Oncology
Metastatic Pancreatic Cancer
Clinical Importance of Early Diagnosis in Patients With Metastatic Pancreatic Cancer
Overview
Metastatic pancreatic cancer is associated with an extremely poor prognosis with a low survival rate; early detection and screening for pancreatic cancer remain a challenging and unmet need. In most patients, the diagnosis of pancreatic cancer is made when the disease is metastatic. Most patients are first seen by a general practitioner due to symptoms of weight loss, fatigue, or anorexia, with a median delay between the onset of symptoms and diagnosis of pancreatic cancer of 41 to 65 days (or an average of 2 weeks longer if symptomatic treatment was provided). Due to the lack of early symptoms and the tendency of pancreatic cancer to metastasize at an early stage, many patients already have advanced pancreatic cancer when they are diagnosed. Early diagnosis is critical to improve patient survival. Currently, increasing survival with early detection may happen by identifying patients with high-risk factors or precursor lesions through screening, including ultrasound, biologic markers, or familial registration.
Expert Commentary
Andrew Hendifar, MD, MPH
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Regarding early diagnosis, unfortunately, more than 75% of our patients are being diagnosed in the advanced setting. This is really troubling. As clinicians, we have to figure out some way to identify these patients earlier. I am not sure how that is going to be done because in a lot of cases, these patients do not have symptoms. They are asymptomatic for a long time before they present with any symptoms that would concern the physician to order screening tests. Early diagnosis is an area that I hope will be addressed on an ongoing basis and hopefully improve the outcomes in this patient population. |
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“As clinicians, we have to figure out some way to identify these patients earlier.”
References
Hammel P, Coriat R, Lledo G, et al. Care pathway of patients with metastatic pancreatic cancer in daily practice in France: results from the REPERE national survey. Bull Cancer. 2017;104(4):321-331.
Hanada K, Okazaki A, Hirano N, et al. Effective screening for early diagnosis of pancreatic cancer. Best Pract Res Clin Gastroenterol. 2015;29(6):929-939.
Hidalgo M, Cascinu S, Kleeff J, et al. Addressing the challenges of pancreatic cancer: future directions for improving outcomes. Pancreatology. 2015;15(1):8-18.
Laquente B, Calsina-Berna A, Carmona-Bayonas A, Jiménez-Fonseca P, Peiró I, Carrato A. Supportive care in pancreatic ductal adenocarcinoma. Clin Transl Oncol. June 13, 2017. doi: 10.1007/s12094-017-1682-6. [Epub ahead of print].
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Pavlidis ET, Pavlidis TE. Current molecular and genetic aspects of pancreatic cancer, the role of metastasis associated proteins (MTA): a review. J Invest Surg. January 6, 2017. doi: 10.1080/08941939.2016.1269854. [Epub ahead of print].
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