A new study from Cedars-Sinai Cancer has revealed that doctors often misjudge the stage of early pancreatic cancer, with staging errors happening in about 80% of cases. This means that many patients who are told they have early-stage cancer may actually have more advanced disease than originally thought.
The findings, published in the respected medical journal JAMA, highlight a major problem in diagnosing and planning treatment for this aggressive cancer.
Pancreatic cancer is one of the deadliest types of cancer. It is often found too late, and even when it seems to be caught early, the cancer may have already spread further than expected.
Staging refers to how far the cancer has spread, and it plays a critical role in deciding which treatments are suitable. For example, early-stage cancer may be treated with surgery alone, while later stages may require chemotherapy or other treatments.
In this large study, researchers analyzed data from more than 48,000 patients in the National Cancer Database who were diagnosed with either stage 1 or stage 2 pancreatic cancer based on pre-surgery imaging tests.
However, after these patients had surgery to remove their tumors, doctors found that the cancer was more advanced in a majority of cases. Over 78% of those originally diagnosed with stage 1 cancer were moved to a higher stage after surgery, and nearly 30% of stage 2 patients were also upstaged.
The main issue, according to Dr. Srinivas Gaddam, senior author of the study and a specialist in pancreatic cancer at Cedars-Sinai, is that current imaging technology isn’t very good at detecting cancer that has already spread to the lymph nodes.
These lymph nodes are small, bean-shaped structures that are part of the body’s immune system. If cancer spreads to them, it usually means the disease is more serious.
Dr. Gaddam explained that imaging scans like CT or MRI sometimes miss these small but important signs. Because of this, the real extent of the cancer is often not clear until after surgery. This mismatch between what scans show and what is actually found later can lead to incorrect treatment plans.
This is especially troubling because survival rates for pancreatic cancer drop quickly as the disease advances. If caught at stage 1, the five-year survival rate is over 83%. But if the cancer is not diagnosed until stage 4, the survival rate drops to just 3%. Most people today are still diagnosed at these later stages.
Dr. Dan Theodorescu, director of Cedars-Sinai Cancer, emphasized the need for better tools to guide treatment. His team is working on something called the Molecular Twin Precision Oncology Platform.
This technology uses a person’s individual biology to find new signs, or “biomarkers,” of cancer. These biomarkers may help doctors better diagnose the disease and choose more accurate treatments. However, accurate staging remains essential, even with better testing.
Currently, people who have a strong family history of pancreatic cancer or who carry certain gene changes are recommended to undergo screening. This involves MRI scans or endoscopic ultrasound, but even these methods are limited in what they can detect.
Dr. Gaddam’s main message to other doctors is to be cautious when staging pancreatic cancer and to look closely for any signs that the disease may have spread to the lymph nodes. He also urges researchers to focus on creating better screening and staging tools.
With the right advancements, he hopes that within the next 10 years, doctors will be able to detect pancreatic cancer in its earliest stages for most patients, improving survival and treatment options.
In conclusion, this study clearly shows that current methods for diagnosing and staging pancreatic cancer are far from perfect. Most early-stage cases are actually more advanced than they appear on scans. This highlights the urgent need for better imaging and testing tools to ensure patients get the right treatment as early as possible.
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The research findings can be found in JAMA.
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