Pancreatic cancer study finds most early-stage diagnosis inaccurate

Staging of early-stage pancreatic cancer patients is inaccurate up to 80 percent of the time, according to a new Cedars-Sinai Cancer study published in the journal Neurology. CAVITY. This finding underscores the urgent need for improved diagnostic and staging technologies, which could significantly change early treatment and research for 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 of the patients in the study had stage 1 or stage 2 pancreatic cancer.

After surgery to remove the tumors, more than 78% of stage 1 patients and more than 29% of stage 2 patients experienced disease progression—usually to a stage that involved lymph nodes.

“Our study reveals that staging — essential for making treatment decisions and determining study eligibility — is often inaccurate in early-stage pancreatic cancer,” said Dr. Srinivas Gaddam, associate director of biliary pancreas 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 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 system structures, play an important role in determining the stage of cancer and make the key difference between early and late stage pancreatic cancer.

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

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

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

“With cutting-edge tools like our Molecular Twin Precision Oncology Platform, we are developing assays that will guide precision treatment for pancreatic and other cancers. We have demonstrated for the first time the utility of Molecular Twin by identifying novel biomarkers for pancreatic cancer; these biomarkers aid in diagnosis, which must be coupled with accurate staging of the cancer to guide therapy.”

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

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

“We know that our current screening and staging tools are not great,” Gaddam said. “Hopefully, in the next 10 years, we will have advanced screening and staging tools for pancreatic cancer that will allow us to diagnose most patients at stage 1 and stage 2, rather than stage 4. With these advances, we can detect this disease much earlier, improving outcomes for many more patients.”