No conventional test detects pancreatic cancer early. Scientists want to fix that.

There are mammograms that can detect breast cancer at an earlier stage. There are colonoscopies that can detect colon cancer at an earlier stage. The early detection of pancreatic cancer, which occurs before the cancer cells have spread and when surgery is more likely to be beneficial, is not now possible by the use of a conventional test.

When pancreatic cancer is detected at an earlier stage, it has the potential to improve a patient’s odds of survival. Pancreatic cancer is the third largest cause of death from cancer in the United States, and it is anticipated to become the second greatest cause of death from cancer by the end of this decade. This is despite the fact that pancreatic cancer accounts for just around three percent of all new instances of cancer in the country.

The use of blood-based liquid biopsy tests is becoming increasingly popular among research teams who are conducting investigations around the United States to find ways to detect early instances.

The term “liquid biopsy” refers to the process of attempting to identify indicators in the blood that indicate the presence of a tumor. There are numerous methods that can be utilized to accomplish this task for liquid biopsy. “There are a lot of different characteristics of a tumor that can end up in the blood that you could use,” said Dr. Brian Wolpin, director of the Gastrointestinal Cancer Center at Dana-Farber Cancer Institute, whose laboratory has done work in this territory. Wolpin’s laboratory has also conducted research in this area.

Nevertheless, a significant number of studies that are currently in the preliminary stages of investigation into the possibility of liquid biopsy tests for the early identification of pancreatic cancer are still. In addition, the United States Preventive Services Task Force advises against screening for pancreatic cancer in people who are not exhibiting any symptoms. This is particularly due to the fact that there is no established method or test that can detect this form of the disease in the general population at an early stage.

“There is a large scientific community working to try to change this and to identify a screening test that we can use in the clinic, but it’s quite difficult,” Wolpin said. This is despite the fact that there is presently no single blood test that is recommended for the detection of early pancreatic tumors. A further amount of effort needs to be done in order to arrive to the desired destination.

At the annual meeting of the American Association for Cancer Research, which took place on Monday, one group presented their findings. They described the invention of a liquid biopsy test that was found to detect 97% of stage I and stage II pancreatic tumors in hundreds of volunteers. A number of institutes from all around the world, including the City of Hope Comprehensive Cancer Center, are responsible for doing the research.

Their study, which has not been published in a journal that is subject to peer review, included 984 individuals from Japan, the United States of America, South Korea, and China. Some of the participants were healthy, while others were diagnosed with pancreatic cancer.

The researchers took blood samples from each individual and examined the expression of a group of microRNAs, which are small genes that are found in the blood and are encapsulated within exosomes that are found in the blood. In the bloodstream, both malignant and healthy cells are responsible for the release of exosomes, which are tiny vesicles.

Dr. Ajay Goel, the senior author of the study and the chair of the Department of Molecular Diagnostics and Experimental Therapeutics at City of Hope, stated that cancer cells have a tendency to release a great number of exosomes in comparison to our healthy cells. This is due to the fact that our healthy cells do not multiply as quickly as cancer cells do. When these exosomes are produced by the tumor cells, they travel via our bloodstream and circulate throughout our bodies.

Eight microRNAs were discovered in exosomes, which are shed by malignant cells in the pancreas, and five microRNAs were discovered in blood. These microRNAs were discovered by Goel and his colleagues. With the help of those indicators, they devised a method for determining whether or not the exosomes of a person are linked to pancreatic cancer. The liquid biopsy method was shown to detect 93% of pancreatic cancers among the volunteers from the United States who participated in the trial. Additionally, the researchers discovered that their method recognized 91% of pancreatic cancers in the South Korean cohort and 88% of pancreatic cancers in the Chinese cohort.

These tests were repeated, and this time the researchers not only employed their exosome-based indicators, but they also tested for a critical protein known as CA19-9, which is known to be related with pancreatic cancer. The researchers were able to accurately detect 97% of stage I and stage II pancreatic tumors in the members of the United States volunteer population when they combined their method with the CA19-9 tests.

“That is what we are excited about: not only did this test work beautifully in all stages, but it is also 97% accurate in finding those who have either stage I or stage II disease,” Goel said. “This is what we are excited about.”

In addition, he mentioned that the test had a rate of less than five percent of producing false positive results for pancreatic tumors in stages I and II, according to the findings of the study.

“It is very important to diagnose the disease at the earliest possible stage, such as stage I or stage II disease,” Goel said. “This means that there is a higher chance that the cancer can be operated on surgically.” Instead of chemotherapy or medications, the most effective treatment for a patient with pancreas cancer is to remove the cancerous cells.

It is possible that surgeons will be “very reluctant” to perform surgery on a patient who has stage III or IV pancreatic cancer, according to him. This can be the case due to the intricacy of such an operation, the potential for long-term problems, and the possibility that surgery performed at such an advanced stage could not be sufficient to prevent the cancer from returning.

