Early detection of pancreatic cancer: Where are we now and where are we going?

Abstract

Pancreatic cancer (PC) is one of the most lethal malignancies. Recent studies indicate that patients with incidentally diagnosed PC have better prognosis than those with symptoms and that there is a sufficient window for early detection. However, effective early diagnosis remains difficult and depends mainly on imaging modalities and the development of screening methodologies with highly sensitive and specific biomarkers. This review summarizes recent advances in effective screening for early diagnosis of PC using imaging modalities and novel molecular biomarkers discovered from various "omics" studies including genomics, epigenomics, non-coding RNA, metabonomics, liquid biopsy (CTC, ctDNA and exosomes) and microbiomes, and their use in body fluids (feces, urine and saliva). Although many biomarkers for early detection of PC have been discovered through various methods, larger scale and rigorous validation is required before their application in the clinic. In addition, more effective and specific biomarkers of PC are urgently needed.

Mining Exosomal Genes for Pancreatic Cancer Targets

“…The levels of exosomes in cancer patients are higher than the levels found in normal patients (12)(13)(14). This phenomenon may be due to altered physiology in diseased organs.…”

A review of lifestyle, metabolic risk factors, and blood‐based biomarkers for early diagnosis of pancreatic ductal adenocarcinoma

“…A positive family history of PDAC has been reported to be associated with an 80–200% higher risk . Previous reviews have summarized inherited disorders that carry an increased risk of PDAC, the genes involved, and the corresponding RRs . These involved germline mutations in BRCA1, BRCA2, CDK2A, STK11, PRSS1, SPINK1, PALB2, ATM, and CFTR, and the associated RRs ranged from 2.2 to over 100.…”

Familial Pancreatic Cancer

“…Therefore, additional screening options are necessary for high-risk individuals. In general, biomarkers for PDAC can include genomics, epigenomics, non-coding RNAs, metabonomics, liquid biopsies, and microbiomes in several body fluids such as urine or plasma [82]. Biomarkers such as CA19-9 are mainly used for disease monitoring but not for screening, and more effective and validated biomarkers are needed [26,82,83].…”

“…In general, biomarkers for PDAC can include genomics, epigenomics, non-coding RNAs, metabonomics, liquid biopsies, and microbiomes in several body fluids such as urine or plasma [82]. Biomarkers such as CA19-9 are mainly used for disease monitoring but not for screening, and more effective and validated biomarkers are needed [26,82,83]. Newly found biomarkers such as AHNAK2 or THBS2, which are potentially successful diagnostic markers, need to be involved in studies to show their effects in screening programs [84,85,86].…”