A Trial For People At Highest Risk
Since Bob Aronsons diagnosis more than 15 years ago, researchers have come to recognize that several clinical factors can also be used to identify a subset of people with new-onset diabetes who have an especially high risk of pancreatic cancer.
Three key differences that tend to be found together distinguish these people from others with new-onset diabetes, said Dr. Maitra. One is their age, he explained. People who develop diabetes as a consequence of pancreatic cancer tend to be older, he explained.
The second is that blood sugar levels tend to rise more rapidly in people whose diabetes is driven by a tumor. And the third is weight loss, Dr. Maitra explained. Normally with type 2 diabetes, people gain weight when they become diabetic. People whose diabetes is caused by pancreatic cancer can instead experience unexpected weight loss around the time of a diabetes diagnosis.
In 2018, Dr. Chari and his colleagues proposed that these three clinical risk factors, which they called the Enriching New-Onset Diabetes for Pancreatic Cancer score, may be useful for identifying people who need additional testing now, before a blood test has been developed.
As part of the EDI, CT scans will be stored in a repository. This resource could potentially be used for future studies using artificial intelligence-based approaches to improving pancreatic cancer imaging, explained Eva Shrader, PanCANs director of scientific initiatives.
Why Is Pancreatic Cancer Mortality So High
One can identify three main reasons for the dismal prognosis of pancreatic cancer.
A) Disease is diagnosed at a late stage
The only hope of long-term survival in pancreatic cancer is if curative resection can be undertaken. However, since pancreatic cancer patients seldom exhibit disease-specific symptoms until late in the course of the disease, very few patients have resectable disease by the time the diagnosis is made . A proportion of patients thought to be resectable by imaging studies will be found to have metastatic or locally unresectable disease at surgery the proportion varies from 15% to 50% depending on quality of pre-operative imaging . Finally, a subset of patients undergoing curative resection will have positive resection margins , reflecting incomplete resection. Thus, eventually < 10% of pancreatic cancer patients undergo a margin-negative resection.
B) Complete resection is not curative
If resectable disease were curable, the survival of pancreatic cancer could increase ~5-fold. Unfortunately surgery is only palliative in majority of patients undergoing resection the median survival of patients undergoing curative resection is only about 1218 months longer than that of patients with unresectable disease . Thus ineffectiveness of aggressive and apparently complete resection of pancreatic cancer to effect a cure is another contributor to the poor survival in pancreatic cancer.
C) Adjuvant therapy is only palliative
How You Can Help Early Detection Research
- Make a gift to support the Pancreatic Cancer Action Networks work, including early detection research, that would not be possible without the help of generous supporters
- If you have been diagnosed or have taken care of someone diagnosed with pancreatic cancer, join our Patient Registry to advance research
- If your family has had multiple pancreatic cancer diagnoses or someone diagnosed before age 50, you may consider joining a genetic or family registry
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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.
New Study Indicates Artificial Intelligence’s Potential For Predicting Who Will Develop Disease Based On Ct Images
An artificial intelligence tool developed by Cedars-Sinai investigators accurately predicted who would develop pancreatic cancer based on what their CT scan images looked like years prior to being diagnosed with the disease. The findings, which may help prevent death through early detection of one of the most challenging cancers to treat, are published in the journal Cancer Biomarkers.
This AI tool was able to capture and quantify very subtle, early signs of pancreatic ductal adenocarcinoma in CT scans years before occurrence of the disease. These are signs that the human eye would never be able to discern, said Debiao Li, PhD, director of the Biomedical Imaging Research Institute, professor of Biomedical Sciences and Imaging at Cedars-Sinai, and senior and corresponding author of the study. Li is also the Karl Storz Chair in Minimally Invasive Surgery in Honor of George Berci, MD.
Pancreatic ductal adenocarcinoma is not only the most common type of pancreatic cancer, but its also the most deadly. Less than 10% of people diagnosed with the disease live more than five years after being diagnosed or starting treatment. But recent studies have reported that finding the cancer early can increase survival rates by as much as 50%. There currently is no easy way to find pancreatic cancer early, however.
The investigators are currently collecting data from thousands of patients at healthcare sites throughout the U.S. to continue to study the AI tools prediction capability.
