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A reliable early warning system for pancreatic cancer is highly sought after because the disease progresses so quickly once detected. If caught while still con

A reliable early warning system for pancreatic cancer is highly sought after because the disease progresses so quickly once detected. If caught while still confined to the pancreas it can often be cured by surgery, but the large majority of patients are already metastatic before symptoms appear. The one-year relative survival rate after diagnosis is 20%, and the five-year rate is 7%. In the US it is the 4th most common cause of death from cancer, and kills more than half a million people per year worldwide. http://pancreatic.org/pancreatic-cancer/about-the-pancreas/prognosis/ http://pancreatic.org/pancreatic-cancer/about-the-pancreas/p... https://en.wikipedia.org/wiki/Pancreatic_cancer https://en.wikipedia.org/wiki/Pancreatic_cancer

gthtjtkt 9y ago
Every time I read about something like this, I wonder how people can make it through medical school without dying of anxiety. So many terminal illnesses that could already be killing you with no early warning signs... how can they sleep!?
- wodencafe 9y ago
  The anxiety is killing me without being in medical school. Cancer is the worst.
- fixermark 9y ago
  It helps to acknowledge the fact that you are constantly dying from something. Everyone's time is finite, and there's very little benefit in chasing the tail of the "If only I'd known about X" dragon, because there will always eventually be an X you don't know about that gets you. (... at least until we perfect the longevity treatments ;) ).
  - louithethrid 9y ago
    Newsflash: First Immortal killed by car during victory dance on the street
- rscho 9y ago
  Medical school makes you dead inside, which is very practical to work long hours and not worrying about dying on the outside :) As a European working in the US medical system, my general impression is that US people fear death much more than in Europe, where people bother much more about suffering than dying in itself. I don't really understand why, but americans seem in my experience far more willing to undergo invasive procedures to live longer, even if it means bad quality life.
  - killjoywashere 9y ago
    We tend to interpret suffering as virtue. Even PG advises faced with a choice, doing what sucks more is probably the right answer.
  - arwhatever 9y ago
    All the better to politically motivated is with :-)
- arkh 9y ago
  You just have to realize that you're on your way to dying the moment your parents made you. At the moment medicine can only slow the process so don't stress too much.
- epmaybe 9y ago
  Lots of medical students have illness anxiety while in medical school. So far it hasn't bothered me too much, but I have friends that are on medication because of how stressed they would get thinking they had symptoms pertaining to diseases. I can relate my only illness anxiety experience though: I had some lab tests done for autoimmune diseases, and came back negative for everything except a liver antibody test. The disease that the test is specific for has initial symptoms of fatigue and itching. You can imagine how most students have some amount of fatigue, and I must have had some contact dermatitis from something else giving me an itching sensation. There was a week long period where I thought my life was going to revolve around when I'd get a liver transplant.
rosser 9y ago
What ever happened to the point-of-care test developed by a teenager (Jack Andraka) using CNTs to isolate and test for mesothelin, a potential biomarker for pancreatic cancer? EDIT: Looks like it's tied up in various patent and testing limbos, the former of which seem somewhat self-imposed. There's also some doubt about the specificity of mesothelin to pancreatic cancer.
- msie 9y ago
  Ugh, I wonder how we ever make any process nowadays.
- lazerpants 9y ago
  The most promising early warning tests I've seen in the past few years look at degraded DNA fragments floating in the blood that have been shed by cancers. This will probably be the winning technology for all cancer early diagnoses, though genetic biomarkers will probably fail to catch all cancers.
  - gms7777 9y ago
    Circulating tumor DNA has several challenges towards being an effective test. The first is just the relatively low proportion of it in the blood (especially before growth is significant) makes reliable detection fairly difficult. The bigger issue though will likely be managing the false discovery rate. Nearly everyone will have precancerous growths and benign lesions which may share many genetic biomarkers with potentially malignant growths. Many genetic variants associated with cancers occur years or decades before the development of a tumor. It may be difficult to develop a test that doesn't have a difficult tradeoff between sensitivity and specificity, prior to significant tumor growth. I do think its a promising approach, however, and look forward to see the progress researchers make in the coming years. Relatedly, circulating tumor DNA is not only useful in diagnosis, but its already proving to be useful in the treatment of cancer. Its much less invasive than surgical biopsy, and as a result, clinicians can track the evolution of the tumor, response to specific treatments, and development of resistance in way that was just never possible before.
creepydata 9y ago
The most important thing you can do today to prevent pancreatic cancer is.... believe it or not, don't smoke. Smoking causes somewhere around 30% or so cases of pancreatic cancers.
- melling 9y ago
