4 ms·

Pancreatic cancer (and other abdominal-area cancers like stomach, gallbladder, etc) are notoriously hard to find and diagnose because they're almost completely

Pancreatic cancer (and other abdominal-area cancers like stomach, gallbladder, etc) are notoriously hard to find and diagnose because they're almost completely asymptomatic. Once we see the cancer, it's in a place where it's noticeable like the lungs at which point it's in later stage metastasis. Unfortunately there's not necessarily a cure that just needs more money. And enhanced screening has been a total dead end.

melling 6y ago
Sounds like it’s an impossible problem. I remember people saying AIDS was impossible to treat. It took less than 10 years to find a treatment. I’m in the camp that believes we will eventually find a solution sooner or later. I was hoping for sooner.
- selectodude 6y ago
  I'd like to hope that nothing is impossible but a cure for abdominal cancers is going to be one of the last cancers we figure out. They're basically perfect as far as being difficult to kill.
- toomuchtodo 6y ago
  It takes about a year for pancreatic cancer to go from stage one to stage four. With improved biomarker detection in biannual blood tests, I think we’d make a lot of headway to earlier detection, with CRISPR for (more effective) immunotherapy treatment (vs surgery and chemo). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813368/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813368/
  - selectodude 6y ago
    Easier said than done, unfortunately. https://www.targetedonc.com/view/challenges-persist-with-car-tcell-therapy-in-pancreatic-cancer https://www.targetedonc.com/view/challenges-persist-with-car...
    - melling 6y ago
      I don’t think anyone is saying it’s going to be easy. I simply wish we would have more of a “can do” attitude rather than “it’s a really hard problem. There’s nothing more we can do“
      - iancmceachern 6y ago
        I also will miss him. He and Jeopardy were a fixture in our home, and life. What a great human. I'm willing to work on this. I have lots of relevant experience, and a can do attitude. I've tackled (mostly successfully) similar challenges like artificial hearts, dialysis, AI and surgical robots. Coincidentally I'm giving a talk on making an artificial heart in 45 mins at the hackaday remoticon: https://www.eventbrite.com/e/remoticon-tickets-115886905855 https://www.eventbrite.com/e/remoticon-tickets-115886905855 I'm confident we could solve this problem. Lets do it.
        panabee 6y ago
        1. how do we match talented people like you with organizations who could use help? 2. how can we model medicine to be more like open-source, where talented individuals can contribute in surgical ways, in case they can't afford to quit their jobs and focus on healthcare 100%?
  - mlyle 6y ago
    Maybe. But earlier detection isn't the panacea that we thought it might be in cancer. The problem is--- staging isn't independent of the cancer's aggressiveness. If you detect a cancer at stage 2, it may be "earlier" detection, or it may be a much less aggressive cancer than one that would have reached stage 4 by the same point.
- mensetmanusman 6y ago
  ~ 1 million people a year die of HIV/AIDS... It is endemic, which is why we don’t have a global lockdown for it, but it is still there killing about the same number of people as automobiles.
dmurray 6y ago
What are the problems with earlier stage screening? Without knowing much about pancreatic cancer screening in particular, it sounds like it might be one of those screenings that aren't recommended "because of the risk of false positives", which is a failure of the medical system rather than a deficiency in the medical technology. Some cancer screenings aren't recommended below whatever age because if you have a false positive test, it may lead to worse outcomes due to anxiety, low trust in future tests, or large costs and risks from additional more invasive tests the doctors feel they have to recommend [0]. The medium term solution should be better education and cleverer processes for recommending the invasive tests - if the false positive risk is high, maybe just make sure they get screened again every year - but instead it's just to stop the screening. Pick your own narrative about whether the root cause here is poor application of medical ethics, fear of malpractice cases, or the principal/agent problem in health insurance. Having less information should never be advantageous. And if the benefits are marginal, doing millions of screens "for real" incentivizes improving the process far more then when it's just a research problem. Is early diagnosis of pancreatic cancer something like this that needs to be fixed in the "system" or just something we don't have the technology to do? [0] https://www.sciencedaily.com/releases/2004/12/041220002224.htm https://www.sciencedaily.com/releases/2004/12/041220002224.h... - I'm sure there are better resources but just one paper about how early screening can be "bad" even if it's free.
- selectodude 6y ago
  > What are the problems with earlier stage screening? It's not false positives that are the issue. It's the huge number of false negatives. The standard biomarker we look for is only present in 70 percent of people with the cancer. Furthermore, only 5 percent of the people who present with CA 19-9 even have pancreatic cancer to begin with since it also presents with almost any other gut issue. >which is a failure of the medical system rather than a deficiency in the medical technology. The technology that we have to actually find pancreatic cancer is an endoscopy which is going to find a whole lot of stuff. 5 percent of the issues present on your pancreas are pancreatic cancer. >Is early diagnosis of pancreatic cancer something like this that needs to be fixed in the "system" or just something we don't have the technology to do? We simply don't have the technology. Below is a link with a bunch of statistics showing just how devilishly hard pancreatic cancer is to find before metastasis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113008/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113008/

melling 6y ago

Sounds like it’s an impossible problem. I remember people saying AIDS was impossible to treat. It took less than 10 years to find a treatment. I’m in the camp that believes we will eventually find a solution sooner or later. I was hoping for sooner.

