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There are mammograms for early detection of breast cancer. Colonoscopies are available for early detection of colon cancer. But there is no standard test to detect early cases of pancreatic cancer, before cancer cells have spread and when surgery might be beneficial.
Early detection of pancreatic cancer can increase a patient's chances of survival. Although the pan is fair About 3% of all new cancer cases In the United States, it is The third leading cause of cancer death And it is. It is expected to be the second leading cause of cancer death At the end of this decade.
Across the United States, research teams are investigating ways to detect cases earlier, with many turning to blood-based liquid biopsy tests.
“This term 'liquid biopsy' is basically trying to find markers in the blood that indicate the presence of a tumor – and there are many different ways to do that. There are many different aspects of the tumor that can enter the bloodstream that you can use,” said Dr. Brian Wolpin, director of the Gastrointestinal Cancer Center. Dana-Farber Cancer Institute, Whose laboratory has done work in this area.
However, many studies investigating the potential of liquid biopsy screening for early detection of pancreatic cancer are still in the early stages. and the US Defense Services Task Force He advises against screening for pancreatic cancer. When there are no symptoms of the disease in adults, especially in the general population, since there is no proven method or test to identify this type of disease.
Although there is currently no recommended blood test for early pancreatic cancers, “there is a large scientific community working to change that and identify a screening test that we can use in the clinic,” Wolpin said. . There is still a lot of work to be done to get there.
A team presented the study Monday at the annual meeting of the American Association for Cancer Research, which outlines the development of a liquid biopsy test that can detect 97% of stage 1 and stage 2 pancreatic cancers in hundreds of volunteers. The researchers from City of Hope Comprehensive Cancer Center and other institutions around the world.
Their study included 984 people, some healthy and others with pancreatic cancer, in Japan, the US, South Korea and China.
The researchers collected blood samples from each person and tested the expression of microRNAs in the blood and tiny genes packaged in exosomes. Exosomes are small vesicles that circulate in the bloodstream of cancer and healthy cells.
“Cancer cells release many, many more exosomes compared to our healthy cells because our healthy cells don't reproduce as quickly as cancer cells do,” said Dr. Ajay Goel, senior author of the study and chair of the Department of Molecular Biology. Tests and experimental treatments in the City of Hope. “And after these exosomes are released by tumor cells, they circulate in our blood.”
Goel and colleagues identified eight microRNAs in exosomes secreted by cancer cells in the pancreas and five microRNAs in blood. They used those markers to develop a method to determine whether a person's exosomes were associated with pancreatic cancer.
The researchers found that their liquid biopsy procedure detected 93% of pancreatic cancers among the US volunteers in their study, 91% of pancreatic cancers in the South Korean group, and 88% of pancreatic cancers in the Chinese group.
The researchers ran their experiment again and this time, they not only tested their exosome-based marker, but also tested for a key protein. CA19-9It is known to be associated with pancreatic cancer. When they combined their approach with the CA19-9 assay, they were able to accurately detect 97% of stage I and secondary pancreatic cancer in US volunteers.
“What we're really excited about is that not only does this test work beautifully across all stages, but it's 97% accurate in detecting both stage 1 and stage 2 disease,” Goel said.
The study's data indicated that screening for stage I and II pancreatic cancer produced false-positive results at a rate of less than 5%.
“It's important to diagnose the disease as early as possible, such as stage I or II disease, which means the cancer is more likely to be resectable,” Goel said. The best cure for pancreatic cancer is not chemotherapy or drugs, but the removal of the cancer.
Surgeons may be “very reluctant” to operate on someone with stage III or IV pancreatic cancer, he said. That's because sometimes the complexity of such a procedure, the long-term complications, and the fact that surgery at that high level may not be enough to keep the cancer from coming back.
“That's why this blood test is so good that 97% of the time it can find cancers at a stage where we can detect and intervene, and we can remove it with surgery. Cancer is effective,” Goel said.
are there Blood tests for pancreatic cancer They are used in medicine, but they are often used on people who are infected. Doctors may repeat blood tests during and after treatment to determine how the cancer is responding. But there is no blood test that can detect pancreatic cancer early.
Goel and colleagues note that their approach “may be further validated for clinical use in the near future.”
“Overall, we're very excited about this particular data, because the type of cancer we're looking at here is very lethal,” Goel said.
“The number of people affected by this disease or this cancer will increase,” he said. So we need to do something about this and that's why we were very excited to have this high-sensitivity blood-based liquid biopsy for early detection of pancreatic cancer.
The liquid biopsy test study presented by Goel and his colleagues is “exciting,” Wolpin said, and may point to a method for developing an early detection test — where there is great interest.
for sure Examine a person with Pancreatic cancer can involve a series of tests, blood tests, and biopsies, which are typically only done after a person has been diagnosed. Signs, which is yellow or yellow eyes and skin, weight loss, stomach or back pain, or tiredness and fatigue. But at that time the cancer is probably high.
“Most patients with pancreatic cancer have advanced disease at the time of their diagnosis. So 80% or more of patients have advanced disease that we know at the time of presentation, and we can't cure the cancer,” he said.
“This is very different from major cancers like breast cancer or colorectal cancer, where most patients actually have early disease,” he said. “Symptoms of pancreatic cancer, such as some abdominal cramping or sometimes weight loss, are generally not very specific — things that usually don't prompt people to go to their doctor.”
But some experts warn that mass testing of asymptomatic, average-risk healthy people could lead to false positives and do more harm than good.
City of Hope researchers aren't the only scientists hoping to develop a reliable test that can detect pancreatic cancer patients as early as possible.
By 2020, a Research from the University of Pennsylvania A blood test to test for specific biomarkers associated with pancreatic cancer has proven to be 92% accurate in detecting the disease.
By 2022, a Experimental study from researchers at UC San Diego And other institutions have confirmed that a blood test to detect proteins associated with cancer cells was able to identify 95.5% of stage I pancreatic cancer in a sample of more than 300 volunteers, including 139 cancer patients and 184 healthy people.
Pancreatic cancer in general is an area where little progress has been made, whether it's early stage or advanced disease, said Dr. Al Nugut, MD, a medical oncologist at Columbia University's Herbert Irving Comprehensive Cancer Center. of Epidemiology at Columbia University's Mailman School of Public Health, who was not involved in any liquid biopsy screening research.
“Pancreatic cancer is the poster child for cancers that we haven't gotten to,” Nugget said.
“The pancreas is a very strange organ, and it's different from the rest of the body,” he said. “It's behind the abdomen, so it's hard to get to. It's not easy for a surgeon. It's not easy for an oncologist. It makes it very difficult to even approach. You can't physically examine it. It's hard to get to radiology. It's hidden.”
Although pancreatic cancer is rare, people can reduce their risk by eating a healthy diet, maintaining a healthy body weight, getting regular exercise, avoiding alcohol, limiting exposure to carcinogens, and not smoking.
“Smoking is the most important preventable risk factor for pancreatic cancer,” he said American Cancer Society.
Still, having some form of screening for early detection of pancreatic cancer would “really change the landscape” for patients, Wolpin said, adding that he hopes such a tool can be developed in the medical field.
The more patients we find earlier, the greater the chance to cure pancreatic cancer patients and reverse the dire statistics – 90 percent of pancreatic cancer patients die from the cancer. “We really need to change those numbers, and finding cancer early is a wonderful way to do that.”