What Are The Types Of Pancreatic Cancer
There are two types of tumors that grow in the pancreas: exocrine or neuroendocrine tumors. About 93% of all pancreatic tumors are exocrine tumors, and the most common kind of pancreatic cancer is called adenocarcinoma. Pancreatic adenocarcinoma is what people usually mean when they say they have pancreatic cancer. The most common type begins in the ducts of the pancreas and is called ductal adenocarcinoma.
The rest of the pancreatic tumors about 7% of the total are neuroendocrine tumors , also called pancreatic NETs , an islet cell tumor or islet cell carcinoma. Some NETs produce excessive hormones. They may be called names based on the type of hormone the cell makes for instance, insulinoma would be a tumor in a cell that makes insulin.
Blood Tests And Tumor Markers For Pancreatic Neuroendocrine Tumors
Commercially available blood tests that detect multiple cancer types may also be able to find pancreatic neuroendocrine tumors .
Other tests that may help detect PNETs measure:
- Chromogranin A : A molecule that is high in most people with PNETs
- Pancreatic polypeptide : A hormone often high in people with PNETs
- Specific hormones made by pancreatic neuroendocrine tumors
Doctors can use these blood tests along with imaging tests to get more information to diagnose a pancreatic neuroendocrine tumor.
Diagnosis Of Pancreatic Cancer
Diagnosis is the process of finding out the cause of a health problem. Diagnosing pancreatic cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for pancreatic cancer or other health problems.
The process of diagnosis may seem long and frustrating. Its normal to worry, but try to remember that other health conditions can cause similar symptoms as pancreatic cancer. Its important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of pancreatic cancer.
The following tests may be used to rule out or diagnose pancreatic cancer. Many of the same tests used to diagnose cancer are used to find out the stage . Your doctor may also order other tests to check your general health and to help plan your treatment.
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Pancreatic Cancer Early Detection
Its challenging to detect pancreatic cancer early because theres currently no standard diagnostic screening test for patients at average risk. For those with an above-average risksuch as those who have a family history of pancreatic cancer or a diagnosed genetic syndrome known to raise their predisposition, doctors may use screening tools such as an endoscopic ultrasound or magnetic resonance imaging .
Additionally, the pancreas is located so deep inside the body that its extremely difficult for doctors to palpate any tumors during a physical examination.
However, its possible that pancreatic cancer may cause early symptoms, or that testing for other medical conditions may show signs of pancreatic cancer, causing the care team to diagnose it early. Most often, symptoms arent apparent in early stages, and small lesions arent always detected by pancreatic cancer diagnostic tests, so cases tend to be diagnosed in more advanced stages.
Pancreatic cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your pancreatic cancer in a way that fits your individual needs and goals.
Validate Validate And Cross Validate
The validation phase included multiple independent investigations. Beginning with high-quality plasma samples from 10 patients with pancreatic cancer and 10 carefully matched control individuals without disease , they found that elevated levels of only one of the three proteins, THBS2, accurately and reliably discriminated between the patient samples and those from healthy controls.
Confirmation of the potential importance of THBS2 came when they looked at data from The Cancer Genome Atlas, which showed that THBS2 levels were much higher in pancreatic tumors than nearly all other tumor types.
The next phase of the validation involved testing for THBS2 in two larger collections of human plasma samples . These collections included a broader array of samples, including from patients with early- and late-stage pancreatic cancer, healthy individuals, and patients with a history of chronic pancreatitis.
Again, measuring THBS2 levels accurately distinguished the samples from patients with pancreatic cancer from the non-cancer samples. Plasma levels of a protein biomarker already used to track the progression of pancreatic cancer, CA19-9, also demonstrated similar accuracy, they reported.
They then refined the testing approach to identify the levels of the two markers that would most accurately detect cancer, settling on levels that provided 99% specificity , and 87% sensitivity .
And, for the most part, they were able to validate our data, Dr. Zaret said.
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Specialized Testing For People At High Risk
Some people are at increased risk of developing pancreatic cancer because of family history, such as two or more first-degree relatives who have had the disease or a first-degree relative who developed the disease before age 50.
Other men and women may be at high risk because of an inherited genetic syndrome associated with pancreatic cancer.
These people may have access to surveillance programs that involve regular monitoring through imaging tests such as EUS, CT scans, or ERCP.
They may also take part in experimental imaging procedures, receive advanced genetic testing, and permit researchers to collect biological fluids, such as blood and pancreatic juice, for analysis.
Not only do participants get the benefit of cutting-edge detection methods, but they are also helping researchers develop new options for early diagnosis that can improve mortality rates overall.