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What Are The Screening Options For Fpc
It is unknown if screening for pancreatic cancer is effective, and there is no routine screening for pancreatic cancer that is currently recommended for the general population. The medical community continues to research who to screen, which tests to use, and how often to use them.
Given that individuals from FPC families, or individuals with germline genetic mutations in BRCA1, BRCA2, PALB2, CDKN2A, ATM, MLH1, MSH2, MSH6, PMS2, STK11, and EPCAM, are at increased risk for pancreatic cancer, there is much interest in researching pancreatic cancer screening for these high-risk individuals. Its important to talk with your doctor about the screening options below, as each person is different.
- Magnetic resonance imaging An MRI uses magnetic fields to produce detailed images of the pancreas.
- Endoscopic ultrasound A thin, lighted tube is passed through the patient’s mouth and stomach. The tube goes down into the small intestine to take a picture of the pancreas.
Screening options are likely to change over time as new technologies are developed and more is learned about FPC. Its important to talk with your doctor about screening tests that are right for you. Learn more about what to expect when having common tests, procedures, and scans.
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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The Power Of Algorithms
One approach is to use what is called deep learning, a kind of subset of AI that uses algorithms to find patterns in massive amounts of data. Data doesnt just mean numbers, Rosenthal says. It can be anything that we can feed into a computer to help us find those important patterns and potential trends that might tip you off that something is going on with a patient that may be linked to the development or early diagnosis of pancreatic cancer.
At the Mayo Clinic, for example, researchers are building algorithms to systematically identify those at higher risk for pancreas cancer, such as those with a family history of the disease. Scientists at other sites will also look for genetic mutations as well as new onset diabetes. At Dana-Farber a research team is also developing risk assessment models by using deep learning analysis of clinical records and images gathered from large, diverse patient population datasets to identify individuals at highrisk for pancreatic cancer in the general population. These risk models will lead to a practical tool that can identify patients who are at elevated risk for pancreatic cancer and should be enrolled in screening programs for disease prevention and early detection.
All of that might not raise a flag when taken alone, but when taken together based on an algorithm were going to see an important pattern and say lets check this out more and see if theres something going on with the pancreas.
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.
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Early Detection Of Pancreatic Cancer
Treating pancreatic cancer is challenging when it’s discovered at an advanced stage, as is usually the case. Researchers are seeking methods of early detection, but so far none has proved useful. These methods include:
Blood tests. Certain substances, such as carcinoembryonic antigen and CA 19-9, are elevated in people with pancreatic cancer. However, blood tests don’t allow for early detection of pancreatic cancer, because these levels may not rise until pancreatic cancer is advanced, if at all. These tests also may produce a false positive result.
Endoscopic ultrasound. Some families have multiple members affected by pancreatic cancer. The American Cancer Society says that up to 10% of pancreatic cancers may be caused by inherited DNA changes. Studies are ongoing to see if aggressive screening with endoscopic ultrasound works for early detection of pancreatic cancer in healthy family members. Early results are promising. However, endoscopy is an invasive procedure, so its use is only justified in people already at high risk for pancreatic cancer.
Related Programs & Services
The Cedars-Sinai PanScan program includes specialists in gastrointestinal disease, oncology, pancreatic surgery, genetic counseling and imaging. Our comprehensive, team-based approach to care includes screening, evaluation and treatment of pancreatic cancer. If you’re diagnosed with pancreatic cancer or we detect pancreatic lesions, you receive treatment from a dedicated team of physicians and surgeons with expertise in pancreatic cancer.
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Types Of Pancreatic Cancer Screening
- Contrast-enhanced magnetic resonance cholangiopancreatography is a special type of MRI imaging that looks closely at the pancreas, liver, gallbladder, bile duct and pancreatic duct to find abnormalities such as cancer. People undergoing MRCP must fast for four hours before the procedure. An injection of contrast agentcalled gadoliniumis given before the test in order to help radiologists to find abnormalities more easily.
- Endoscopic involves passing a tiny scope with an attached ultrasound probe down the esophagus to the stomach. This allows doctors to look closely at the pancreas. EUS is performed as an outpatient procedure under anesthesia.
Endoscopic procedure to look for pancreatic tumors
Cancer Of The Pancreas Screening Study
- Participating in Research >
- Cancer of the Pancreas Screening Study
Early detection offers one of the best hopes for a cure. Unfortunately, there are no proven effective early detection tests currently available. We have therefore assembled a team at Hopkins whose focus is to develop and test new approaches to the early detection of pancreatic cancer and its precursors.
