Improving detection of pancreaticobiliary malignancy

Improving the early detection of pancreaticobiliary malignancy is key to trying to improve poor survival rates, with a number of promising international collaborative studies and projects showing early promise, delegates attending the Irish Society of Gastroenterology 2025 Winter Meeting heard.

Prof Steve Pereira, Consultant Gastroenterologist and Professor of Hepatology and Gastroenterology, University College London Hospitals, UK, is involved with a number of key studies in the area, and told delegates that he is hopeful of making meaningful progress.

Pancreatic cancer is most frequently detected at an advanced stage. Such late detection limits treatment options and contributes to the persistently low five-year survival rates of 3 to 15 per cent, which have improved only modestly in recent years.

As the disease is relatively uncommon, screening of the asymptomatic adult population is not feasible or recommended with current modalities. However, screening of individuals in high-risk groups is recommended, Prof Pereira noted. Groups at high risk include individuals with inherited predisposition and patients with pancreatic cystic lesions.

He discussed a number of studies aimed at improving early detection of this cancer.

Such studies include those aimed at finding ways of identifying pancreatic ductal adenocarcinoma (PDAC) in high-risk groups, such as among individuals with new-onset diabetes mellitus and people attending primary and secondary care practices with symptoms that suggest this cancer, as well as trials on cancer ‘liquid biopsies’ in large populations.

He highlighted the ongoing work on novel early-detection biomarkers, the use of biobanks, and prediction models being developed using ‘big data’ from electronic health records and pooled research studies.

Prof Pereira also examined the application of artificial intelligence to medical imaging for the purposes of early detection.

“The landscape has changed quite a lot. In the past there was a lot of pessimism about the possibility of early detection, as once people have symptoms that signifies they have advanced disease,” he told the Medical Independent.

Prof Pereira noted that earlier efforts had focused largely on pharmacological treatments, which delivered limited success; however, emerging research aimed at improving early detection is now beginning to show promise.

He is the Chief Investigator of a major ongoing UK early-detection study.

The research aims to develop a prospective biobank and early diagnostic tool that can differentiate early PDAC, PNETs (pancreatic neuroendocrine tumours) and high-risk pancreatic lesions from benign disease, by combining a risk factor/early symptom electronic clinical decision support tool with novel panels of blood and urine biomarkers of early disease. This diagnostic tool may then be used for surveillance of high-risk populations and triage of patients with non-specific symptoms concerning for pancreatic cancer.