The past 40 years’ have been marked by significant progress in the fight against cancer, thanks to better screening and diagnostic tests, expanded knowledge about prevention strategies, and new treatments that are more effective and easier to tolerate. Survival rates have improved dramatically for certain cancer types — more than 15-fold for colon cancer, and 10-fold for non-Hodgkin’s lymphoma.

But each type of cancer is unique, and progress has proven more difficult for some of the most serious types, such as pancreatic cancer, which kills more than 300,000 people every year, predominantly in developed countries across Europe, North America, and Japan.

Difficulties in Diagnosis

Earlier diagnosis is one of the critical factors driving progress against cancer. When cancer is diagnosed in its earliest stages , the extent of damage is limited; more treatment options are available — including surgical removal of the tumor — that lead to better outcomes for patients; and the likelihood of the cancer having already spread, or metastasized, is much lower.

Challenges and obstacles continue to hinder earlier diagnosis of pancreatic cancer. Only 10 to 15 percent of diagnoses are made during the first stage — when the cure rate is above 70 percent. Over half of all diagnoses are made only after the disease has already reached its most advanced metastatic stage. By this point, the cancer has spread beyond the pancreas — most commonly to the liver, the abdominal area, and the lungs — and survival is unlikely.

The challenging circumstances for diagnosing pancreatic cancer include:

• Lack of early symptoms: Pancreatic cancer develops and progresses with few or no symptoms during early stages; recognizable physical symptoms usually begin occurring when the disease is already in its late stage and has metastasized beyond the pancreas.
• Vague, non-unique symptoms: Pancreatic cancer symptoms — jaundice , abdominal pain and/or bloating, back pain, unexplained weight loss — are vague and common symptoms of many other medical problems far less serious than cancer. So even when the symptoms become noticeable, the patient may not feel any urgency to get it checked out. And doctors with little or no pancreatic cancer experience may overlook the disease as a potential cause worth investigating.
• Lack of non-invasive test for widespread screening: Screening tests, such as the prostate-specific antigen (PSA) test for prostate cancer and mammogram screenings for breast cancer, are widely used to check for a disease in people who have no symptoms. They are designed to be easy and quick to administer, and affordable for the population at large. While some progress has been made, an effective non-invasive screening test for pancreatic cancer — most likely through blood, saliva, or stool samples — has yet to be developed.

Diagnostic Tools and Risk Factors

While the specific causes of pancreatic cancer are still unknown, several factors have been shown to increase a person’s risk for the disease.

• Family history: Having one or more family members with pancreatic cancer increases one’s risk for the disease — and the closer the relationship, the greater the risk. In some cases, the risk is connected to a particular genetic syndrome.
• Health history: Pancreatic cysts and chronic pancreatitis, a condition involving long-term continuing inflammation of the pancreas, are risk factors for pancreatic cancer — though most cases of chronic pancreatitis don’t develop into cancer. Obesity and type 2 diabetes are also risk factors for pancreatic cancer.
• Lifestyle: Smoking doubles the risk of pancreatic cancer, and having a high level of body fat is an additional risk factor. Age is also a risk factor, as most patients are over 60 at the time they are diagnosed with the cancer.

CT, MRI, EUS, FNA

The diagnostic process typically begins with the doctor reviewing the patient’s medical and family history, followed by a physical examination. If there’s an indication of possible cancer, or if the patient has a family history of pancreatic cancer and wishes to proceed with diagnostic screening, the doctor will recommend one or more of the following diagnostic tools:

• Blood tests: There isn’t an individual blood test capable of diagnosing pancreatic cancer. Your doctor may want to check your blood for certain proteins, or tumor markers, such as CA19-9 and CEA, which are associated with pancreatic cancer cell production. While the test results aren’t accurate enough to confirm the presence of cancer, they may be used later on to monitor cancer progression and treatment response in patients found to have cancer.
• Computerized Tomography (CT) : The CT scanner creates detailed cross-sectional images of the body. CT is frequently used in the diagnosis of pancreatic cancer because the images are of high quality, and CT’s ability to identify areas where the cancer may have spread, even to more distant lymph nodes and organs.
• Magnetic Resonance Imaging (MRI) : MRI scans use strong magnets instead of x-rays to create detailed images of parts of your body. An MRI may be preferred over a CT in certain situations, including detection of small tumors, and for characterizing pancreatic masses.
• Endoscopic Ultrasound (EUS) : EUS is one of the tools of a diagnostic endoscopy, an investigative examination inside the body using an ultrasound probe at the tip of a long, flexible tube (the endoscope). The tube is guided through the sedated patient’s mouth and down to the esophagus. The ultrasound will show images of the pancreas located adjacent to the stomach. EUS is especially useful for detecting smaller tumors, and it has the added advantage of being capable of taking tissue samples for biopsy using needle aspiration.
• Biopsy: There are generally two types of biopsies used to take a tissue sample for laboratory examination. EUS is one option as mentioned above, and a biopsy can also be done using fine-needle aspiration (FNA) , wherein the doctor inserts the needle through the abdominal skin to reach the pancreas.

Specialized Knowledge and Expertise

The digestive system is complex and interconnected. Digestive disorders, including those affecting the pancreas, require expertise and specialized knowledge. The Digestive Disease (GI) Center at Bumrungrad International Hospital provides diagnosis and treatment of a full range of gastrointestinal tract disorders.
 

Written by Dr. Yudhtana Sattawatthamrong, Digestive Disease Center, Bumrungrad International Hospital