Diagnosing Pancreatic Cancer May Get Easier

Pancreatic cancer detected by measuring levels of VEGF in bile

(RxWiki News) In some cancers, doctors can have a hard time telling the difference between a cancerous tumor and a condition that's not cancer (benign). This is particularly true for pancreatic cancer. New research suggests there may be an easier and more effective way to tell.  

A small study revealed that testing the levels of a protein in bile — a digestive fluid — accurately distinguished between common bile duct problems and pancreatic cancer.

The protein scientists measured is called VEGF (vascular endothelial growth factor), which plays a role in the growth of solid tumors.

According to the authors of this study, measuring VEGF is a simple and inexpensive test that could speed the diagnosis and treatment of pancreatic cancer.

"If your skin takes on a yellowish look, see your doctor right away."

Udayakumar Navaneethan, MD, a researcher at the Cleveland Clinic, directed this study to see if VEGF levels in bile taken from the pancreas could help differentiate between pancreatic cancer and other causes of biliary stricture — a narrowing of the common bile duct which moves bile from the liver to the small intestine.

Tumors in the pancreas and common bile duct usually show up with a biliary blockage or jaundice (yellowing of the skin). Billiary obstruction can also be caused by benign conditions such as bile duct stones.

Currently, the process of distinguishing between cancer and a benign (not cancer) condition is a complicated combination of imaging tests, using a tube called an endoscope to produce ultrasound (sound wave) images, fine needle aspiration (small needle to remove tissue or fluids) and advanced technology called endoscopic retrograde cholangiopancreatography (ERCP).

Even with all this technology, some patients don’t receive a clear diagnosis.

For this study, investigators analyzed the bile VEGF levels in 53 patients who had undergone an ERCP.

The function of VEGF is to grow new blood vessels. When it’s overexpressed, VEGF helps tumors grow and spread by giving them plenty of nourishment from newly formed blood vessels.

The researchers found that patients with pancreatic cancer had significantly higher levels of VEGF than did patients with benign conditions, primary sclerosing cholangitis and cholangiocarcinoma. The test was also able to distinguish pancreatic cancer from cholangiocarcinoma with a high degree of certainty.

These findings were validated in another independent group of 18 patients and further confirmed by examining the tumor removed from a pancreatic cancer patient.

Dr. Navaneethan said in a prepared statement, “In patients with indeterminate biliary strictures, we feel that measurements of markers in bile can help identify pancreatic malignancy and plan for earlier treatment. Also in patients where tissue diagnosis cannot be obtained in spite of multiple biopsies, measurement of markers in bile fluid to improve our diagnostic ability would be of immense interest.”

He added, “We can measure VEGF in bile fluid which is an inexpensive test and confirm the presence of cancer rather than other expensive investigations.”

This research was presented at the 78th Annual Scientific Meeting of the American College of Gastroenterology (ACG).

All research is considered preliminary before it is published in a peer-reviewed journal.

Review Date: 
October 18, 2013