“Scientists search for early detection of pancreatic cancer through testing pancreatic juice”

The scientists receive help from approximately 400 people with a greatly increased risk of pancreatic cancer

Researchers at Erasmus MC will find out whether pancreatic cancer can be detected at a very early stage. They analyze the juice of the pancreas for substances that indicate the presence of a tumor, even before it is visible with ultrasound.

The scientists receive help from approximately 400 people with a greatly increased risk of pancreatic cancer. They have been closely monitored at the Erasmus MC Cancer Institute since 2006 because they are relatives of patients who have died of pancreatic cancer. About 3000 people get pancreatic cancer every year. That number is rising, partly due to poor nutrition and alcohol consumption.

Endoscopy
These 400 people receive an annual endoscopy to see what the pancreas looks like with ultrasound. ‘But if you see abnormalities in the pancreas, you’re already too late,’ says lead researcher Prof. Maikel Peppelenbosch, head of the Stomach, Bowel and Liver Laboratory. ‘We are therefore going to see whether we can find cells in the juice of the pancreas that give a reliable signal at a very early stage that a tumor has developed.’

Here’s the thing: the pancreas produces – just like the stomach and the liver – juices that are necessary for digestion. ‘The enzymes in that juice flow past the tumor and loosen tumor cells. You can then detect those tumor cells in the pancreatic juice’, Peppelenbosch explains.

Secretine
In previous small studies, his lab has already tested the method on the pancreatic juice of the aforementioned 400 relatives of cancer patients. ‘Just before the endoscopy, we give these people an injection of the hormone secretin, which is the hormone that causes the pancreas to produce its juice. During the endoscopy we collect the juice for research in the lab.’

The researchers believe that this detection method works well, but they want to prove this with the new study. ‘You can subject the juice to molecular diagnostics, but we think that there are also other markers in the juice that indicate a tumour. Lab research into these markers is much cheaper than molecular diagnostics, but of course we have to be sure that this method is just as good,’ says Peppelenbosch.

Cyst
He thinks pancreatic juice testing could also be a good way to monitor people with pancreatic cysts. ‘Those cysts come to light, for example, when people have a full body scan done. A cyst usually does no harm, only 2 percent of people develop into cancer. An operation to remove the cyst is not done quickly. That is not without risk: it is a serious procedure that kills 2 percent of patients.’

Cost effectiveness
Peppelenbosch works together with his colleagues Djuna Cahen, Gwenny Fuhler and Marco Bruno and with Inge Driesprong – de Kok and Iris Lansdorp-Vogelaar from the Department of Public Health (MGZ). MGZ will conduct research into the cost-effectiveness of the various methods to identify markers in the pancreatic juice. ‘Health insurers also only want to reimburse preventive examinations if they are cost-effective.’

Early detection of pancreatic cancer is important. Of the people who get it, only 6 percent are still alive after 5 years. The tumor usually arises in the ‘tail’ of the pancreas. If the tumor is detected early, it can be removed with surgery.

Maikel Peppelenbosch will receive almost 800,000 euros from the KWF and NWO, which will allocate a total of 4.3 million euros for all kinds of research into early detection of various types of cancer.

The MGZ department also studies the quality of life of people with an increased risk of pancreatic cancer. ‘These people often feel like they have a ticking time bomb inside them, panic as soon as they have a stomach ache. We want to know whether the new research method improves their quality of life.’

Bron: Erasmus MC / Joyce de Bruijn

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