Ground-breaking research finds key to early diagnosis of 'deadly' form of cancer

SCIENTISTS in Spain may have found the key to early detection of a type of cancer which is rarely diagnosed until it is too late.

Pancreatic cancer is one of a number of strains known as a 'silent killer', since it is largely without symptoms until it is at a very advanced stage – typically stage four, which is incurable, meaning treatment will, at best, be about prolonging life by a few months or, at best, years, but is often too advanced for anything other than palliative care.

Now, though, a three-year research project by Barcelona's Hospital del Mar (pictured above) and the Barcelona Bio-Medical Research Institute (IIBB), part of Spain's National Research Council (CSIC), has identified a tumour marker present in 90% of pancreatic cancer cases.

Specific to pancreatic cancer, even early-stage

The third cause of cancer death in developed countries, with 8,700 cases diagnosed in Spain in 2021, the vast majority are known as 'pancreatic ductal adenocarcinoma', explains Dr Pilar Navarro, team coordinator.

For the remaining 10%, the types found are so vast and varied that they continue to be rare in themselves, meaning effective research has not, as yet, been carried out.

And these are not as aggressive as the other 90%, meaning they are often more curable.

Until now, blood tests have been carried out to detect the tumour marker CA19-9, but its presence does not necessarily mean cancer – it also shows up in the case of pancreatitis, a health condition which is unpleasant, but treatable.

The latest discovery, though, is a protein called AXL Tirosine-Quinase, which shows up on a blood test in pancreatic cancer, from the earliest stage, but is not present with pancreatitis or any other illnesses affecting the organ.

Also, says senior researcher Dr Pablo García de Frutos, the AXL protein is not present in all types of cancer, meaning it is easier to narrow its presence down to specific strains of the disease.

Finding out why it is not involved in all tumour cells means honing treatment targets, and working out how cancerous cell mechanisms work, Dr García de Frutos explains.

Only two in 10 have a chance of a cure

According to Pilar Navarro: “Many patients with pancreatic cancer are not diagnosed until a very advanced stage, meaning surgery is not possible as the tumour has spread too far. We're talking about only around 20% of patients who can even have surgery, which is the only possible cure.

“In all other cases, drug treatment [such as chemotherapy] can extend the patient's life, but the only way we can actually cure pancreatic cancer is if we get to it in time to operate.”

Samples from 200 patients with chronic pancreatitis or pancreatic cancer were used – from 59 patients at the Hospital del Mar, and later, from 142 being treated at Barcelona's Hospital Clínic.

A third set of samples came from those with pancreatic cancer who have a family history of the disease, and a fourth from mice.

Models included in-vitro analysis of human tumour cells – examining them in test tubes – and the result was that the AXL protein was absent in pancreatitis and in healthy individuals, only showing up in those with the type of pancreatic cancer which affects nine in 10 of those diagnosed.

'Low-cost' testing: Could be routine for whole population above a certain age

Within a year, Dr Navarro says, research will have advanced enough that the AXL marker could be used in clinical settings – through blood tests to detect its presence.

Doing so would come at 'very little cost' to the health service, compared with other forms of diagnosing cancer, she explains, as it would simply be another value to add to those being tested for in a routine blood sample.

Although the IIBB and Hospital del Mar appear to have done the spade-work, Dr Navarro says the hardest bit is putting it into practice – if late diagnosis is already the norm due to the condition being asymptomatic, testing for the AXL protein may not be carried out in time.

“It's now a question of health service policies – the State would have to perform a cost-benefit analysis, but we think this will prove to have more benefits than costs, as there's very little expense involved,” she says.

This means, in theory, it might just become part of routine blood tests, which local GP practices like to perform at least once a year on the entire population, even healthy ones.

If not, the AXL could be tested for as standard in people who have ever had a blood relative with pancreatic cancer, people with diabetes – Type I and Type II – or who have had, or still have, pancreatitis, among other situations.

Otherwise, it might be tested for as standard, suggests Dr Navarro, in all patients, even healthy ones, upwards of a certain age, in the same way as the population as a whole is tested for breast and prostate cancer from around age 45 and for bowel cancer from approximately 55, using screening methods that can detect them early or, in the case of the latter, even prevent them.