The Stealth of Pancreatic Cancer

Pancreatic cancer’s furtiveness is what makes it so deadly: Symptoms of the disease rarely emerge until it is nearly impossible to eradicate. Eight years ago, Mimi Canto, a gastroenterologist who specializes in a technique called endoscopic ultrasonography—which can detect pancreatic lesions as small as 2 millimeters—decided to find out whether that technique could act as an early warning system. Her plan would be to study people most at risk for this cancer, those with two or more diagnosed relatives, and see if she could pick up precursors to the disease.

Canto sent out a call to participants in the National Familial Pancreas Tumor Registry, established here in 1994, to ask if they wanted to be screened. She needn’t have worried. Many registrants ended up spending their own money to fly here. Now, her screening studies have shown that eight of 78 high-risk people she examined had precancerous lesions suspicious enough to warrant removal. “Compared with other screening tools,” she says, “that’s a high yield.”

Seven of the patients she identified successfully underwent surgery, offering pathologist Ralph Hruban an opportunity to study the resected tissue. “We learned,” says Canto, “that there are pancreatic cancer precursor lesions in large and small ducts that cause chronic pancreatitis. This explains why we see chronic pancreatitis-like changes during screening tests so commonly.” The study has also provided specimens for biomarker research being conducted by pathologist Michael Goggins.

“When we began,” Canto says, “we didn’t know what pancreatic precursor lesions were. Now we know what to look for so we can intervene. We offer all out-of-town patients referral to a local center of excellence or to return here for ongoing follow-up. As long as they’re being watched, they feel better about their risk.”

Mary Ann Ayd

John's Hopkins Medical Institutions unveils possible early detection device.