December 18, 2001
Surveillance of patients at risk for pancreatic cancer, research into early diagnosis point to cure in next decade
Pancreatic cancer seems swift and unforgiving to its victims. Typically, the disease is not detected until after it has spread to other organs, and it is highly resistant to chemotherapy and radiation. Of the 29,000 people who will be diagnosed with pancreatic cancer this year, approximately 28,900 will die within a few months of that diagnosis. Experts at the University of Washington say this situation is changing, and they predict huge breakthroughs in both early detection and therapy in the next 10 years.
“The outlook on pancreatic cancer is exponentially improving, after not changing much in the past hundred years,” said Dr. Terry Brentnall, University of Washington assistant professor of medicine and pathology. “Thanks to new breakthroughs in molecular biology, we can now gain a much better understanding of pancreatic cancer and how it forms. Understanding the mechanism of how pancreatic cancer forms is critical to early diagnosis.” UW researchers have been working with scholars from other schools to develop early diagnostic tests.
At least 10 percent of pancreatic cancers occur in people with relatives who died of pancreatic cancer. The UW has developed a surveillance program for high-risk patients who have a strong family history of the disease. Drs. Brentnall and Michael Kimmey, both gastroenterologists, David R. Byrd, surgeon, and Mary Bronner, a pathologist, run this surveillance program. Before pancreatic cancer forms, the pancreas displays certain pre-cancerous changes, or dysplasia. The UW surveillance program allows the physicians to find pre-cancer in the pancreas and recommend pancreatectomy, or removal of the pancreas, when there is a family history of the disease and other criteria are met. The program currently serves 35 patients from 13 families. They each either have 2 or more relatives who had pancreatic cancer, or a first degree relative who developed the disease when he or she was younger than age 50.
“The patients in the surveillance program are doing very well,” Brentnall said. “They are all alive without any development of pancreatic cancer. Everybody whose pancreas has been removed had pre-cancer present in the organ but had not yet developed cancer. We hope to make surveillance programs even better in the future. Ideally it would be best if we could identify patients who are on the brink of developing cancer by using a blood test or by taking a sample of fluid from the pancreas. Currently a tissue biopsy is required.”
Efforts are also under way to find the gene that is responsible for pancreatic cancer in families. Research by Brentnall and Bronner together with Dr. Leonid Krugliak at the Fred Hutchinson Cancer Research Center and Dr. David Whitcomb at the University of Pittsburgh is showing progress.
“We know what chromosome this gene is on, but we don’t know exactly what the gene is yet,” Brentnall said. “I anticipate we’ll probably have it narrowed down within the next year. This could help us with surveillance by identifying patients who have the gene and it will also help us understand the mechanism of how the cancer develops.”
Ultimately, the identification of any pancreatic cancer genes would aid the creation of a medication that could prevent high-risk patients getting cancer, or delay its development. Brentnall and Bronner said that if a medication could prevent or delay the onset of pancreatic cancer until very old age, patients would be more likely to die of other causes.
The UW Division of Gastroenterology is also conducting research on environmental and behavioral risk factors that might influence the development of pancreatic cancer. Anyone interested in participating in the surveillance or research programs may call Josephine Maurer at (206) 221-7454.
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