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Pancreatic cancer: Slow and deadly

JOHNS HOPKINS (US) — Pancreatic cancer develops and spreads much more slowly than scientists have thought, new research finds.

“For the first time, we have a quantifiable estimate of the development of pancreatic cancer, and when it would be best to intervene,” says Christine Iacobuzio-Donahue, associate professor of pathology and oncology at Johns Hopkins University, “so there is potentially a very broad window for screening.”

The problem, she adds, is that right now “pretty much everybody is diagnosed after that window has closed.”

Pancreatic cancer is notoriously difficult to detect in its early stages because there are frequently few symptoms. Current imaging techniques are not specific for cancer.

The new study shows that “many pancreatic cancer cases have a long lag time before they are detected through conventional tests. This leaves room to develop new early, diagnostic tools and intervene with potentially curative surgery,” says Bert Vogelstein, professor and director of the Ludwig Center for Cancer Genetics and Therapeutics and an investigator at the Howard Hughes Medical Institute.

The research, published in the Oct. 28 issue of the journal Nature, suggests that it takes at least a decade for the first mutation in a pancreatic lesion to turn a cell into a full-fledged cancer cell.

After the first cancer cell appears, it takes an average of nearly seven more years for that cell to turn into the billions that make up a cancerous tumor the size of a plum, after which at least one of the cells within the tumor has the ability to spread to other organs. Patients die an average of two and a half years after this metastasis.

The results contradict the idea that pancreatic cancers metastasize very early in their development, Iacobuzio-Donahue says.

For the study, scientists collected tissue samples during autopsies of seven patients who died from pancreatic cancer that had metastasized to other organs. Because the tissue samples were taken within six hours of each patient’s death, the scientists were able to keep some of the cells alive long enough to extract the DNA and sequence the series of chemical “letters” that form genes.

In each patient, metastatic deposits were found in two or more sites in the body, most often the liver, lung, and lining of the abdomen. The researchers found similar mutations present in both the areas of metastasis and in the primary pancreatic tumors from which the metastases arose.

They also identified and classified the types of mutations, ones that occur before metastasis and others that happen after the cancer has spread. Both types of mutations were present within the primary tumor years before the metastases became clinically evident, Iacobuzio-Donahue says.

Using mathematical models to study the timing of pancreatic cancer progression, the scientists conservatively estimated an average of 11.7 years before the first cancer cell develops within a high-grade pancreatic lesion, then an average of 6.8 years as the cancer grows and at least one cell has the potential to spread, and finally, an average of 2.7 years from then until a patient’s death.

The scientists say the goal is develop a pancreatic cancer screening method similar to the protocol used for breast and colon cancer. Though early stages of pancreatic cancer cause no symptoms, Iacobuzio-Donahue says, perhaps at a certain age people should undergo an endoscopy to screen for pancreatic cancer.

Endoscopy is a procedure allowing doctors to look inside the body through the use of an instrument that has a tiny camera attached to a long, thin tube.

The genome sequencing work received support from many organizations, including the National Institutes of Health and the Bill and Melinda Gates Foundation.

Other scientists involved in the research were from Johns Hopkins, Harvard University, and the University of Edinburgh.

More news from Johns Hopkins: http://releases.jhu.edu/

chat14 Comments

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14 Comments

  1. Lorraine Cherry

    There are ~40,000 new cases of pancreatic cancer each year, compared with ~145,000 new cases of colorectal cancer (CRC). For CRC, the benefits of colonoscopy to detect and remove early stage disease have been well documented, yet only about 25% of people who should be getting colonoscopies actually do so. I’d predict that the chances that anyone would ever undergo an endoscopy to screen for a relatively rare cancer are slim to none.

  2. Dr. O'

    I agree, but expect that improvements in technology will reduce the resistance factor, especially if someone has a genetic profile that indicates a predisposition to the cancer.

  3. Lorraine Cherry

    Today’s headline in the NY Times about the sDNA test for colon cancer and precancerous lesions is a case in point about ‘improvements in technology.’ I anticipate that, if clinical trials for this new test turn out well, we will see an explosion in the number of 50+ people being screened for CRC.

  4. Barbara Brown

    I lost my father, and recently my mother, to pancreatic cancer, and you can believe if there is a test available, I would pursue getting it. Both my mother’s internal medicine doctor and her cancer doctor said they had never had a case where both the husband and the wife had pancreatic cancer. I get a colonoscopy every three years, but it doesn’t sound like that would catch it. Hopefully there will be a test available soon.

  5. Barbara Brown

    I lost my father, and recently my mother, to pancreatic cancer, and you can believe if there is a test available, I would pursue getting it. Both my mother’s internal medicine doctor and her cancer doctor said they had never had a case where both the husband and the wife had pancreatic cancer. I get a colonoscopy every three years, but it doesn’t sound like that would catch it. Hopefully there will be a test available soon.

  6. Nick D.

    Besides colonic irrigation cleansings; what are some of the best foods to eat and drink besides water, tomatoes, fiber, steamed seafoods in order to prevent this? Americans love coffees; but aren’t they terrible for this, and may cause problems earlier, too?
    Coffees are known to be good, and/or excellent for some A + blood types! REF: Medical books
    etc.
    Doesn’t Steve Bartkowski have colon cancer; and agrees coffees hurt him later on in construction work yrs. ago? How are both of his sons now? What are they doing now? etc.

  7. Doug H.

    This article isn’t really that helpful from a real-world point of view. Until some test is devised to detect during all this time it’s claimed the pancreatic cancer takes to become deadly, the common perception remains accurate: pancreatic cancer, once diagnosed, is a virtually certain sentence to rapid and usually tragically premature death.

    The article claims an average of 2.7 years to death after initial metastasis. Granted, their n is bigger than mine, and metastasis may be required before diagnosis, but Randy Pausch lived longer after diagnosis than anyone else I knew (several), and that was only 1.8 years.

  8. Trina Murry

    My father-in-law passed away in July of 2010 from pancreatic cancer and my husband was diagnosed in April of 2010. We are currently in San Antonio coming through from family Christmasn where we have been staying for 2 weeks as my husband had emergency surgery. He had to get a coloscopy due to a blocked bowel. This stuff is deadly.

  9. Donna D.

    My grandmother recently passed away from pancreatic cancer. My grandfather, her husband, passed away 10 years ago from the same thing (pancreatic cancer). I was wondering how often this happens and if anyone has any information about this being related to the type of diet they followed or something else. Thank you.

  10. Tab

    I would like to know I’d there are any case studies or links to spousal pancreatic cancer. My mother passed away last year and my father has been diagnosed this year.

  11. Mahesh

    I would like to know about pancreatic cancer I.e how we can identify this cancer on starting stage..

  12. mike

    my dad passed about 18 months ago from pancreatic cancer and now my mom has it. according to the posts here, there seems to some dubious relationship present here because the chances of simultaneous cancers of like kind seem remote in such a close circle.

  13. Janice Krinsky

    I knew a couple when I was growing up where both the husband and wife died of pancreatic cancer within months of each other. My died also died of it. What is happening to evaluate the effectiveness of the test strip developed by Jack Andraka, the high school prodigy who provided the proof of concept using antigens on nanotubules. I hope his work isn’t ignored just because he was a teenager when he figured it out.

  14. joel

    It sucks not being to tell early on if you have cancer, there is another interesting article that promotes pancreatic cancer detection . I know it’s WedMD but i found it helpful.

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