  What about the other 70% chance? We really need early detection. The list of famous people that I've heard of who died from pancrer cancer keeps growing: Randy Pausch - Last Lecture Steve Jobs Patrick Swayze Sally Ride - astronaut Piers Sellers - astronaut Hans Rosling Richard Hatch
  - knodi123 9y ago
    Although to be fair, if it weren't for his pancreatic cancer, Randy Pausch wouldn't really be famous.
  - creepydata 9y ago
    And? Where did I say anything about not needing early detection(1) or anything negative at all? I'm giving actionable advice that you can follow right now at this very moment until we have other methods of prevention. That's what we got and it's easy to implement(2) and mildly effective. (1) Though that's another can of worms considering there's cases where routine screening of asymptomatic individuals at low-to-average risk of a disease can actually do more harm than good, but that's another topic. Screening certainly can also be beneficial too, I'm not hating on it as a concept. (2) Provided you aren't already a smoker. If you are, it can be difficult to quit, obviously.
    - posterboy 9y ago
      > If you are [a smoker], it can be difficult to quit, obviously Stop telling people that.
    - melling 9y ago
      Yes, not smoking helps with all sorts of cancers, heart disease, strokes, etc. We don't all know that by now? An awful lot of healthy people get cancer. The current belief is that a lot of cancers are just "bad luck": https://www.scientificamerican.com/article/most-cancer-cases-arise-from-bad-luck/ https://www.scientificamerican.com/article/most-cancer-cases...
fixermark 9y ago
Precisely. It's that "metastatic before symptoms appear" part that gets you. Pancreatic cancer doesn't generally compromise the pancreas before it metastasizes and compromises something else. That's the worst thing about that one; the first self-identifiable symptom is usually "My stomach is upset (because this thing has already grown past the borders of the pancreas and is now playing general hell with the abdominal cavity)."
melling 9y ago
What you are saying doesn't make sense: "the disease spreads quickly once detected ". From the article, it appears that the disease is active in your body a long time before it's detected. It's just at a very late stage before it's detected. "Because it can take 20 years or more for precancerous cells to develop into full-blown pancreatic cancer"
- jessriedel 9y ago
  "The disease is spreading quickly by the time it's detected" would be more clear, but my statement is technically correct as written.
  - melling 9y ago
    This rate of change thing you are implying doesn't really exist, right? Can you provide a reference? Once the cancer has spread outside the pancreas to other organs then it becomes more easily detectable, and symptoms show. By then it's throughout your body and you can't easily remove it. Here's some better information on the topic: https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/signs-and-symptoms.html https://www.cancer.org/cancer/pancreatic-cancer/detection-di...
gilbetron 9y ago
9 years ago a good friend of ours told us he had pancreatic cancer, but he hadn't yet looked into the details of the disease. The look on my face told him it was bad. Turned out to be Islet Cell (the same type that Jobs had), and they were able to catch it in time. He's one of the extremely rare to actually have been cured of it - and I still don't think he ever really researched the disease and doesn't really count himself one of the "real" cancer survivors. I had Thyroid cancer at the same time and he was more worried about me ;)
johapers 9y ago
A quite interesting Swedish company that uses immune system biomarkers for early detection http://immunovia.com/ http://immunovia.com/ They use these biomarker together with a statistical algorithm to find very high specificity and sensitivity at the same time.
odiroot 9y ago
Yes, this kind of cancer is brutally fast. My father died less than a year from the diagnosis. The only real symptoms appeared 2-3 months before doctors even considered cancer. The tumor was sneakily sandwiched between different organs, on the tail of pancreas. As far as I know (from Polish oncologists) it was basically undetectable early enough to fight successfully. And it was probably developing for 15-20 years before. I would really love to be able to easily check my pancreas for any unhealthy changes as the inherited risk is pretty high.
- petercooper 9y ago
  I would really love to be able to easily check my pancreas for any unhealthy changes as the inherited risk is pretty high. That sounds good, but it would be necessary to do this in a way where problems with only a low risk would not be highlighted. For example, to avoid a brain aneurysm, you might opt to be scanned on a frequent basis. Except what happens if they find a blood vessel with a 1% annual chance of rupture but the fatality rate of an operation to reduce the risk is, say, 10%? This places most people into a very difficult situation where the difficulty of having a 1% annual risk of rupture is hard to balance against the 10% chance. This is just one reason why proactive screening is not done in otherwise healthy subjects.
  - nerdponx 9y ago
    That doesn't make sense to me. What if that 1% chance suddenly turns into a 50% chance? If I suddenly present with symptoms of a risky aneurism, wouldn't having that "1% chance, last we checked" on my medical history help accelerate the correct diagnosis and treatment?
    - petercooper 9y ago
      That's a great point, but then someone might be so panicked they take the more dangerous "fix" than just sit out the risk. I know I would totally obsess over it if I knew about that minor risk, for example. But this is why everyone should get the option, perhaps.