selectodude 6y ago
I'd like to hope that nothing is impossible but a cure for abdominal cancers is going to be one of the last cancers we figure out. They're basically perfect as far as being difficult to kill.
toomuchtodo 6y ago
It takes about a year for pancreatic cancer to go from stage one to stage four. With improved biomarker detection in biannual blood tests, I think we’d make a lot of headway to earlier detection, with CRISPR for (more effective) immunotherapy treatment (vs surgery and chemo). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813368/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813368/
- selectodude 6y ago
  Easier said than done, unfortunately. https://www.targetedonc.com/view/challenges-persist-with-car-tcell-therapy-in-pancreatic-cancer https://www.targetedonc.com/view/challenges-persist-with-car...
  - melling 6y ago
    I don’t think anyone is saying it’s going to be easy. I simply wish we would have more of a “can do” attitude rather than “it’s a really hard problem. There’s nothing more we can do“
    - iancmceachern 6y ago
      I also will miss him. He and Jeopardy were a fixture in our home, and life. What a great human. I'm willing to work on this. I have lots of relevant experience, and a can do attitude. I've tackled (mostly successfully) similar challenges like artificial hearts, dialysis, AI and surgical robots. Coincidentally I'm giving a talk on making an artificial heart in 45 mins at the hackaday remoticon: https://www.eventbrite.com/e/remoticon-tickets-115886905855 https://www.eventbrite.com/e/remoticon-tickets-115886905855 I'm confident we could solve this problem. Lets do it.
      - panabee 6y ago
        1. how do we match talented people like you with organizations who could use help? 2. how can we model medicine to be more like open-source, where talented individuals can contribute in surgical ways, in case they can't afford to quit their jobs and focus on healthcare 100%?
- mlyle 6y ago
  Maybe. But earlier detection isn't the panacea that we thought it might be in cancer. The problem is--- staging isn't independent of the cancer's aggressiveness. If you detect a cancer at stage 2, it may be "earlier" detection, or it may be a much less aggressive cancer than one that would have reached stage 4 by the same point.
mensetmanusman 6y ago
~ 1 million people a year die of HIV/AIDS... It is endemic, which is why we don’t have a global lockdown for it, but it is still there killing about the same number of people as automobiles.

dmurray 6y ago

What are the problems with earlier stage screening? Without knowing much about pancreatic cancer screening in particular, it sounds like it might be one of those screenings that aren't recommended "because of the risk of false positives", which is a failure of the medical system rather than a deficiency in the medical technology. Some cancer screenings aren't recommended below whatever age because if you have a false positive test, it may lead to worse outcomes due to anxiety, low trust in future tests, or large costs and risks from additional more invasive tests the doctors feel they have to recommend [0]. The medium term solution should be better education and cleverer processes for recommending the invasive tests - if the false positive risk is high, maybe just make sure they get screened again every year - but instead it's just to stop the screening. Pick your own narrative about whether the root cause here is poor application of medical ethics, fear of malpractice cases, or the principal/agent problem in health insurance. Having less information should never be advantageous. And if the benefits are marginal, doing millions of screens "for real" incentivizes improving the process far more then when it's just a research problem. Is early diagnosis of pancreatic cancer something like this that needs to be fixed in the "system" or just something we don't have the technology to do? [0] https://www.sciencedaily.com/releases/2004/12/041220002224.htm https://www.sciencedaily.com/releases/2004/12/041220002224.h... - I'm sure there are better resources but just one paper about how early screening can be "bad" even if it's free.

selectodude 6y ago
> What are the problems with earlier stage screening? It's not false positives that are the issue. It's the huge number of false negatives. The standard biomarker we look for is only present in 70 percent of people with the cancer. Furthermore, only 5 percent of the people who present with CA 19-9 even have pancreatic cancer to begin with since it also presents with almost any other gut issue. >which is a failure of the medical system rather than a deficiency in the medical technology. The technology that we have to actually find pancreatic cancer is an endoscopy which is going to find a whole lot of stuff. 5 percent of the issues present on your pancreas are pancreatic cancer. >Is early diagnosis of pancreatic cancer something like this that needs to be fixed in the "system" or just something we don't have the technology to do? We simply don't have the technology. Below is a link with a bunch of statistics showing just how devilishly hard pancreatic cancer is to find before metastasis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113008/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113008/