A new study has revealed that about 80 per cent of early staging of pancreatic cancer is inaccurate with most patients with stage one and stage two cancer upstaged after surgery.
 
The findings of the new Cedars-Sinai Cancer study published in the peer-reviewed journal JAMA underscores the urgent need for advancements in diagnostic technology and staging, which could significantly alter early pancreatic cancer treatment and research.
  
For the study, the investigators looked at data from more than 48,000 patients and based on preoperative imaging, all of the patients in the study had either stage one or stage two pancreatic cancer but the results revealed that more than 78 per cent of stage one patients and more than 29 per cent of stage two patients were upstaged, following surgery to remove their tumors.
  
While pancreatic cancer is cancer that begins in the organ lying behind the lower part of the stomach (pancreas), the researchers reported that the majority of the cases they examined were inaccurately diagnosed to a stage that includes lymph node involvement known as clusters of small immune structures and are an important factor in cancer staging, as well as also being the key difference between early-stage and later-stage pancreatic cancer.
   
One of the authors, Srinivas Gaddam, said their research revealed that staging is essential for making treatment decisions and determining research eligibility but is often inaccurate in early-stage pancreatic cancer. “As the field is racing toward earlier diagnosis, early staging will become increasingly important,” he added.
   
Gaddam noted the pancreas which is a digestive organ is located deep in the body and that the current imaging technology isn’t always able to detect smaller tumors or lymph node involvement making diagnosis and staging of pancreatic cancer difficult.
   
The professor also warned that when imaging is unable to detect lymph node involvement, staging may not reflect the true extent of the disease and patients who have lymph node involvement have a worse survival rate than those without lymph node involvement.
  
“Our findings suggest that lymph node involvement is being missed in four out of every five patients during the staging process,” he warned.
  
He continued that most patients are diagnosed at stage four, which has a five-year survival rate of three per cent unlike stage one pancreatic cancer with more than 83 per cent survival rate and advised clinicians to recognise the limitations of current imaging technology in staging pancreatic cancer and actively assess and report lymph node involvement.
   
A co-author, Prof Dan Theodorescu, said there is a tremendous need to improve outcomes for patients through leading-edge tools. He revealed that they are currently developing tests that will guide precision treatment of pancreatic and other cancers, which would be used in identifying new biomarkers for pancreatic cancer, adding that and the biomarkers would assist in the diagnosis coupled with accurate cancer staging to appropriately guide therapeutics.
  
“Pancreatic cancer screening employs MRI and endoscopic ultrasound. Screening is recommended for people with a family history of pancreatic cancer and those who carry variants in certain genes associated with the disease.
  
World Health Organisation (WHO) said the report of error in staging for pancreatic cancer couldn’t have come at a better time than now to encourage patient safety because errors can occur at any stage and can have significant consequences, “Therefore careful attention is needed to prevent incorrect, delayed or missed diagnosis, which can prolong illness, cause disability or even death.”
   
The report, released to celebrate this year’s World Patients Safety Day, focused on improving diagnosis for patient safety with the theme: “Get it right, make it safe!”
  
While correct and timely diagnosis is the first step to preventative interventions and effective treatment, WHO reported that diagnostic errors account for 16 per cent of preventable patient harm and are common in all healthcare settings.
  
According to WHO, a range of solutions are available to address diagnostic errors and encourage policymakers and healthcare leaders to foster positive workplace environments and provide quality diagnostic tools.
  
“The health workers should be encouraged to continuously develop their skills and address unconscious bias in judgment; and patients should be supported to be actively engaged throughout their diagnostic journey.”