There is no standard test to detect cancer early

Mammograms are one way to detect breast cancer early. Colonoscopies are used to detect colon cancer at an early stage. To identify pancreatic cancer cases in their early stages, before cancer cells have spread, and when surgery is most likely to be beneficial, there is, however, no established test.

A patient’s chances of survival may be improved by discovering pancreatic cancer early. Pancreatic cancer is currently the third most common cause of cancer-related deaths in the United States, but by the end of this decade, it is expected to overtake all other cancers combined in terms of total new cases.

Blood-based liquid biopsy tests are being used by many research teams across the United States as they look into ways to identify cases early.

There are numerous methods for essentially attempting to identify blood markers that indicate the presence of a tumor, which is what is meant to be understood by the term “liquid biopsy.”. Many distinct characteristics of a tumor can wind up in the blood that you could utilize, according to Dr. Brian Wolpin, the director of the Dana-Farber Cancer Institute’s Gastrointestinal Cancer Center, whose lab has conducted research in this field.

However, there are still a lot of studies in their early stages looking into the possibility of liquid biopsy tests for the early diagnosis of pancreatic cancer. Furthermore, the US Preventive Services Task Force advises against screening adults without symptoms for pancreatic cancer, primarily due to the lack of a reliable test or method for early detection of this type of the disease in the general population.

The scientific community is working hard to try to change this and find a screening test that we can use in the clinic, but Wolpin noted that there is currently no one recommended blood test to detect early pancreatic cancers. To get there, additional work must still be done. “.

A research team described how they developed a liquid biopsy test that was found to detect 97% of stage I and stage II pancreatic cancers in hundreds of volunteers during their presentation on Monday at the annual meeting of the American Association for Cancer Research. The researchers come from various institutions across the globe, including the City of Hope Comprehensive Cancer Center.

Their study comprised 984 participants from Japan, the US, South Korea, and China, some of whom were healthy and others who had pancreatic cancer. It has not been published in a peer-reviewed journal.

After drawing blood samples from each subject, the researchers examined the expression of a group of tiny genes known as microRNAs that are encapsulated in exosomes that are present in the blood. Exosomes are tiny vesicles released into the bloodstream by both healthy and malignant cells.

According to Dr. Ajay Goel, senior author of the study and chair of the Department of Molecular Diagnostics and Experimental Therapeutics at City of Hope, “cancer cells tend to release many, many more exosomes compared to our healthy cells because our healthy cells do not multiply as fast as cancer cells do.”. “And once the tumor cells release these exosomes, our bloodstream is exposed to them. “.

Eight microRNAs and five microRNAs in blood were discovered by Goel and his colleagues. Exosomes are secreted by cancerous cells in the pancreas. They created a method for figuring out whether a person’s exosomes are linked to pancreatic cancer using those markers.

Among the US study participants, the researchers’ liquid biopsy method identified 93% of pancreatic cancers; in the South Korean cohort, it detected 91%, and in the Chinese cohort, 88% of pancreatic cancers.

The scientists repeated their experiments, adding to their exosome-based markers the screening for a crucial protein called CA19-9, which has been linked to pancreatic cancer. They found that 97 percent of the stage I and stage II pancreatic cancers in the US volunteers could be correctly identified when they paired their method with the CA19-9 test.

We are thrilled that this test is 97% accurate in identifying patients with either stage I or stage II illness, in addition to the fact that it performed flawlessly in every stage, according to Goel.

The test yielded false-positive results for stage I and II pancreatic cancers at a rate of less than 5 percent, he continued, citing study data.

“It’s critical to diagnose the illness as early as possible, ideally at stage I or II, as this increases the likelihood that the cancer may be surgically removed,” Goel stated. “Removing the cancer is the best treatment for someone with pancreatitis—chemotherapy or medication are not as effective. “.

According to him, patients with stage III or IV pancreatic cancer may make surgeons “very reluctant” to perform surgery. That can occasionally be attributed to the difficulty of the operation, potential long-term side effects, and the possibility that surgery at that advanced stage might not be sufficient to stop the cancer from returning.