Who Is At High Risk For Pancreatic Cancer
Youre considered high risk if you have several of the known risk factors for pancreatic cancer.
People at high risk for pancreatic cancer are candidates for surveillance programs. In a surveillance program, a doctor can monitor you for signs and symptoms of cancer. People who are in surveillance programs might be eligible for early-detection blood tests.
Risk factors for pancreatic cancer include:
Some studies have also shown that there might be a link between pancreatic cancer and factors such as:
- eating red meat
- eating foods with high saturated fat
- consuming sugary drinks
- changes in blood sugar levels
Most of these symptoms are more likely to be caused by conditions other than pancreatic cancer. However, its still important to see a doctor as soon as possible. Early detection of pancreatic cancer makes a big difference in treatment options and outcomes.
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The Future Of Pancreatic Cancer Diagnosis
Developing new tools and methods that can diagnose pancreatic cancer early is key to helping patients survive.
Scientists are actively studying the genetics of pancreatic cancer in order to identify biomarkers of early-stage pancreatic cancer.
Some of this research has been encouraging. For instance, one early-phase study, led by teams at the University of Pennsylvania Abramson Cancer Center and the Mayo Clinic, homed in on two specific proteins: THBS2 and CA19-9. A screening test that measures levels of these proteins in the blood may help physicians diagnose early-stage cancer in people at high risk.
More testing and clinical trials are in the works.
Scientists are also developing new imaging methods that show potential. One method under investigation enables doctors to look for minute changes in the cells of the duodenum that may be early evidence of pancreatic cancer.
Positron Emission Tomography Scan
For a PET scan, you are injected with a slightly radioactive form of sugar, which collects mainly in cancer cells. A special camera is then used to create a picture of areas of radioactivity in the body.
This test is sometimes used to look for spread from exocrine pancreatic cancers.
PET/CT scan: Special machines can do both a PET and CT scan at the same time. This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT scan. This test can help determine the stage of the cancer. It might be especially useful for spotting cancer that has spread beyond the pancreas and wouldnât be treatable by surgery.
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What Is The Jack Andraka Test For Pancreatic Cancer
In 2012, high school student Jack Andraka won the Intel International Science and Engineering Fair grand prize and the Smithsonian American Ingenuity Award for developing a possible method of detecting the early stages of pancreatic cancer.
His test method used paper antibody sensor strips to measure levels of a cancer biomarker called mesothelin. The test was said to be fast, accurate, and inexpensive.
However, although it received acclaim and drew international attention, Jack Andrakas work hasnt been published in any peer-reviewed scientific journals. Additionally, the initial results havent been duplicated by further studies. The test strips arent currently in development and no further clinic tests have been announced.
Pain In The Stomach Or Back
Pancreatic cancer can cause a dull pain in your upper tummy , which may spread to your back.
To begin with, the pain may come and go, but as the tumour becomes larger and more advanced, the pain may be more constant and last longer.
The pain is often worse when you lie down or after you’ve eaten. You may also have pain or tenderness in your abdomen if your liver, pancreas or gallbladder are enlarged.
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The Grails Galleritm Test
The GalleriTM test looks for the presence of over 50 types of cancer. This includes two different types of pancreatic cancer, pancreatic adenocarcinoma, and pancreatic neuroendocrine tumors. The test is designed for people who have a high risk of cancer, such as people with certain genetic abnormalities or people with a family history of cancer.
The GalleriTM test is a blood test. Youll need a doctors order to take the test. Once you have a doctors order, a blood test kit can be mailed to your home or your doctors office. Youll then have blood drawn, and the results will be available in about 2 weeks.
Results of the GalleriTM test cant diagnose pancreatic cancer. However, they can indicate the presence of cancer in your body. If your results are positive, you and your doctor can take additional steps.
What Is A Ca 19
A CA 19-9 test measures the amount of a protein called CA 19-9 in a sample of your blood. CA 19-9 is a type of tumor marker. Tumor markers are substances made by cancer cells or by normal cells in response to cancer in your body.
Healthy people can have small amounts of CA 19-9 in their blood. High levels of CA 19-9 are often a sign of pancreatic cancer. But high levels can also be a sign of other types of cancer or certain conditions that aren’t cancer. For example, gallstones and cirrhosis of the liver can cause high CA 19-9 levels.
Because high levels of CA 19-9 can mean different things, the test is not used by itself to screen for or diagnose cancer or other diseases. But it can help monitor your cancer and check how well your treatment is working.