gthtjtkt 9y ago

Every time I read about something like this, I wonder how people can make it through medical school without dying of anxiety. So many terminal illnesses that could already be killing you with no early warning signs... how can they sleep!?

wodencafe 9y ago
The anxiety is killing me without being in medical school. Cancer is the worst.
fixermark 9y ago
It helps to acknowledge the fact that you are constantly dying from something. Everyone's time is finite, and there's very little benefit in chasing the tail of the "If only I'd known about X" dragon, because there will always eventually be an X you don't know about that gets you. (... at least until we perfect the longevity treatments ;) ).
- louithethrid 9y ago
  Newsflash: First Immortal killed by car during victory dance on the street
rscho 9y ago
Medical school makes you dead inside, which is very practical to work long hours and not worrying about dying on the outside :) As a European working in the US medical system, my general impression is that US people fear death much more than in Europe, where people bother much more about suffering than dying in itself. I don't really understand why, but americans seem in my experience far more willing to undergo invasive procedures to live longer, even if it means bad quality life.
- killjoywashere 9y ago
  We tend to interpret suffering as virtue. Even PG advises faced with a choice, doing what sucks more is probably the right answer.
- arwhatever 9y ago
  All the better to politically motivated is with :-)
arkh 9y ago
You just have to realize that you're on your way to dying the moment your parents made you. At the moment medicine can only slow the process so don't stress too much.
epmaybe 9y ago
Lots of medical students have illness anxiety while in medical school. So far it hasn't bothered me too much, but I have friends that are on medication because of how stressed they would get thinking they had symptoms pertaining to diseases. I can relate my only illness anxiety experience though: I had some lab tests done for autoimmune diseases, and came back negative for everything except a liver antibody test. The disease that the test is specific for has initial symptoms of fatigue and itching. You can imagine how most students have some amount of fatigue, and I must have had some contact dermatitis from something else giving me an itching sensation. There was a week long period where I thought my life was going to revolve around when I'd get a liver transplant.

rosser 9y ago

What ever happened to the point-of-care test developed by a teenager (Jack Andraka) using CNTs to isolate and test for mesothelin, a potential biomarker for pancreatic cancer? EDIT: Looks like it's tied up in various patent and testing limbos, the former of which seem somewhat self-imposed. There's also some doubt about the specificity of mesothelin to pancreatic cancer.

msie 9y ago
Ugh, I wonder how we ever make any process nowadays.
lazerpants 9y ago
The most promising early warning tests I've seen in the past few years look at degraded DNA fragments floating in the blood that have been shed by cancers. This will probably be the winning technology for all cancer early diagnoses, though genetic biomarkers will probably fail to catch all cancers.
- gms7777 9y ago
  Circulating tumor DNA has several challenges towards being an effective test. The first is just the relatively low proportion of it in the blood (especially before growth is significant) makes reliable detection fairly difficult. The bigger issue though will likely be managing the false discovery rate. Nearly everyone will have precancerous growths and benign lesions which may share many genetic biomarkers with potentially malignant growths. Many genetic variants associated with cancers occur years or decades before the development of a tumor. It may be difficult to develop a test that doesn't have a difficult tradeoff between sensitivity and specificity, prior to significant tumor growth. I do think its a promising approach, however, and look forward to see the progress researchers make in the coming years. Relatedly, circulating tumor DNA is not only useful in diagnosis, but its already proving to be useful in the treatment of cancer. Its much less invasive than surgical biopsy, and as a result, clinicians can track the evolution of the tumor, response to specific treatments, and development of resistance in way that was just never possible before.

creepydata 9y ago

The most important thing you can do today to prevent pancreatic cancer is.... believe it or not, don't smoke. Smoking causes somewhere around 30% or so cases of pancreatic cancers.

