of Pennsylvania

The information and services provided by the Pancreatic Cancer Action Network, Inc. are for informational purposes only.  The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment.  If you are ill, or suspect that you are ill, see a doctor immediately!  The Pancreatic Cancer Action Network does not recommend nor endorse any specific physicians, products or treatments even though they may be mentioned on this site.  081001