Respirology | APSR Respiratory Medicine Journal
Know The Symptoms: Pancreatic Cancer
This year, approximately 1,000 Alabama residents will be diagnosed with pancreatic cancer. With a trending increase in cases for patients under the age of 55, experts at the University of Alabama at Birmingham Department of Surgery say it is important for individuals to familiarize themselves with common signs and symptoms associated with pancreatic cancer to reduce their risk and identify key indicators of the disease.
"Pancreatic cancer is known for its reputation of being harder to detect in its earliest stages," said J. Bart Rose, M.D., an associate professor in the UAB Division of Surgical Oncology. "Fortunately, there are still several ways you can reduce your chances of pancreatic-related illness and monitor your overall well-being for any sudden changes."
Lifestyle changesThe pancreas is a vital organ to both the endocrine and digestive systems. It produces insulin, which plays a major role in the regulation of blood sugar and creates enzymes that aid in the breakdown of food.
There are several ways one can increase their health and reduce the strain put on their pancreas through diet and wellness modifications. There are several ways one can increase their health and reduce the strain put on their pancreas through diet and wellness modifications:
Listen to the bodyIf an individual experiences any of the following sudden changes, they should make a note of the onset of symptoms and contact their primary care provider:
Pancreatic care"If an individual has had these symptoms or been recently diagnosed with a pancreatic disorder, they can speak to their current provider about being referred to UAB's Pancreatobiliary Disease Center," said Rose, who serves as the director of the center.
The PDC is the first multidisciplinary program in the state to treat diseases of both the pancreas and bile ducts. Together with local medical providers, members of the center will create a care plan that maximizes the treatment patients can receive close to home, while providing access to clinical trials, personalized treatment plans and comprehensive care.
NTUH Unveils AI Tool For Early Cancer Detection
By Lin Chih-yi and Jonathan Chin / Staff reporter, with staff writer
National Taiwan University Hospital (NTUH) has developed an artificial intelligence (AI) tool capable of detecting pancreatic tumors smaller than 2cm, potentially increasing patients' five-year survival rate to 80 percent.
In a news release yesterday, the hospital said its launch of the technology, named PANCREASaver, late last year represents a major breakthrough in the early detection and treatment of pancreatic cancer.
Pancreatic tumors are among the deadliest cancers due to their typically asymptomatic onset, difficulty in early detection and rapid progression, NTUH radiologist Chen Po-ting (陳柏廷) told a news conference in Taipei.
Photo: Lin Chih-yi, Taipei Times
Globally, about 90 percent of people diagnosed with pancreatic cancer die from the disease, he added.
Only 2 to 3 percent of people with pancreatic cancer are fortunate enough to be diagnosed when their tumor is smaller than 2cm, and just 10 to 15 percent are diagnosed while the tumor remains operable, although even then, the risk of recurrence remains high, he said.
About 80 percent of patients are diagnosed only after the tumor has progressed to an inoperable stage, he added.
While early detection of tumors smaller than 2cm is critical for improving the chances of survival, identifying them through medical imaging is difficult with the naked eye, he said.
"With the sheer amount of images doctors have to process on a daily basis, [finding a small tumor] is like looking for a needle at the bottom of the ocean," Chen said.
Clinical trials showed that PANCREASaver achieved an 86.4 percent success rate in detecting pancreatic tumors smaller than 2cm, and a 93.4 percent success rate for pancreatic tumor detection overall, he said.
Testing conducted by the Ministry of Health and Welfare using archived medical images found the system had a 74.4 percent success rate, he added.
The AI-powered system can analyze medical images and highlight suspicious regions for radiologists to review, completing the process within two minutes, Chen said.
In the past, physicians often had no choice but to passively observe people suspected of having pancreatic tumors, which could prove deadly, as tumors can grow beyond 2cm in just three months, said Liao Wei-chi (廖偉智), director of the hospital's integrated diagnosis and therapeutics department.
PANCREASaver has obtained four patents in Taiwan and the US, and research on the technology has been published in Lancet Digital Health and other leading medical journals, he added.
The technology allows people to receive a diagnosis within a week, but it is not suitable for people with stents, other metal implants or a history of prior surgeries, said Chen Shyh-jye (陳世杰), director of the hospital's Medical Imaging Technology Department.
PANCREASaver is available at the hospital as a self-paid image analysis service.
Pancreatic, Colorectal Cancer Incidence Rising Fastest Among Younger Individuals
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Key takeaways:Cases of pancreatic cancer have increased significantly among younger individuals compared with those aged 35 years and older during the past 2-plus decades, according to results of a retrospective study published in JAMA Network Open.
The annual rate of diagnoses in patients aged 15 to 34 years rose more than 4% from 2000 to 2021, findings showed.
