Pancreatic cancer, the four blood tests that help early diagnosis and improve prognosis

Two previously explored blood biomarkers were initially identified for this use, carcinoembryonic antigen19-9 (CA19-9), used to monitor response to treatment in pancreatic cancer patients (unfortunately, this is not an accurate specific test, as values can also be elevated in the presence of other pancreatic and biliary diseases), and thrombospondin 2 (THBS2), a glycoprotein used as a diagnostic marker for this tumour form but not only, as it is also a potential indicator of liver fibrosis. And it is at this point that the quadri-test is born. By studying blood samples, two new potential biomarkers were identified.

These are proteins that have elevated values in individuals with early-stage pancreatic cancer, compared to healthy volunteers. Their names? Aminopeptidase N or ANPEP (exerts various functions in the body and on the oncological front can result in various tumour forms, with action on cell migration and thus the spread of neoplastic cells as well as the formation of new blood cases, i.e. angiogenesis) and another protein, defined by the acronym PIGr, which stands for polymeric immunoglobulin receptor.

The investigation by the American scholars, coordinated by Kenneth Zaret, shows how combining these four values together in a single panel resulted in pancreatic cancer being recognised in comparison to healthy organs in more than nine out of ten cases (91.9% of cases for all stages combined), with 5% false positives in subjects who did not have the disease. Not only that.

In recognising the tumour at an early stage, the combined test identified the pathology in 87.5% of cases. In short: there is hope of arriving earlier with a correct diagnosis, also considering that the 'quadritest' correctly distinguished cancer patients from both healthy individuals and those with non-cancerous pancreatic diseases, such as pancreatitis.

Zaret's comment in the NIH note is clear: we have not yet reached the solution, but a step forward has been taken. 'The results of our retrospective study justify further testing in larger populations, particularly in people before they show symptoms,' is the expert's opinion. Such 'prediagnostic' studies would help determine whether the test could be used as a screening tool for people at high risk of developing the disease based on family history, genetic screening results, or personal history of pancreatic cysts or pancreatitis'.

Although the number of people alive after being diagnosed with pancreatic cancer is increasing in Italy, this disease remains one of the most complex to deal with. And although research is moving forward, there is still no decrease in the number of cases, which will be 13,585 (6,873 are men and 6,712 women) in our country in 2024.

Above all, in only about 20 per cent of patients is the pathology detected when it is still localised and surgical excision is possible, with a greater chance of survival.

Pancreatic ductal adenocarcinoma is the most common and aggressive form of the disease. It affects mainly (but not only) elderly people and unfortunately tends to recur locally and give distant localisations.