A study of pancreatic cancer showed that most of the early stages are inaccurate.

According to a new Cedars-Sinai Cancer study published in JAMA, the determination of the stage in patients with early pancreatic cancer is inaccurate in 80% of cases. This discovery highlights the urgent need to improve diagnostic technologies and staging, which can significantly change early treatment and research of pancreatic cancer.

"Our study shows that determining the stage necessary to make a treatment decision and determining compliance with the criteria for participation in the study is often inaccurate in the early stages of pancreatic cancer," said Srinivas Gaddam, MD, deputy director of the biliary tract research department at Cedars-Sinai and senior author of the study. "As the industry strives for earlier diagnosis, the early stage will become more and more important."

Diagnosis and determination of the stage of pancreatic cancer are difficult for the same reason. The pancreas, the digestive organ, is located deep in the body, and modern imaging technologies are not always able to detect small tumors or lymph node damage, says Gaddam, who is also an associate professor of medicine and heads the Center for Screening and Early Detection of Pancreatic Cancer. Detection program in Cedars-Sinai.

Lymph nodes, clusters of small immune structures, are an important factor in determining the stage of cancer and a key difference between early and late stages of pancreatic cancer.

"Patients with lymph node damage have a worse survival rate than patients without lymph node damage," Gaddam said. "When visualization does not detect lymph node damage, the stage may not reflect the true degree of the disease. Our results show that lymph node damage is not taken into account in four out of every five patients during the staging process."

The five-year survival rate for stage 1 pancreatic cancer is more than 83%, but for patients with stage 4 of the disease, which is currently diagnosed with the majority of patients, this figure drops to 3%.

"Pancreatic cancer is a complex diagnosis, and there is an urgent need to improve the results of patient treatment," said Dan Teodorescu, MD, director of the Cedars-Sinai Oncology Department and Honorary Chairman of the PHASE ONE Foundation.

"With the help of advanced tools, such as our Molecular Twin precision oncology platform, we are developing tests that will determine the exact treatment of pancreatic cancer and other types of cancer. For the first time, we demonstrated the usefulness of Molecular Twin by identifying new biomarkers of pancreatic cancer; these biomarkers help in diagnosis, which must be combined with the exact stage of cancer in order to properly prescribe therapy."

Gaddam's main message to doctors determining the stage of pancreatic cancer is to recognize the limitations of modern imaging technologies and actively evaluate and report lymph node damage. And for those who are at the forefront of innovation, it emphasizes the urgent need to improve screening and diagnostic technologies.

MRI and endoscopic ultrasound are used for pancreatic cancer screening. Screening is recommended for people with a family history of pancreatic cancer and those who are carriers of variants of certain genes associated with this disease.

"We know that our current verification and staging tools are not very good," Gaddam said. "I hope that over the next 10 years we will develop advanced tools for screening and determining the stage of pancreatic cancer, which will allow us to diagnose most patients at stages 1 and 2, not at stage 4.