According to Goel, “This is why it is very important that this blood test is so good that it can, 97% of the time, find the cancers at the earliest possible stages where we can intercept the cancer, where we can intervene, and where we can surgically remove this cancer effectively.” This is because the malignancies can be found at the earliest possible stages.

“We have to take action,” they said.
In the field of medicine, there are blood-based diagnostics for pancreatic cancer that are utilized; however, these tests are often administered to individuals who have already been diagnosed with the disease. In order to detect how the cancer is reacting to treatment, doctors may perform additional blood tests both during and after the treatment. On the other hand, there is no blood test that can detect pancreatic cancer in its early stages.

In the abstract that they submitted, Goel and his colleagues stated that their method “has the potential to be further validated for clinical use in the near future,” more specifically for the purpose of detecting pancreatic cancer at an earlier stage.

“We were generally excited about these particular data that we were looking at because the type of cancer that we are looking at here is extremely lethal,” Goel added.

“The number of people who are going to be affected with this disease or this cancer is going to continue to go up,” he added of the future of the disease or cancer. Because of this, we are quite happy about the fact that we have a blood-based liquid biopsy for the early diagnosis of pancreatic cancer that has such a high level of sensitivity. Thus, we need to take action. The liquid biopsy test study that Goel and his colleagues presented is “interesting,” according to Wolpin, and it explains one route to perhaps establishing a test for early detection, which is an area where there is a significant need.

In order to make a certain diagnosis of pancreatic cancer, it is necessary to conduct a series of scans, blood tests, and biopsies. These procedures are normally carried out only after the individual has experienced symptoms, which may include jaundice or yellowing of the eyes and skin, weight loss, abdominal or back discomfort, fatigue, and weakness. On the other hand, at that time, the cancer has most likely progressed.

In the vast majority of cases, people who are diagnosed with pancreatic cancer have already reached an advanced stage of the disease when they are diagnosed. Consequently, eighty percent or more of patients present with advanced disease, which means that we are aware that it is quite improbable that we would be able to cure the cancer at the time of their presentation, as Wolpin explained.

“That is very different from many other major cancer types, such as breast cancer or colorectal cancer, where the vast majority of patients actually present with early disease,” he added. “This is a very significant difference.” “The symptoms of pancreatic cancer are generally less specific, such as some abdominal discomfort or sometimes weight loss – things that frequently do not immediately trigger people to go to their doctor,” the author writes.

The mass testing of healthy individuals who are not exhibiting symptoms and who are considered to be at an average risk could result in false positive results, which would be detrimental to the patient’s health rather than beneficial.

“The pancreas is a very peculiar organ of the body.”
The researchers at City of Hope are not the only scientists who are enthusiastic about the prospect of developing a trustworthy test that can diagnose pancreatic cancer patients at the earliest possible stage.

In a study that was conducted in the year 2020 at the University of Pennsylvania, it was discovered that a blood test that was designed to screen for specific biomarkers that are related with pancreatic cancer was 92% accurate in order to diagnose disease.

A blood test that detects proteins associated with cancer cells was able to identify 95.5% of stage I pancreatic cancers among a sample of more than 300 volunteers in 2022, according to the findings of a pilot study conducted by researchers at UC San Diego and other institutions. Of the participants, 139 were cancer patients and 184 were healthy people.

According to Dr. Al Neugut, a medical oncologist at Columbia University’s Herbert Irving Comprehensive Cancer Center and a professor of epidemiology at Columbia University Mailman School of Public Health, who was not involved in any of the liquid biopsy testing research, the field of pancreatic cancer is an area in which there has not been much advancement when it comes to either early-stage or advanced disease. Neugut was not involved in any of the research that was conducted. In his statement, Neugut referred to pancreatic cancer as the “poster child” for cancers that have not been successfully treated.

According to him, “The pancreas is a very peculiar organ, and it is simply distinct from every other organ in the body.” It is difficult to access because it is located behind the abdomen. For a surgeon, it is not a simple task. The job of an oncologist is not an easy one. Because of this, simply approaching it is quite challenging. It is not possible to physically examine it. Radiologically speaking, it is difficult to reach. “It is concealed.”

A balanced diet, maintaining a healthy weight, engaging in regular exercise, avoiding alcohol, minimizing exposure to carcinogens, and not smoking are all ways in which individuals can reduce their risk of developing pancreatic cancer, despite the fact that the disease is extremely uncommon.

A statement made by the American Cancer Society states that “smoking is the most important avoidable risk factor for pancreatic cancer.”

Having a test that might detect pancreatic cancer at an early stage would “dramatically change the landscape” for patients, according to Wolpin, who also expressed his hope that the medical field will be able to develop such a tool.

“The more patients we are able to find early on, the greater the chance we have to cure patients of pancreatic cancer and begin to reverse the statistics that are pretty difficult to reverse,” Wolpin said. “Almost 90 percent of patients who get pancreatic cancer die from their cancer.” Finding the cancer earlier would be a dramatic way to modify those numbers, which is something that we really need to do before we can move forward.