An Early Test for Pancreatic Cancer

Summarized by Robert W. Griffith, MD
September 11, 2007

The recent death of Luciano Pavarotti has once again reminded us of the poor prognosis for people diagnosed with pancreatic cancer. The American Association for Cancer Research has kindly provided us with the basic information for this article about an exciting new test to detect this cancer, earlier than has been so far possible. Robert Griffith, Content Editor

Introduction

Pancreatic cancer is one of the leading causes of cancer death in America - over 33,000 Americans will likely die from it in 2007, according to projections from the American Cancer Society. The five-year survival rate is less than 5% of all cases. However, if caught at an early stage, available treatments cause the five-year survival rate to jump 10-fold to 50%.

Earlier Diagnosis

A new optical technology, coupled with routine endoscopy, may enable doctors to detect subtle tell-tale traces of early pancreatic cancer. The technology, developed by biomedical engineers at Northwestern University, exposes cellular changes indicating cancer in tissue near the pancreas that had previously been detectable only through intensive radiologic scanning or invasive surgery, two techniques that can put patients at risk. If the technique is applied to those at high risk - such as people with chronic pancreatitis or who have a family history of pancreatic cancer - one might expect a drastic improvement in pancreatic cancer survival.

A Pilot Study

The results of a pilot study, published in Clinical Cancer Research, a journal of the American Association for Cancer Research, are very encouraging. In an examination of 51 patients using tissue sampled through upper endoscopy (a minimally invasive procedure that entails placing an endoscope down the throat and through the stomach to the duodenum), the researchers were able to identify those patients with pancreatic cancer from the control group with a 95% accuracy. Importantly, the researchers could identify all 10 patients with early stage tumors that could be removed surgically.

How It Works

Two different means of detecting the optical properties of a tissue sample are used: four-dimensional elastic light scattering fingerprinting (4D-ELF) and low-coherence enhanced backscattering spectroscopy (LEBS). In essence, the 4D-ELF/LEBS instrument shines an intense white light onto a tissue sample and then measures how cellular structures on the micro- or nanoscale (on the order of a billionth of a meter) refract the light, causing it to scatter in different directions. Computer analysis of the scatter patterns can then determine if these cellular structures are different from those seen in structures within "normal" tissue. The researchers looked for the same optical changes that have been identified in a colorectal cancer. The optical properties of a cell's structure can thus serve as a marker for disease. Optical markers are independent of other factors within the tissue microenvironment. They do not change if the patient is a smoker, or with the location, stage or size of the tumor in the pancreas.

The Future

With the success of the pilot study, the researchers are currently involved in a larger study of the technique and its refinement. They estimate that the technology may be put into practice within three years. "If we could reliably detect the presence of cancer prior to our ability to visualize it with our current imaging studies, such as a CT scan or MRI, we would have justification to pursue aggressive surgical options," said Dr. Brand, the lead investigator.

Source

• Optical markers in duodenal mucosa predict the presence of pancreatic cancer. Y. Liu, RE. Brand, V. Turzhitsky,  et al., Clin Cancer Res, 2007, vol. 13, pp. 4392--4399

Related Links
American Association of Cancer Research
Cancer of The Pancreas
Pancreatic Cancer Update

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