Pancreatic cancer is a cancer of the
pancreas that is difficult to detect early
- It is difficult
to distinguish between cancerous and non-cancerous variants of pancreatic
- Two tests that
assess the level of proteins VEGF-A and CEA have been found to be good
indicators of cysts that are not cancerous
- These tests are
potential biomarkers and can be used to limit the need for invasive
Pancreatic lesions or cysts develop within the pancreas, and while some cysts
are non-inflammatory, others are inflammatory in nature. These cysts range in
size from millimeters to several centimeters; some cysts may be small and
benign without resulting in any symptom. However, some cysts are cancerous.
has been difficult to distinguish between lesions that are cancerous and those
that are benign, without invasive testing procedures. However, a recent study
by a research team from Indiana University has found that when two laboratory
tests are performed in tandem, pancreatic lesions that are benign, but which
closely resemble pre-cancerous lesions, may be identified.
‘Early detection of pancreatic cysts that will not become cancerous, using two protein biomarkers, can help avoid further surgical interventions and invasive diagnostic procedures.’
study was published in the journal of the American
College of Surgeons,
and it is one of the largest studies conducted on
- 2-3% of patients get
detected with pancreatic lesions on a routine abdominal scan.
of these patients develop pancreatic cancer, especially the most severe form
called pancreatic adenocarcinoma.
- The 5 year
survival rate of these patients is
- 12-14% for those
with early stage disease
- 1-3% for those with
advanced stage of disease
- A small
percentage of these patients detected with pancreatic lesion would have
serious cystic neoplasms (SCN). These are non-malignant and do not develop
people with SCN do not progress to cancer, they are often subjected to undergo
imaging every 6 months in order to monitor the lesion. Sometimes, patients with
these lesions are required to undergo surgical intervention as a precautionary
measure to remove the lesions. Almost 60% of these patients are not predicted
to be in the benign state till after the surgery. Radiological imaging has been
found to miss nearly 50 to 70%
Potential Diagnostic Testing
The study by the research team from
Indiana University has found that two proteins play an important role in
determining if the lesions are pre-cancerous or cancerous.
Testing for the Proteins
- Vascular endothelial growth factor A (VEGF-A) is a protein that is found to be involved in the
formation of new blood vessels. This protein's expression is increased in
many different types of tumors and the research team from Indiana
University has used this protein in its diagnostic test.
- Carcinoembryonic antigen (CEA) is a protein that is found to be involved in cell
adhesion. This protein, while being present in low levels in healthy
individuals, is found in increased levels in individuals with certain
types of cancer.
The level of these proteins is tested in
pancreatic cyst fluid and the results of the findings are:
identification of serious cystic neoplasm (SCN) from other types of
- The levels of VEGF-A independently identified
serious cystic neoplasms with a specificity of 83.7% and a sensitivity of
- The levels of CEA independently identified
serious cystic neoplasms with a specificity of 81.5% and a sensitivity of
- When the tests
for the proteins were taken together, they reached the gold standard of
pathologic testing. The combined specificity was 100% while sensitivity
- In the study, the
research team found that 26 patients could have been prevented from opting
cysts have always worried patients as well as doctors, because of the unknown
risk of these lesions developing into cancer. Most patients are subjected to
surgery or invasive tests to ensure that these cysts are harmless and that they
do not lead to cancer. Dr. C. Max Schmidt, MD, PhD, FACS, who is the study
author and a professor of surgery and biochemical/molecular biology at Indiana
University School of Medicine said that the test that involves both VEGF-A as
well as CEA could be used to identify patients who do have the risk for cancer
and hence avoid the need for surgery in them.
Developing a Diagnostic Technique
149 study participants who had previously
undergone a surgery to remove a pancreatic cyst were included in the study.
- Out of these, 26
participants had serious cystic neoplasm
examinations were used to confirm the diagnosis
samples of the pancreatic cyst fluid were used to detect the levels of VEGF-A
and CEA, using enzyme linked biochemical assays.
research studies are required to confirm the accuracy of the VEGF-A and CEA
levels and the risk of developing pancreatic cancer.
research team stated that there was a need to carry out the test under
stringent conditions, and specimens could be sent to Indiana University Health
Pancreatic Cyst and Cancer Early Detection Center for analysis, if required.
are many ongoing research studies being carried out to identify biological
markers for pancreatic cancer. The current study focuses on differentiating
between cysts that will not develop into cancer and cysts that would. This will
help in reducing the number of people who would require invasive surgical
- Treatment & Support - (https://www.cancer.org/treatment.html)
- Rosalie A. Carr, Michele T. Yip-Schneider, Scott Dolejs, Bradley A. Hancock, Huangbing Wu, Milan Radovich, C. Max Schmidt. Pancreatic Cyst Fluid Vascular Endothelial Growth Factor A and Carcinoembryonic Antigen: A Highly Accurate Test for the Diagnosis of Serous Cystic Neoplasm. Journal of the American College of Surgeons, 2017; 225 (1): 93 DOI: 10.1016/j.jamcollsurg.2017.05.003
- General Information About Pancreatic Cancer - (https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq)