Why is early diagnosis so important?
Pancreatic cancer has the lowest 5-year survival rate of all the common cancers and is the only one to remain in single figures. Beating pancreatic cancer will involve progress on several fronts: developing new treatments, finding ways to make existing treatments more effective, and diagnosing the disease earlier, so that more people can benefit from surgery or start their treatment earlier.
If we can detect pancreatic cancer when it’s still operable and when the tumours are small and not yet spread to other organs, we could see a significant impact on patient survival. Removing tumours that are 1cm or smaller can increase 5-year survival to around 60%.
What is the UroPanc clinical study investigating?
There are around 1500 proteins naturally found in urine. The Barts Cancer Institute team, led by Professor Tatjana Crnogorac-Jurcevic, has shown that a combination of three of these proteins, if found at high levels, may signify early stage pancreatic cancer. Tanja has tested several hundred urine samples from three different groups of people: pancreatic cancer patients; patients with other diseases of the pancreas (such as chronic pancreatitis) and healthy individuals. Her biomarker test was nearly 95% accurate in detecting the possibility of early stage pancreatic cancer when measuring these three protein ‘biomarkers’. We now need to test much greater numbers of urine samples to prove that her biomarker test is accurate and reliable.
The UroPanc clinical study will now look at how well Tanja’s test performs against diagnoses made by traditional means, such as endoscopic ultrasound, MRI and CT scans. She will perform the urine biomarker test on around 3,000 urine samples collected from people who are recruited to the study.
In addition to validating the accuracy of the biomarkers in detecting early stage pancreatic cancer, there are also other important considerations to asses, such as whether this test is easy to use and cost-effective to use in a clinical setting.
Who will take part in the UroPanc study?
The study will recruit 2 groups of people.
Group 1: This group will be patients whose GPs think they might have pancreatic cancer because of the symptoms they have, and who have referred them for further investigation at one of the three partner hospitals in the UroPanc study. These hospitals are University College London Hospital, the Royal Free Hospital or the Royal London Hospital. These patients will undergo the standard investigations, scans and tests. In addition, they will have a urine sample collected for testing, and the results will ultimately be compared with the diagnosis made by the standard investigations.
Group 2: This group will be drawn from participants in the EUROPAC registry, based at the University of Liverpool. The registry includes people with a spectrum of risk for pancreatic cancer and urine samples will be collected from around 400 individuals. Some of these people are already being screened through EUROPAC, and this will allow the UroPanc researchers to compare results of screening tests to results of the urine biomarker test. Other participants may not be involved in screening but are still at higher-than-normal risk. Their involvement in UroPanc will allow the researchers to identify other added benefits of a non-invasive test.
Can anyone else take part in the UroPanc study?
Only patients referred to the partner hospitals listed and those involved in the EUROPAC registry are eligible to participate in the study.
If the clinical study confirms the accuracy of the biomarkers, will the biomarker test replace the current ways of diagnosing pancreatic cancer?
A diagnosis of pancreatic cancer is currently generally confirmed with a tissue biopsy, so the research team believe the urine biomarker test could initially be a ‘diagnostic aid’ rather than a standalone early diagnostic test. Because pancreatic cancer’s symptoms are vague, the biomarker test could be a highly useful way to help clinicians ‘rule in or rule out’ the possibility of pancreatic cancer as soon as possible in patients who have symptoms that could be caused by the disease.
The biomarker test would confirm whether or not a patient needed to have an MRI or other imaging scans, speeding up the diagnostic pathway for those whose urine tests detected early stage pancreatic cancer, and ensuring that those for whom the test was negative could avoid unnecessary, invasive tests for a disease they did not have.
Ultimately, of course, we hope that the biomarker test would be used more widely in a range of clinical settings. For now, our main focus is to find out with certainty whether it works or not to a high enough standard to be used by clinicians.
Am I at higher risk of developing pancreatic cancer if a member of my family has been diagnosed with it?
Most cases of pancreatic cancer are described as ‘sporadic’ – meaning that it is a one-off. Only around 10% of pancreatic cancer cases are known to be caused by hereditary factors. If any of the following apply to you, you can contact the EUROPAC team to discuss whether you are eligible for the EUROPAC screening programme on europac@liverpool.ac.uk
- Two or more first degree relatives (parent, sibling, offspring) who have been diagnosed with or who have died from pancreatic cancer
- Three or more relatives who have been diagnosed with or who have died from pancreatic cancer
- Families with an associated cancer syndrome and at least one case of pancreatic cancer.
This includes families with a BRCA2 mutation, Familial Atypical Multiple Mole Melanoma (FAMMM) syndrome, Hereditary Non-Polyposis Colorectal Cancer (HNPCC) and Peutz-Jeghers syndrome.