melling 9y ago
What about the other 70% chance? We really need early detection. The list of famous people that I've heard of who died from pancrer cancer keeps growing: Randy Pausch - Last Lecture Steve Jobs Patrick Swayze Sally Ride - astronaut Piers Sellers - astronaut Hans Rosling Richard Hatch
- knodi123 9y ago
  Although to be fair, if it weren't for his pancreatic cancer, Randy Pausch wouldn't really be famous.
- creepydata 9y ago
  And? Where did I say anything about not needing early detection(1) or anything negative at all? I'm giving actionable advice that you can follow right now at this very moment until we have other methods of prevention. That's what we got and it's easy to implement(2) and mildly effective. (1) Though that's another can of worms considering there's cases where routine screening of asymptomatic individuals at low-to-average risk of a disease can actually do more harm than good, but that's another topic. Screening certainly can also be beneficial too, I'm not hating on it as a concept. (2) Provided you aren't already a smoker. If you are, it can be difficult to quit, obviously.
  - posterboy 9y ago
    > If you are [a smoker], it can be difficult to quit, obviously Stop telling people that.
  - melling 9y ago
    Yes, not smoking helps with all sorts of cancers, heart disease, strokes, etc. We don't all know that by now? An awful lot of healthy people get cancer. The current belief is that a lot of cancers are just "bad luck": https://www.scientificamerican.com/article/most-cancer-cases-arise-from-bad-luck/ https://www.scientificamerican.com/article/most-cancer-cases...

fixermark 9y ago

Precisely. It's that "metastatic before symptoms appear" part that gets you. Pancreatic cancer doesn't generally compromise the pancreas before it metastasizes and compromises something else. That's the worst thing about that one; the first self-identifiable symptom is usually "My stomach is upset (because this thing has already grown past the borders of the pancreas and is now playing general hell with the abdominal cavity)."

melling 9y ago

What you are saying doesn't make sense: "the disease spreads quickly once detected ". From the article, it appears that the disease is active in your body a long time before it's detected. It's just at a very late stage before it's detected. "Because it can take 20 years or more for precancerous cells to develop into full-blown pancreatic cancer"

jessriedel 9y ago
"The disease is spreading quickly by the time it's detected" would be more clear, but my statement is technically correct as written.
- melling 9y ago
  This rate of change thing you are implying doesn't really exist, right? Can you provide a reference? Once the cancer has spread outside the pancreas to other organs then it becomes more easily detectable, and symptoms show. By then it's throughout your body and you can't easily remove it. Here's some better information on the topic: https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/signs-and-symptoms.html https://www.cancer.org/cancer/pancreatic-cancer/detection-di...

gilbetron 9y ago

9 years ago a good friend of ours told us he had pancreatic cancer, but he hadn't yet looked into the details of the disease. The look on my face told him it was bad. Turned out to be Islet Cell (the same type that Jobs had), and they were able to catch it in time. He's one of the extremely rare to actually have been cured of it - and I still don't think he ever really researched the disease and doesn't really count himself one of the "real" cancer survivors. I had Thyroid cancer at the same time and he was more worried about me ;)

johapers 9y ago

A quite interesting Swedish company that uses immune system biomarkers for early detection http://immunovia.com/ http://immunovia.com/ They use these biomarker together with a statistical algorithm to find very high specificity and sensitivity at the same time.

odiroot 9y ago

Yes, this kind of cancer is brutally fast. My father died less than a year from the diagnosis. The only real symptoms appeared 2-3 months before doctors even considered cancer. The tumor was sneakily sandwiched between different organs, on the tail of pancreas. As far as I know (from Polish oncologists) it was basically undetectable early enough to fight successfully. And it was probably developing for 15-20 years before. I would really love to be able to easily check my pancreas for any unhealthy changes as the inherited risk is pretty high.

petercooper 9y ago
I would really love to be able to easily check my pancreas for any unhealthy changes as the inherited risk is pretty high. That sounds good, but it would be necessary to do this in a way where problems with only a low risk would not be highlighted. For example, to avoid a brain aneurysm, you might opt to be scanned on a frequent basis. Except what happens if they find a blood vessel with a 1% annual chance of rupture but the fatality rate of an operation to reduce the risk is, say, 10%? This places most people into a very difficult situation where the difficulty of having a 1% annual risk of rupture is hard to balance against the 10% chance. This is just one reason why proactive screening is not done in otherwise healthy subjects.
- nerdponx 9y ago
  That doesn't make sense to me. What if that 1% chance suddenly turns into a 50% chance? If I suddenly present with symptoms of a risky aneurism, wouldn't having that "1% chance, last we checked" on my medical history help accelerate the correct diagnosis and treatment?
  - petercooper 9y ago
    That's a great point, but then someone might be so panicked they take the more dangerous "fix" than just sit out the risk. I know I would totally obsess over it if I knew about that minor risk, for example. But this is why everyone should get the option, perhaps.