Pancreatic cancer tumors are being missed on CT scans and MRIs, narrowing the window for life-saving curative surgery, research presented at UEG Week 2022 has revealed.
The study looked at post-imaging pancreatic cancer (PIPC) cases, in which a patient undergoes imaging that fails to diagnose pancreatic cancer, but is later diagnosed with the disease .
The results revealed that more than a third (36%) of PIPC cases were potentially preventable, demonstrating a low detection rate of a cancer that has alarming outcomes for patients.
Researchers in the United Kingdom studied the records of 600 patients diagnosed with pancreatic cancer between 2016 and 2021. Of them, 46 (7.7%) patients did not have their cancer diagnosed through their first scan, but later received a diagnosis of pancreatic cancer between 3 and 18 months later.
CT and MRI images were independently reviewed by radiologists to develop an algorithm to categorize missed cases and identify the most likely explanation for why they were missed.
Dr Nosheen Umar, lead author of the study, from the University of Birmingham, UK, commented: "There is often only a very short window for curative surgery in pancreatic cancer, meaning it is vital that patients are diagnosed with the disease as soon as possible" to give them the best chance of survival. “The study found that evidence of pancreatic cancer was initially missed in more than a third of pancreatic cancer patients after imaging, which is a huge window of missed opportunity.”
In almost half (48%) of the PIPC patients examined, there were signs of cancer that had been missed when a hepatobiliary radiologist reviewed the scans. In 28% of patients with PIPC, imaging signs associated with pancreatic cancer, such as dilation of the bile or pancreatic ducts, were not recognized or further investigated.
“We hope this study will raise awareness about the problem of post-imaging pancreatic cancer and the common reasons why pancreatic cancer may initially go undetected,” explained Dr. Umar. "This will help standardize future studies on this topic and guide quality improvement efforts, so that we can increase the likelihood of an early diagnosis of pancreatic cancer, increase patients’ chances of survival, and ultimately , save lifes".
Responsible for 95,000 deaths in the EU each year, pancreatic cancer has the lowest survival rate of all cancers in Europe and life expectancy at diagnosis is just 4.6 months. By 2035, the number of pancreatic cancer cases is expected to increase by almost 40%.
Many patients are diagnosed at a late stage because the disease often presents vague early symptoms, making early recognition difficult. Symptoms may include jaundice, abdominal and back pain, unexplained weight loss, and nausea. The complex nature of the disease also makes screening for early diagnosis difficult to implement.
Pancreatic cancer: a medical emergency
A growing burden
Pancreatic cancer, the current fourth cause of cancer-related death in the EU for both men and women, is a growing cause of cancer mortality across Europe. Responsible for more than 95,000 deaths in the EU each year, pancreatic cancer has the lowest survival rate of all common cancers, with a life expectancy at diagnosis of just 4.6 months.
There are several potentially modifiable risk factors that have been shown to increase the chances of developing the disease. These include smoking, chronic pancreatitis, diabetes, obesity and a family history of the disease.
Main challenges
• Early detection and diagnosis
Pancreatic cancer is difficult to diagnose early, as it is often asymptomatic or presents symptoms at an advanced stage. In most cases, by the time the diagnosis is finally confirmed, the patient should be treated as an emergency. The complex nature of diseases makes screening for early diagnosis difficult to implement. Therefore, improving early detection of pancreatic cancer requires more research into improved screening and surveillance strategies.
• Treatment
By 2035, the number of pancreatic cancer cases is expected to increase by almost 40%4. Currently, surgical removal of the tumor is the only curative approach for pancreatic cancer. Additionally, pancreatic cancer tumors often do not respond well to emerging chemotherapies and immunotherapies, further impacting treatment. The way to follow
• Research funding
Pancreatic cancer research receives less than 2% of all cancer research funding in Europe. There is an urgent need for more research into early detection and better diagnosis of early pancreatic lesions, as well as the development of less invasive treatment techniques to facilitate more accurate results. Greater importance should be given to environmental factors for cancer development, including the microbiota, as well as the establishment of prognostic and particularly predictive biomarkers.
• Greater public awareness
Despite its dire outcomes, knowledge of the disease is alarmingly low: 64% of Europeans say they know almost nothing about pancreatic cancer. Primary prevention through increased awareness of modifiable risk factors for pancreatic cancer, such as smoking and obesity, is vital. To improve prevention, the European Cancer Plan will address existing knowledge gaps.
• Biobanks throughout Europe
Improving understanding of tumor biology can significantly improve diagnoses and aid in the development of more precise treatment. This is an area where the EU can lead the way by creating biobanks and pseudonymised patient registries across Europe, through actions such as the European Initiative to Understand Cancer.
• Harmonized standards of care
To ensure that treatment is provided in centers of excellence and that comprehensive data on quality of life are available, there should be a pan-European standard for pancreatic cancer care. This can only be achieved by addressing health inequalities, increasing scientific and research capacities across the EU.
