This minimally invasive technique, called Polarization GatingSpectroscopy, will now be tested in a much larger internationalclinical trial led by the Mayo Clinic researchers. The preliminarystudy suggests it may be possible, one day, to use a less invasiveendoscope to screen patients for early development of pancreaticcancer. The findings are being highlighted in a special address by MayoClinic gastroenterologist Michael Wallace, M.D., at theinternational Digestive Disease Week 2012. The pancreas is notoriously hard to reach and see due to its verydeep location in the abdomen, surrounded by intestines. |
The studyinvestigators theorized that there may be changes in the nearby"normal appearing" tissue of the small intestine which ismuch more accessible. "No one ever thought you could detect pancreatic cancer in anarea that is somewhat remote from the pancreas, but this studysuggests it may be possible," says Dr. Wallace, the chairmanof the Division of Gastroenterology at Mayo Clinic in Florida."Although results are still preliminary, the concept ofdetection field effects of nearby cancers holds great promise forpossible early detection of pancreatic cancer." Pancreatic cancer is one of the most deadly of human tumors. It isonly curable in 5 percent of cases, and even when it is surgicallyremoved, 70 percent of patients have a recurrence that is fatal,Dr.
Wallace says. There are no ways currently to detect the cancerearly enough to cure a substantial number of patients, he says. Pancreatic cancer is now usually detected through an imaging scan,followed by an invasive biopsy. Tumors found in this way areusually at an advanced stage.
In this study, the Mayo Clinic physicians tested a light probedeveloped by their long-time collaborators at NorthwesternUniversity. The light, attached to a small fiber-optic probe known as anendoscope, measures the amount of oxygenated blood as well as thesize of blood vessels in tissue near the duct where the pancreasjoins the small intestine. Because a growing tumor requires aheightened supply of blood, normal tissue in the vicinity of thecancer reveals evidence of enlarged blood vessels and changes inthe amount of oxygen within the blood. Such "field effects" from cancer can be measured in otherareas of the GI tract, says Dr.
Wallace. "With thistechnology, others studies have shown that cancerous polyps can bedetected more than 11 inches from the polyp itself. Early studiesare evaluating if esophageal cancers can also be detectedremotely," he says. The probe acts "a bit like a metal detector that beeps fasterand louder as you get close to cancer," he says. Theresearchers are measuring within six to 10 inches of the pancreasin the small intestine immediately next to the pancreas.
Dr. Wallace and his team tested the probe on 10 patients who werelater determined to have pancreatic cancer, and on nineparticipants who did not have pancreatic cancer. They found that testing both measures -- blood vessel diameter andblood oxygenation -- detected all 10 pancreatic cancers. But theprobe was less precise (63 percent accurate) in determining whichof the healthy volunteers did not have pancreatic cancer.
"There is room for improvement in this instrument, and ourgroup is working on that," he says. "If the studiesconfirm the early results, it would make the pancreas accessible toa much simpler upper endoscope and that would be a real advance inthe treatment of pancreatic cancer." Patients now often undergo an endoscopic examination of the upperintestine to search for the cause of heartburn or stomach pain, Dr.Wallace says. An endoscopic probe could be easily outfitted toexplore for evidence of pancreatic cancer in patients at heightenedrisk, he says. Mihir Patel, M.D., a gastroenterologist who worked with Dr. Wallaceon the study, says that despite of intense research, we haven'tbeen successful in significantly improving the overall survivalassociated with pancreatic cancer in the past several decades.That's because we haven't been able to detect the cancer earlyenough.
Developing a technique to screen the patients and detectpancreatic cancer at an early stage would be a potentialbreakthrough. In our preliminary data, this technology has shown tohold similar potential. The study's co-authors include Vadim Backman, Ph.D., a professor inthe biomedical engineering department at Northwestern Universityand Hemant Roy, M.D., a gastroenterologist at NorthwesternUniversity. The study was funded by the National Institutes of Health and MayoClinic.
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