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Why Is Pancreatic Cancer So Under-Diagnosed?
The pancreas is situated deep in the abdomen, making it difficult to detect tumours
Pancreatic cancer is a type of cancer that originates in the tissues of the pancreas, an organ located behind the stomach that plays vital role in digestion and helps in blood sugar regulation. It most commonly arises in the pancreatic ducts (exocrine tumours) however may also occur in hormone-producing cells (endocrine tumours). Pancreatic cancer is notoriously hard to diagnose because it can often present with vague or no symptoms in its early stages. By the time symptoms such as abdominal pain, jaundice, or weight loss become noticeable, the disease has progressed to the advanced stages, making treatment more challenging. Additionally, the pancreas's deep location within the abdomen can make early detection through physical examination nearly impossible. In this article, we cover some common reasons why pancreatic cancer may be hard to diagnose.
10 Reasons why pancreatic cancer is so under-diagnosed 1. Lack of early symptomsIn its early stages, pancreatic cancer often causes no noticeable symptoms or only nonspecific signs like fatigue, indigestion, or mild discomfort. These are easily attributed to less serious conditions, delaying a diagnosis.
2. Non-specific symptoms in advanced stagesEven as the disease progresses, symptoms such as abdominal or back pain, nausea, and weight loss can mimic more common gastrointestinal issues like ulcers or gallstones, leading to misdiagnosis or late diagnosis.
3. Deep location of the pancreasThe pancreas is situated deep in the abdomen, making it difficult to detect tumours through routine physical exams or imaging without targeted investigations. This anatomical location hinders early diagnosis.
4. Lack of screening testsUnlike breast or cervical cancer, there are no routine screening protocols or reliable biomarkers for pancreatic cancer in asymptomatic individuals. This absence significantly contributes to its under-diagnosis.
5. Rapid progressionPancreatic cancer tends to grow and spread quickly, often reaching an advanced stage before it is detected. This aggressive nature leaves little window for early diagnosis through regular health check-ups.
6. Overlap with common conditionsSymptoms like jaundice, nausea, and loss of appetite are often mistaken for benign liver or gastrointestinal issues. Misattribution to common illnesses delays specialised diagnostic procedures.
7. Low awareness among the publicPancreatic cancer lacks the awareness campaigns and funding that cancers like breast or prostate cancer receive. Many people are unaware of its risk factors or warning signs, leading to delayed medical attention.
8. Challenges with imaging testsStandard imaging techniques like ultrasounds may miss small pancreatic tumours due to the organ's location and surrounding structures. Advanced imaging tools like CT scans or MRIs may not be utilised unless specific symptoms are present.
9. Rare nature of the diseasePancreatic cancer is relatively less common than other cancers, so healthcare providers may not immediately suspect it. This rarity leads to delays in pursuing specialised diagnostic procedures.
10. Misinterpretation of diagnostic resultsEven when tests are conducted, small tumours or subtle changes in the pancreas can be overlooked or misinterpreted as benign abnormalities, especially if the physician is not specifically looking for pancreatic cancer.
Addressing these challenges requires a multifaceted approach, including increasing awareness, developing better screening tools, and improving healthcare access to ensure timely diagnosis and intervention.
Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.Early Detection Of Pancreatic Cancer Using Liquid Biopsy
Liquid biopsy enhances early detection of pancreatic cancer, offering a minimally invasive approach to identifying pancreatic incidentaloma. Pancreatic incidentaloma is a lesion in the pancreas that is detected incidentally during the imaging scans done for other conditions. Liquid Biopsy: Early Detection of Pancreatic Cancer These pancreatic lesions are a sign of pancreatic cancer in its early stage and they vary in severity. However, traditional imaging techniques like MRI and CT scans have limited invasiveness, are expensive, and show variable sensitivity to early pancreatic changes. 'Liquid biopsy, a less invasive test can detect #pancreaticcancer at an early stage. #cancer #diagnosis #medindia' In recent research published in eGastroenterology, Dr. J-Matthias Löhr and colleagues provide an in-depth review of diagnostic methods for pancreatic incidentaloma. It highlights the potential of liquid biopsy, a minimally invasive test that analyzes blood for circulating tumor DNA, genetic predispositions, and cancer-specific biomarkers (1✔ ✔Trusted SourcePancreatic incidentaloma: incidental findings from history towards the era of liquid biopsyGo to source).
"Liquid biopsy is promising for screening, especially in asymptomatic individuals, as it opens the possibility of detecting genetic markers and circulating cancer cells," notes Dr. Löhr. "Unlike traditional imaging, which requires specific equipment and expertise, liquid biopsy could become a widely accessible tool for early detection."
