Early Diagnosis of Pancreatic Cancer: Clinical Premonitions, Timely Precursor Detection and Increased Curative-Intent Surgery

Abstract

Background The overall poor prognosis in pancreatic cancer is related to late clinical detection. Early diagnosis remains a considerable challenge in pancreatic cancer. Unfortunately, the onset of clinical symptoms in patients usually indicate advanced disease or presence of metastasis. Analysis and Results Currently, there are no designated diagnostic or screening tests for pancreatic cancer in clinical use. Thus, identifying risk groups, preclinical risk factors or surveillance strategies to facilitate early detection is a target for ongoing research. Hereditary genetic syndromes are a obvious, but small group at risk, and warrants close surveillance as suggested by society guidelines. Screening for pancreatic cancer in asymptomatic individuals is currently associated with the risk of false positive tests and, thus, risk of harms that outweigh benefits. The promise of cancer biomarkers and use of ‘omics’ technology (genomic, transcriptomics, metabolomics etc.) has yet to see a clinical breakthrough. Several proposed biomarker studies for early cancer detection lack external validation or, when externally validated, have shown considerably lower accuracy than in the original data. Biopsies or tissues are often taken at the time of diagnosis in research studies, hence invalidating the value of a time-dependent lag of the biomarker to detect a pre-clinical, asymptomatic yet operable cancer. New technologies will be essential for early diagnosis, with emerging data from image-based radiomics approaches, artificial intelligence and machine learning suggesting avenues for improved detection. Conclusions Early detection may come from analytics of various body fluids (eg ‘liquid biopsies’ from blood or urine). In this review we present some the technological platforms that are explored for their ability to detect pancreatic cancer, some of which may eventually change the prospects and outcomes of patients with pancreatic cancer.

The Complexity of the Pancreatic Lymphatic System and the Key Role of Para-Aortic Lymph Node Metastasis in Pancreatic Cancer Prognosis Prediction: A Comprehensive Review

“…Moreover, obtaining biopsies or tissue samples practice at the time of diagnosis in research settings undermines the utility of time-sensitive biomarkers for identifying preclinical, asymptomatic, yet surgically treatable cancers. Embracing novel technologies will be crucial in achieving early diagnosis, with emerging evidence from image-based radiomics, artificial intelligence, and machine learning offering promising avenues for enhanced detection capabilities [24,34,35,56,57].…”

Pancreatic Cancer Health Disparity: Pharmacologic Anthropology

“…Understanding and addressing access-related disparities is crucial for improving PCa outcomes and promoting health equity [86]. Disparities in healthcare infrastructure, including the availability and distribution of medical facilities, cancer centers, and specialized healthcare providers, can contribute to access disparities in PCa [87]. Uneven geographic distribution of healthcare resources can result in limited access to timely diagnosis, treatment, and follow-up care, particularly in rural and underserved areas.…”

Principles of Palliative and Supportive Care in Pancreatic Cancer: A Review

“…Possible symptoms are based on the localization of the tumorobstructive icterus when present in the head of the pancreas, vomiting in the case of Biomedicines 2023, 11, 2690 2 of 12 duodenal oppression, and pain in the epigastrium with propagation to the back. At an advanced stage, stiff resistance in the epigastrium, ascites, or shortness of breath with metastatic involvement of the lungs may appear as the first symptom [5]. As part of the diagnosis, it is possible to find a pancreatic tumor using abdominal ultrasound, abdominal contrast CT, or endosonography (EUS).…”

“…Finding these molecules could lead to a breakthrough in the care of PDAC patients. In recent years, there has been an enormous effort in the field of scientific research to find a suitable methodology for effective screening [2,5].…”