Pancreatic Cancer

Many Pancreatic-Cancer Patients Don't Get the Test They Need

Although pancreatic cancer is one of the deadliest of all cancers, only one in five U.S. pancreatic cancer patients get a blood test that can help tailor their treatment and predict whether they will have a better or worse outcome, a Mayo Clinic study shows.

According to a news release from Mayo, people who test positive for elevated levels of a particular tumor marker tend to do worse than others. But, the researchers found, if patients with this marker have surgery and pre-operative chemotherapy, this personalized treatment sequence eliminates the elevated biomarker’s negative effect, researchers found.

The findings were presented at the Western Surgical Association’s annual meeting in early November.

“This is another argument for giving chemotherapy before surgery in all pancreatic cancer patients and ending the old practice of surgery followed by chemo,” says senior author Mark Truty, M.D., a gastrointestinal surgical oncologist at Mayo Clinic in Rochester, Minn. “The study answers an important clinical question and applies to every pancreatic cancer patient being considered for surgery.”

The Mayo study, which used the National Cancer Data Base, is the first on the subject based on national data and is the largest of its kind, Truty says.

In the study, researchers analyzed outcomes for 97,000 patients. The tumor marker whose impact they studied is known as CA 19-9. It is associated with several cancers, including pancreatic cancer, and can be measured in the blood of most people: only 10 percent do not produce it. Pancreatic cancer patients who didn’t secrete CA 19-9 were also studied.

Pancreatic cancer patients whose blood showed higher-than-normal CA 19-9 levels tended to have worse outcomes than others at the same stage of cancer, the study found. Surprisingly, the elevated tumor marker’s negative effect on survival was most pronounced in patients diagnosed at an early stage, the researchers wrote.

“When we looked at how these patients did after surgical removal of their cancers, the only treatment sequence that completely eliminated the increased risk posed by CA 19-9 elevation was chemotherapy followed by surgical removal of the tumor,” Truty says.

Another key finding was that only 19 percent of pancreatic cancer patients nationally have their CA 19-9 checked at diagnosis, far fewer than anticipated, he says. The CA 19-9 blood test has been standard for pancreatic cancer patients at Mayo Clinic for years.

Failing to test for and address elevated CA 19-9 means that many patients with above-normal levels may undergo significant surgeries that may not be as beneficial long term as anticipated, Dr. Truty says.


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