Improving Pancreatic Cancer Outcomes with Early Detection With pancreatic cancer being one of the deadliest cancers, the ability to catch lesions early could save lives, especially given the disease's high mortality rates. "Our work suggests that integrating liquid biopsy with current diagnostic tools could allow us to intervene sooner, ultimately improving patient outcomes," Dr. Löhr adds. In addition to technical insights, the study also examines the ethical dimensions of such incidental findings, which can cause patient anxiety and require sensitive clinical management. The team underscores the importance of clear guidelines to address incidental findings in a way that balances diagnostic utility with patient well-being.Reference:
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Source-EurekalertLizard Spit Can Help Detect A Rare Pancreatic Tumor
A molecule in lizard saliva may make it easier to find certain tumors in the pancreas.
Insulinomas — benign tumors that can cause low blood sugar and sudden fainting spells — are notoriously hard to detect using current scanning methods. But by using a tweaked variant of a protein found in Gila monster saliva as a radioactive tracer, a new type of PET scan found the tumors in 95 percent of confirmed cases, researchers report in the October Journal of Nuclear Medicine. PET scans used now to detect such tumors had just a 65 percent success rate, the team found.
One of the main functions of the pancreas is to produce insulin, a hormone that keeps blood sugar levels in check (SN: 10/22/24). The task of making that insulin falls to specialized cells called beta cells. But sometimes these cells malfunction and form insulinomas. These tumors are rare, affecting just 1 to 4 people out of a million per year globally, but debilitating to those who have them.
"Many of [these tumors] are benign, very small and very efficient factories of insulin. They can cause you to have low blood sugar, which might even make you pass out or have a seizure," says Peter Choyke, a radiologist at the National Cancer Institute in Bethesda, Md. "Even when they're very small, it's very urgent to get to the diagnosis quickly and accurately, so that a surgeon can go in knowing exactly where the tumor is and remove just that."
If doctors manage to find the tumors, surgically removing them cures the patients and lets them live a normal life. But finding the insulinomas is hard. Current methods of locating them include CT and MRI scans as well as PET scans that are used to find malignant pancreatic tumors, but can't always detect the much smaller insulinomas. In a PET scan, doctors inject radioactive molecules into patients. The molecules build up at specific locations in the body, like in cancers, so analysis of their radiation can give doctors a three-dimensional view of cancerous cells (SN: 4/18/22).
"If [they] didn't know where [the tumor] is, surgeons used to slice the pancreas until they found it," says Martin Gotthardt, a nuclear medicine researcher at Radboud University Medical Center in Nijmegen, Netherlands. "In case an insulinoma cannot be detected nowadays, [the patients] are not operated on, because [doctors] don't want to remove the whole pancreas."
Enter the Gila monster (Heloderma suspectum), a lizard found in the deserts of the U.S. Southwest. One protein found in its saliva, named exendin-4, is made in the lab and used to treat diabetes (SN: 8/12/03). It can bind to and activate pancreatic receptors called GLP1Rs, triggering them to produce more insulin. Shortly after its success with diabetes treatment, Gotthardt and other scientists realized in the mid-2000s that insulinomas, typically a clump of many beta cells, also contain a high amount of GLP1Rs, making exendin-4 an attractive candidate to help localize these pesky tumors.
On the right is the current PET scan being used to detect insulinomas. On the left is the radioactive exendin-4 based scan where the insulinoma is clearly visible in white. Radboud University Medical CenterEarly studies showed that exendin-4 with a radioactive molecule attached could be used in PET scans to detect insulinomas in people, but injecting high amounts caused some side effects, such as nausea, headaches and even lower blood sugar. In the current study, Gotthardt and his team added another molecule to help further stabilize the radioactive exendin-4. This ensured that even low amounts of the modified exendin-4 showed high radioactivity; doctors could inject less of it into the patients, thus leading to fewer adverse effects.
To test their new tracer, the researchers recruited 69 people who had been biochemically diagnosed as having low blood sugar due to excessive insulin. Each underwent all standard imaging tests as well as the new exendin-4 PET scan, which led to 53 individuals undergoing surgery to remove suspected tumors. Out of those 53 confirmed cases, the tumor showed up in 50 of the exendin-4 PET scans, as opposed to just 35 of the standard PET scans. In seven cases, the exendin-4 scans detected insulinomas while standard PET, CT and MRI imaging picked up nothing.
The exendin-4 was also very good at picking up only the insulinomas in the scan, with less background noise compared with currently used PET scans, and had fewer side effects on the patients compared to previous versions of the exendin-4 radiotracer.
"I think [this] work is very valuable in showing how exendin-4 could be used in the diagnosis of insulinoma and maybe replace a lot of the imaging techniques that are currently used that aren't as good," Choyke says.
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Gotthardt and his team are now focused on helping other labs and hospitals set up this technique. "We just want to spread the technology," he says. "Everybody should be able to use it, because it really helps the patients."
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