The death of beloved Jeopardy! host Alex Trebek brings attention to a very difficult diagnosis – pancreatic cancer. As Trebek himself noted throughout his treatment, patients with pancreatic cancer can have very poor prognoses, with among the lowest survival rates for cancers (9% for all stages combined), and often endure arduous medical and surgical treatment. As with all cancers, early detection is key to improving outcomes for patients. While individual risks for pancreatic cancer vary, early detection of pancreatic cancer is challenging, due in part to its location in the body and its lack of obvious symptoms.
Sajan Nagpal, MD, Assistant Professor of Medicine at the University of Chicago Medicine Digestive Diseases Center, focuses on early detection of pancreatic cancer, and in particular, the interaction between diseases of the pancreas and later development of pancreatic cancer.
Physicians may find lesions or cysts on the pancreas, called intraductal papillary mucinous neoplasms (IPMN) during imaging diagnostics conducted for other symptoms, like abdominal pain. Some of these cysts are benign, but others can develop into pancreatic cancer. Nagpal and other scientists are conducting research to determine the criteria for differentiating these growths.
Explains Nagpal, “After we find an IPMN, the next question arises, ‘Which kind of cysts are going to turn into cancer and which kind of cysts are not going to turn into cancer?’ We use certain criteria to classify cysts as high or low risk. But the criteria we use are not perfect. We need better tools to differentiate patients and ‘risk stratify’ these cysts, categorizing them to tell us which of these cysts are going to be aggressive, and which of these cysts are going to be less aggressive.”
Working with Marc Bissonnette, MD, Associate Professor of Medicine and expert in colorectal cancer, and Chuan He, PhD, the John T. Wilson Distinguished Service Professor in the Department of Chemistry, Nagpal and team are extending the same techniques used in identifying the risk factors associated colorectal polyps to pancreatic cysts, pancreatic lesions, and chronic pancreatitis, as well as examining genetic indicators for developing pancreatic cancer. So far, factors include the size of the cyst, the cyst’s appearance in diagnostic imaging, and whether or not it has a solid focal point.
Risk stratification is important, because more intervention is not always better. Explains Nagpal, “The cost of missing the cancer always weighs heavy in the minds of the patient and the physician, but surgery has costs and complications, too—it’s major surgery, which requires a large part of the pancreas and the bowel to be removed. We want to avoid unnecessary tests and stress for the patient.”
Nagpal and the team hope the research they pursue will shed more light on pancreatic cancer. Says Nagpal, “We need good tools to risk stratify cysts—this is what ultimately helps us to save lives.”