A European project seeks to diagnose pancreatic cancer with a blood test

Pancreatic cancer is one of the most difficult types of cancer to detect.

Normally, when it shows its face, it is already in an advanced stage and has caused metastasis, explains Héctor Peinado, head of the Microenvironment and Metastasis Group at the National Cancer Research Center (CNIO).

The scientist participates in a European project that aims to achieve early detection of this disease through a minimally invasive blood test.

The research, which has just begun, will receive 10 million euros from the European Commission until 2027. Eight different countries, such as Germany, France and the United Kingdom, and 17 research centers, including the CNIO, participate in it.

Over the next four years, researchers in the PANCAID (Pancreatic Cancer Initial Detection Using Liquid Biopsy) project will look for biomarkers in the blood that alert to the presence of the tumor in its early stages.

To do this, samples from some 2,000 patients with pancreatic cancer, with precursor lesions of the disease and from people at risk due to genetic factors will be used.

One of those in charge of this task is Peinado, who has been working with liquid biopsy for about five years.

Until now, its use had been mainly aimed at monitoring cancer patients to assess the evolution and response of these people during treatment, says the researcher.

We seek to identify pancreatic cancer before it gives symptoms

Nuria Malats, head of the CNIO's Genetic and Molecular Epidemiology Group

Once they have identified the biomarkers, another team will use artificial intelligence to select the best ones and the possible combinations that can be made.

With these data, they hope to obtain a signature of markers that will allow the detection of the disease in very early stages, when patients can still be treated radically, explains Nuria Malats, head of the CNIO's Genetic and Molecular Epidemiology Group, who is also involved in this work.

The researcher says that some of the reasons why it is so difficult to find this cancer on time are the very nature of the organ, which causes symptoms to appear late, and its location.

The pancreas is located in the posterior part of the abdomen, an area that has plenty of space for a tumor to grow without causing symptoms, according to Malats.

"What we are looking for is, precisely, to identify it before it shows symptoms," she adds.

Added to these difficulties is the fact that in Spain there is no screening policy for the early detection of pancreatic cancer, as happens with breast or colon cancer, says Ana Fernández, member of the Board of Directors of the Spanish Society of Medical Oncology. (SEOM).

In addition, the symptoms are very non-specific and have two forms of presentation.

The patient may present abdominal and lumbar pain;

unexplained loss of weight and appetite, and even jaundice (a yellowing of the skin and whites of the eyes from excess bilirubin).

Other people, in more acute cases, may suffer an obstruction of the bile duct (where bile is transported in and out of the liver), explains the CNIO researcher.

This project may be a new option to try to increase survival

Ana Fernández, member of the SEOM Board of Directors

In the first case, when the doctor sees that the symptoms are prolonged over time and do not subside, he asks the patient for abdominal imaging tests, so that he can have MRIs, and proceeds with the diagnosis, says Malats.

In Spain, 7,663 people died from pancreatic cancer in 2021, according to the INE.

With a mortality rate of 83%, in this pathology "the incidence is almost the same as the mortality," explains Fernández.

The disease usually causes death within the first year after diagnosis, and less than 5% survive five years later.

Only 20% of diagnosed cases are operable and, in this case, five years after surgery, 20% of the people operated on are still alive, adds Fernández.

For this reason, for the medical oncologist at the Ourense Hospital Complex, "this project may represent a new option to try to increase survival."

Another aspect that worries the three professionals is the increase in cases of the disease.

In 2020, 8,200 patients with pancreatic cancer were diagnosed, this year the SEOM estimates that the cases will reach 9,300.

They find no explanation for this phenomenon, but Malats points out that the increase occurs in parallel to that of obesity and diabetes.

The oncologist says that the cause of the disease is not clearly known.

The risk factors are smoking, diabetes, obesity and chronic pancreatitis, but "there are many people who do not have many of them and, nevertheless, develop pancreatic cancer," explains Fernández.

Héctor Peinado, from the CNIO, highlights the ambition of this project: not so much because of the economic investment, but because of the magnitude of the disease and the way of approaching the research.

In addition to the groups that are in charge of developing the liquid biopsy and managing all the information to process it, they have others that address different perspectives, such as the economic impact of the disease and how it can change with this early detection.

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