Other names: cancer antigen 19-9, carbohydrate antigen 19-9, CA 199 measurement, CA 19-9 radioimmunoassay
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Discovering Biomarkers With An Unusual Model
For their study, which was funded in part by NCI, Dr. Zaret and his colleagues conducted a lengthy, multistep biomarker discovery and validation process.
The first step, known in biomarker research as the discovery phase, was to identify potential biomarkers for early detection. Later activities, known as the validation phase, focused on confirming whether the biomarkers identified in the discovery phase accurately identified cancer when analyzed in a larger group of samples.
The process for conducting the study was thorough and well thought-out, said Sudhir Srivastava, Ph.D., who heads the Early Detection Research Network in NCIs Division of Cancer Prevention. The investigators took a meticulous approach to this study and the results are very encouraging, he said.
Early Detection of Pancreatic Cancer Focus of NCI-Supported Consortium
The Penn and Mayo Clinic research team that led this study are one of seven groups in the NCI-funded Pancreatic Cancer Detection Consortium . The PCDC was developed following the enactment of the Recalcitrant Cancer Research Act of 2012, based on recommendations from an NCI-convened workshop on pancreatic cancer.
For the discovery phase, the research team relied on a cell line they developed previously by reprogramming cells from an advanced human pancreatic tumor to become what are known as induced pluripotent stem cell -like cellsmeaning that the cells have mostly regained the properties for forming different cell types.
Noticing The Early Symptoms Of Pancreatic Cancer
How Pancreatic Cancer Is Diagnosed
There are many tests used for diagnosing pancreatic cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:
The type of cancer suspected
Your signs and symptoms
Your age, general health, and family history
The results of earlier medical tests
If a doctor suspects that a person has pancreatic cancer, they will first ask about the person’s medical history and family history. Then, they will examine the person to look for signs of the disease. An appropriate and timely diagnosis is very important. If possible, tests should be done at a medical center that has experience with the disease. The tests described below may be used when pancreatic cancer is suspected. However, the diagnosis should be confirmed with a sample of tissue from the tumor taken during a biopsy, fine needle aspiration, or surgery. These tests are described more below.
Pancreatic Cancer Diagnosis And Early Detection
Pancreatic cancer may go undetected until it’s advanced. By the time symptoms occur, diagnosing pancreatic cancer is usually relatively straightforward. Unfortunately, a cure is rarely possible at that point.
Diagnosing pancreatic cancer usually happens when someone comes to the doctor after experiencing weeks or months of symptoms. Pancreatic cancer symptoms frequently include abdominal pain, weight loss, itching, or jaundice . A doctor then embarks on a search for the cause, using the tools of the trade:
- During a physical exam, a doctor might feel a mass in the abdomen and notice swollen lymph nodes in the neck, jaundiced skin, or weight loss.
- Lab tests may show evidence that bile flow is being blocked, or other abnormalities.
Based on a person’s exam, lab tests, and description of symptoms, a doctor often orders an imaging test:
If imaging studies detect a mass in the pancreas, a pancreatic cancer diagnosis is likely, but not definite. Only a biopsy — taking actual tissue from the mass — can diagnose pancreatic cancer. Biopsies can be performed in several ways:
If pancreatic cancer seems very likely, and the tumor appears removable by surgery, doctors may recommend surgery without a biopsy.
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Finding Those At Highest Risk
At the moment, theres no good answer to that question. Sending every person with new-onset diabetes to get imaging tests of the pancreas would result in too many unnecessary follow-up surgical procedureswhen abnormalities seen on scans turn out not to be cancerpotentially doing more harm than good, explained Suresh Chari, M.D., also of MD Anderson.
To help find these rare patients with pancreatogenic diabetes while limiting harms, including unnecessary surgeries and the fear caused by undergoing diagnostic procedures, Drs. Chari and Maitra are leading a nationwide project, funded by NCI and the National Institute of Diabetes and Digestive and Kidney Diseases, called the New Onset Diabetes Study.
The project, which is in the process of enrolling 10,000 people with new-onset diabetes or hyperglycemia , hopes to develop a blood test that can identify the few individuals who may need further testing for pancreatic cancer, Dr. Maitra explained.
Can we identify biomarkers in the blood that will tell us, in a room of 100 patients with new-onset diabetes, there may be someone who we need to send for more workup and imaging studies? he asked.
Out of 10,000 participants, Drs. Chari and Maitra estimate that about 85 will develop pancreatic cancer during the study.
The longer you have to wait, the closer youre getting to the clinical diagnosis of pancreatic cancer and losing that window of opportunity for early detection, Dr. Maitra said.