Arvind J. Trindade
"It's really important that clinicians are aware of this trend ," Arvind J. Trindade, MD, FACG, FASGE, co-chief of endoscopy at Robert Wood Johnson University Hospital at Rutgers Health and vice president of gastrointestinal clinical operations for RWJBarnabas Health System-Southern Region, told Healio. "It's important that when they're examining younger individuals with abdominal pain and red-flag symptoms that they're aware of this study, they ask pertinent questions and perform the appropriate workup so that pancreatic cancer has not gone undiagnosed for too long."
'Hits home every time'Pancreatic cancer incidence has doubled in the past 25 years and has a 5-year survival rate of about 10%, according to study background.
It is the seventh leading cause of global cancer deaths.
Historically, pancreatic cancer developed in older individuals, but data over the past decade suggest an increased incidence among younger patients.
Trindade, an interventional gastroenterologist, has observed that anecdotally, as well, performing more endoscopic ultrasounds with pancreas biopsy on younger people.
"I'm 45 years old, and so it hits home every time," he said. "There's a 40-year-old or a 30-year-old that you're being sent to diagnose pancreatic cancer, and I'm like, 'Oh, my gosh' and, 'Thank my lucky stars this is not me.'"
These experiences prompted Trindade and colleagues to further investigate pancreatic and colorectal cancer trends.
They used the SEER database to evaluate pancreatic and colorectal adenocarcinoma incidence from 2000 to 2021.
The researchers identified 275,273 cases (87.1% aged 55 years and older; 51.8% men; 91.8% white) of pancreatic adenocarcinoma and 1,215,200 diagnoses (80.4% aged 55 years and older; 52.8% men; 81.1% white) of colorectal adenocarcinoma.
Annual percentage changes of pancreatic and colorectal adenocarcinoma incidence based on age served as the primary endpoint.
'That's huge'Pancreatic adenocarcinoma incidence increased among all age groups.
Most cases occurred among patients aged 55 years and older (n = 239,840), followed by those aged 35 to 54 years (n = 33,800) and those aged 15 to 34 years (n = 1,633).
However, individuals aged 15 to 34 years had a significantly higher annual percentage change (4.35%; 95% CI, 2.03%-6.73%) than those aged 35 to 54 years (1.54%; 95% CI, 1.18%-1.9%) and those aged 55 years and older (1.74%; 95% CI, 1.59%-1.89%).
"That's huge," Trindade said of the change among younger patients. "Obviously the overall incidence is going to be higher in the older age group, but the fact that the annual percentage change is dramatically increased in the younger population really tells us that we need to be paying attention to this trend."
Individuals aged 55 years and older also had the highest number of colorectal cancer diagnoses (n = 976,716), followed by those aged 35 to 54 years (n = 224,591) and those aged 15 to 34 years (n = 13,893).
The annual percentage change decreased among individuals aged 55 years and older (–3.31%; 95% CI, –3.54% to –3.08%) — a significant difference compared with increases seen among those aged 15 to 34 years (1.75%; 95% CI, 1.08%-2.42%) and those aged 35 to 54 years (0.78%; 95% CI, 0.51%-1.06%).
"That wasn't as surprising for me," Trindade said. "We decreased the interval by 5 years [on when to get screened] due to this known observation. Over the years, we've been seeing more and more 50-year-olds with higher risk polyps, so when we saw the data showing 40-year-olds, 45-year-olds may be developing high-risk lesions, polyps and early cancers, it wasn't as surprising to me."
Researchers acknowledged study limitations, including the SEER database representing less than half of the population.
'It could be a cancer'Trindade emphasized clinicians should not assume younger individuals have pancreatic cancer if they present with vague symptoms of epigastric pain, however it should be on their radar.
"I think usually we would say, 'Take antacid medication,' and if it's working, [continue]," he said. "If it's not working, try something maybe less invasive, and then go from there."
Symptoms such as weight loss, anemia, and a family history of pancreatic cancer, should indicate that a patient may need further evaluation.
"These are all things that historically you wouldn't investigate in a young individual, but now things that you want to make sure you're not missing," Trindade said. "If any of those come back as positive, then you may want to consider ordering imaging to see if there's anything brewing in the pancreas."
Future prospective research is needed to investigate risk factors associated with developing pancreatic cancer at a young age.
Additionally, Trindade noted health systems need to be equipped with tools like endoscopic ultrasound with pancreas biopsy to manage the increase among younger patients who may have pancreatic cancer or to screen high risk individuals.
"[Pancreatic cancer] has to be in our radar [for younger patients]," he said. "We have to be thinking as physicians that maybe it could be a cancer."
For more information:Arvind J. Trindade, MD, FACG, FASGE, can be reached at arvind.Trindade@gmail.Com.
Sources/DisclosuresCollapse Disclosures: Trindade reports personal fees from Boston Scientific, Exact Science and Lucid Diagnostics. Please see the study for all other authors' relevant financial disclosures.Add topic to email alerts
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