Pancreatic Cancer Early Detection team at Johns Hopkins brings together experts in gastroenterology, pathology, radiology, surgery and genetics using advances in genetic research and diagnostic technologies to create a multidisciplinary early detection research program. Much of the team’s efforts are focused on individuals and families who have an elevated lifetime risk of developing pancreatic cancer.
Pancreas cancer is an aggressive disease that is difficult to treat, often because it is not detected until it has reached an advanced stage or spread throughout the body. Early detection screening aims to catch the early precancerous lesions and small pancreatic cancers that often present without symptoms with the goal of our research is to develop new approaches to detect and treat the disease when it is operable and before it has spread systemically.
Pancreatic cancer screening, mostly as a part of an ongoing research study, is offered for individuals who have a high risk of developing pancreatic cancer based on their family history, genetic predispositions and certain diagnoses.
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What Happens If A Suspicious Lesion Or Cyst Is Present
The quality of abdominal imaging has significantly improved, allowing for better detection of small pancreatic cysts . Some people who have suspicious lesions may need surgery, because they may be precursors to pancreatic adenocarcinoma. Others may benefit from yearly follow-up appointments. The recommended care plan is determined by symptoms and the type, location and size of the lesion .If surgery is necessary, a general surgeon who specializes in pancreatic surgery will remove the lesions. Our general surgeons are highly experienced at performing the full range of pancreatic surgeries, from minimally invasive procedures to complex surgeries such as the Whipple procedure for treatment of pancreatic cancer.
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Can Pancreatic Cancer Be Found Early
Pancreatic cancer is hard to find early. The pancreas is deep inside the body, so early tumors cant be seen or felt by health care providers during routine physical exams. People usually have no symptoms until the cancer has become very large or has already spread to other organs.
For certain types of cancer, screening tests or exams are used to look for cancer in people who have no symptoms . But for pancreatic cancer, no major professional groups currently recommend routine screening in people who are at average risk. This is because no screening test has been shown to lower the risk of dying from this cancer.
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Why Is Early Detection Important
For eligible patients, surgery is the best option for long-term survival of pancreatic cancer. It can increase a patients survival by about ten-fold. But most patients are diagnosed at later stages and cannot have surgery.
In addition, although 15-20% of pancreatic cancer patients may be eligible for surgery, data shows that up to half of those patients are told they are ineligible. The Pancreatic Cancer Action Network strongly recommends you see a surgeon who performs a high volume of pancreatic surgeries to determine eligibility.
Ways to find pancreatic cancer in the earliest stages are urgently needed. The Pancreatic Cancer Action Network, other advocacy organizations and the scientific community are working to find pancreatic cancer earlier through:
- Studies focused on biomarkers that could help doctors diagnose, monitor and treat the disease
- Efforts to improve how people at high risk are found and monitored
Symptoms Of Pancreatic Cancer: The Importance Of Early Detection
Early-stage pancreatic cancer is primarily treated with surgery. However, only about half of early-stage pancreatic cancer patients in the U.S. are referred to a surgeon or a comprehensive cancer center and undergo surgery. A common misconception about pancreatic cancer is the lack of treatment options and the grim prognosis. But if caught early, pancreatic cancer is treatable and potentially curable. Its critically important to educate patients about the options and the importance of early detection.
Pancreatic cancer is called a silent killer because it often grows or spreads undetected. And like many cancers, it presents few warning signs. Symptoms often resemble other illnesses, such as diabetes, and may include:
- Dark urine, pale stools
- Stools that float in the toilet
- Middle back pain, that is unrelieved by position change
- Non-specific upper belly pain
- Persistent nausea and vomiting
- Loss of appetite feeling of fullness
Pancreatic Cancer Risk Assessment
A combination of two or more of these symptoms should lead to an evaluation of pancreatic cancer, especially for those with a history of tobacco use or someone with a family history of cancer.
If a patient presents with a more advanced stage of pancreatic cancer, chemotherapy or a new targeted drug treatment may be offered through our clinical research studies. Many of these new drugs are showing great promise in improving response rates, survival rates and quality of life.
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