Pancreatic Cancer Study Finds Most Early Stages Are Inaccurate

According to a new study from Cedars-Sinai Cancer published in JAMA. This discovery highlights the urgent need for advances in diagnostic and staging technology, which could significantly change the treatment and research of early pancreatic cancer.

In this study, researchers looked at data from more than 48,000 patients in the National Cancer Database. Based on preoperative imaging, all patients in the study had stage 1 or 2 pancreatic cancer.

Following surgery to remove their tumors, more than 78% of stage 1 patients and more than 29% of stage 2 patients were downstaged, usually to a stage that included lymph node involvement.

“Our research reveals that staging, which is critical for making treatment decisions and determining research eligibility, is often inaccurate in early-stage pancreatic cancer,” said Srinivas Gaddam, MD, associate director of pancreatic biliary research at Cedars-Sinai and senior author of the study. “As the field moves toward earlier diagnosis, early staging will become increasingly important.”

Diagnosing and staging pancreatic cancer is difficult for the same reason. The pancreas, a digestive organ, is located deep in the body, and current imaging technology can’t always detect smaller tumors or lymph node involvement, said Gaddam, who is also an associate professor of medicine and directs the Pancreatic Cancer Screening and Early Detection Program at Cedars-Sinai.

Lymph nodes, clusters of small immune structures, are an important factor in staging cancer and a key difference between early-stage and advanced-stage pancreatic cancer.

“Patients with lymph node involvement have a lower survival rate than those without,” Gaddam said. “When imaging fails to detect lymph node involvement, staging may not reflect the true extent of the disease. Our results suggest that lymph node involvement is missed in four out of five patients during the staging process.”

The five-year survival rate for stage 1 pancreatic cancer is over 83%, but it drops to just 3% for patients with stage 4 disease, the stage at which most patients are currently diagnosed.

“Pancreatic cancer is a challenging diagnosis and there is an urgent need to improve patient outcomes,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and distinguished chairman of the PHASE ONE Foundation.

“Using cutting-edge tools, such as our Molecular Twin precision oncology platform, we are developing tests that will guide precision treatment of pancreatic cancer and other cancers. We first demonstrated the utility of Molecular Twin by identifying novel biomarkers for pancreatic cancer; these biomarkers aid in diagnosis, which must be combined with accurate cancer staging to appropriately guide treatments.”

Gaddam’s message to clinicians staging pancreatic cancer is to recognize the limitations of current imaging technology and to actively assess and report lymph node involvement. And for those at the forefront of innovation, he emphasizes the urgent need for improved screening and diagnostic technologies.

Screening for pancreatic cancer involves MRI and endoscopic ultrasound. Screening is recommended for people with a family history of pancreatic cancer and for those who carry variants of certain genes associated with the disease.

“We know that our current screening and staging tools are not very good,” Gaddam said. “I hope that in the next 10 years, we will develop advanced screening and staging tools for pancreatic cancer that will allow us to diagnose most patients at stages 1 and 2 rather than stage 4. With these advances, we will be able to detect this disease much earlier, which will improve outcomes for many more patients.”