The Sol Goldman Pancreatic Cancer Research Center

Advances and Discoveries Made at Johns Hopkins

Screening for Early Pancreatic Neoplasia in High-Risk Individuals
Dr. Marcia Canto and colleagues from Johns Hopkins report the results of the "CAPS 2" screening for early pancreatic cancer program in the June issue of Clinical Gastroenterology and Hepatology. Dr. Canto screened 72 individuals with a strong family history of pancreatic cancer, 6 patients with the Peutz-Jeghers Syndrome, and 149 controls using a combination of endoscopic ultrasound (EUS) and computerized tomography (CT scanning). If something abnormal was identified the patients also underwent endoscopic retrograde cholangiopancreatography (ERCP). All of the patients were asymptomatic. Remarkably, 8 of the patients were found to have a tumor in their pancreas (10% yield of screening); 6 patients had 8 benign intraductal papillary mucinous neoplasms (IPMNs), 1 had an IPMN that progressed to invasive ductal adenocarcinoma, and 1 had pancreatic intraepithelial neoplasia. Endoscopic ultrasound (EUS) and computerized tomography (CT scanning) also diagnosed 3 patients with 5 extrapancreatic neoplasms. Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography abnormalities suggestive of chronic pancreatitis were more common in high-risk patients than in control subjects. From these studies, Dr. Canto concluded that screening EUS and CT diagnosed significant asymptomatic pancreatic and extrapancreatic neoplasms in high-risk individuals (people with a strong family history of pancreatic cancer and people with the Peutz-Jeghers Syndrome). Dr. Canto also concluded that abnormalities suggestive of chronic pancreatitis are identified more commonly in high-risk individuals. Dr. Canto plans to start "CAPS 3." More information about this research screening protocol will be posted on this web site as it becomes available.

Clin Gastroenterol Hepatol. May 5, 2006

DNA methylation alterations in the pancreatic juice of patients with suspected pancreatic disease
The biggest challenge of pancreatic cancer is to try to detect the cancer at an early stage when it can be surgically removed. Dr. Michael Goggins' Early Detection Laboratory is dedicated to identifying new markers for the early detection of pancreatic cancer. Just as there is mammography for breast cancer and the PSA test for prostate cancer, so too do we need a test for early pancreatic cancer. Scientists working in The Early Detection Laboratory at Johns Hopkins examined the DNA in pancreatic juice samples that were collected from pancreatic cancer patients to determine if the DNA from these samples showed an abnormal amount of methylation. Methylation is the addition of an additional carbon to specific areas of the DNA. Hypermethylation (or too much methylation) of certain genes will stop the genes from working properly. In particular, hypermethylation of genes whose normal function is to protect a cell from developing into a cancer (tumor suppressor genes) or whose function is to repair damaged DNA (mismatch repair genes) have been associated with the development of cancer. The scientists found that there was more methylation in the pancreatic juice samples collected from pancreatic cancer patients than there was in the samples collected from chronic pancreatitis patients and patients with no history of pancreatic disease. This finding is important because it suggests that the detection and quantification of methylated DNA in pancreatic juice may provide a promising approach to the diagnosis of pancreatic cancer.

Cancer Res. 66:1208-17, 2006