“That is the reason it is critical that this blood test is so good that it can detect cancers 97% of the time at the earliest stages at which we can intervene, intercept, and successfully remove the cancer through surgery,” Goel stated.

“Something has to be done,”.

Although blood tests are available for pancreatic cancer, they are typically administered to individuals who have received a diagnosis of the disease. To assess the cancer’s response to treatment, physicians may repeat blood tests both during and after the disease has been treated. However, there isn’t a blood test available to identify pancreatic cancer early on.

The approach developed by Goel and his colleagues “may potentially be further validated for clinical use in the near future,” particularly for the early detection of pancreatic cancer, according to their abstract.

Goel stated, “We were generally excited about these particular data because the cancer type we’re looking at here is extremely lethal.”.

“There will be an increasing number of people affected by this disease or cancer,” he declared. We therefore need to take action, which is why we were thrilled to discover a blood-based liquid biopsy that has such a high sensitivity for the early detection of pancreatic cancer. “.

The liquid biopsy test study that Goel and his colleagues presented is one way to potentially develop a test for early detection, where there is a great need, and Wolpin called it “interesting.”.

A number of scans, blood tests, and biopsies may be necessary to determine a person’s precise diagnosis of pancreatic cancer. These procedures are usually carried out only after the patient exhibits symptoms, which can include weight loss, jaundice or yellowing of the eyes and skin, fatigue, and weakness. However, the cancer has most likely progressed by that time.

“When pancreatic cancer patients are diagnosed, the majority of them already have advanced disease. As a result, at least 80% of patients arrive with advanced cancer, for which there is little chance of a cure at the time of presentation, according to Wolpin.

He stated, “That’s very different from many other major cancer types, where the majority of patients actually present with early disease, like breast cancer or colorectal cancer.”. “Symptoms of pancreatic cancer are typically less specific and include things like occasional weight loss or mild abdominal discomfort, which frequently don’t prompt people to visit their doctor right away. “.

However, a few specialists caution that if average-risk healthy individuals who are asymptomatic are screened widely, the results could be falsely positive, which could be more harmful than beneficial.

“What an odd organ the pancreas is.”.

A trustworthy test to identify pancreatic cancer patients as soon as possible is something that scientists other than those at City of Hope are working toward.

A University of Pennsylvania study from 2020 discovered that a blood test to screen for specific biomarkers linked to pancreatic cancer was 92% accurate in identifying the illness.

A blood test to identify proteins linked to cancer cells was able to identify 95.5 percent of stage I pancreatic cancers in a sample of over 300 volunteers in 2022 (139 of whom were cancer patients and 184 were healthy individuals), according to a pilot study conducted by researchers at UC San Diego and other institutions.

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, there hasn’t been much progress made in the field of pancreatic cancer, either in terms of early-stage or advanced disease. Dr. Neugut was not involved in any of the liquid biopsy testing research.

According to Neugut, pancreatic cancer “is the poster child for cancers we’ve gotten nowhere with.”.

He remarked, “The pancreas is a very weird organ; it’s just different from every other organ in the body.”. It’s difficult to reach because it’s behind the abdomen. It’s challenging for a surgeon. For an oncologist, it’s difficult. It is extremely challenging to even approach. It is not physically attainable for examination. Reaching it radiologically is difficult. It is not visible. “.

Even though pancreatic cancer is uncommon, people can reduce their risk by not smoking, eating a balanced diet, staying at a healthy weight, exercising frequently, abstaining from alcohol, and limiting their exposure to carcinogens.

As per the American Cancer Society, smoking is the primary preventable risk factor for pancreatic cancer.

But Wolpin added that having a test to identify pancreatic cancer early would “dramatically change the landscape” for patients and expressed hope that medicine would be able to produce such a tool.

Nearly 90% of patients with pancreatic cancer die from the disease, so the earlier we identify patients, the better our chances are of curing patients and beginning to change the grim statistics, according to Wolpin. Finding the cancer earlier would be a significant step toward changing those numbers, which we really need to do. “.