How Is PDAC Diagnosed?

Pancreatic cancer is a relatively rare form of cancer, being the 10^th most commonly diagnosed cancer in the UK. Around 10,500 people contract the disease each year, with pancreatic ductal adenocarcinoma (PDAC) the most commonly observed diagnosis. Despite these relatively small figures, pancreatic (and, by extension, PDAC) is one of the biggest killers among cancer types.

For context, of the 10,500 people who are diagnosed with the cancer, some 9,400 (almost 90%) are expected to die within months. Just 7% live for five years or more, while only 1% last a decade. What’s worse, incidence of the disease is on the increase; between 2014 and 2035, pancreatic cancer diagnoses are expected to rise by 6% each year. That means that within a decade, PDAC could become the second bigger killer behind lung cancer, surpassing breast and colorectal, among others.

Too late

The reason behind PDAC’s high death rate? For one thing, almost half (47%) of those recognised to have the disease are 75 years or older. For another, the vast majority of people who are diagnosed have already reached an inoperable state. Approximately one third of patients present with locally advanced spreading of the disease, while over half are diagnosed when the cancer is in a metastatic state.

Given that surgery to remove the tumour entirely is the only realistic chance of curing the disease, and that as many as 90% of cases are not caught before they become inoperable, it’s perhaps not surprising that PDAC has such a high death rate. While all cancers pose their own unique challenges and experiences for the sufferers, PDAC appears to be a particularly problematic one for medical science at present.

A slippery customer

Why, then, are cases of PDAC and other pancreatic cancers not caught sooner? The simple truth is that for many patients, they are entirely asymptomatic until the disease has taken root in their bodies. Even when the warning signs do begin to appear, they are so vague as to be easily missed by GPs and other health professionals, or even the individual themselves. Weight loss, loss of appetite and fatigue are the most common symptoms, while jaundice is the biggest clinical indicator.

However, many people either do not notice these signs or do not believe them serious enough to report to their GP. Even if they do, it’s not guaranteed that the GP will be able to recognise the early stages of PDAC, which is why diagnosis arrives so late for so many sufferers.

Hope on the horizon

Thankfully, it’s a problem of which the medical and scientific communities are well aware – and which they are striving to solve. One promising development has come from Germany, where a collaborative team of researchers from Munich and Ulm may have struck upon a solution. Using cancer on a chip technology, they have modelled the human pancreas organoid in vitro and believe they have pinpointed a novel biomarker for the onset of the disease.

In particular, it is the protein filamin b which has shown promise as a liquid-biopsy biomarker for PDAC patients. Not only can its presence help scientists potentially catch the disease in its early stages, but it could theoretically map out the development and outcome of PDAC in the sufferer, too.