Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2021; 27(26): 4045-4087
Published online Jul 14, 2021. doi: 10.3748/wjg.v27.i26.4045
Biomarkers in the diagnosis of pancreatic cancer: Are we closer to finding the golden ticket?
Robert S O'Neill, Alina Stoita
Robert S O'Neill, Alina Stoita, Department of Gastroenterology, St Vincent's Hospital Sydney, Sydney 2010, Australia
Robert S O'Neill, St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney 2010, Australia
Alina Stoita, St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney 2010, Australia
Author contributions: O'Neill RS researched the paper and wrote the initial draft of the manuscript; Stoita A designed the paper, researched studied and reviewed the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interests relevant to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Alina Stoita, FRACP, MBBS, Doctor, Lecturer, Department of Gastroenterology, St Vincent's Hospital Sydney, 390 Victoria Street, Sydney 2010, Australia.
Received: January 26, 2021
Peer-review started: January 26, 2021
First decision: February 27, 2021
Revised: March 24, 2021
Accepted: June 15, 2021
Article in press: June 15, 2021
Published online: July 14, 2021

Pancreatic cancer (PC) is a leading cause of cancer related mortality on a global scale. The disease itself is associated with a dismal prognosis, partly due to its silent nature resulting in patients presenting with advanced disease at the time of diagnosis. To combat this, there has been an explosion in the last decade of potential candidate biomarkers in the research setting in the hope that a diagnostic biomarker may provide a glimmer of hope in what is otherwise quite a substantial clinical dilemma. Currently, serum carbohydrate antigen 19-9 is utilized in the diagnostic work-up of patients diagnosed with PC however this biomarker lacks the sensitivity and specificity associated with a gold-standard marker. In the search for a biomarker that is both sensitive and specific for the diagnosis of PC, there has been a paradigm shift towards a focus on liquid biopsy and the use of diagnostic panels which has subsequently proved to have efficacy in the diagnosis of PC. Currently, promising developments in the field of early detection on PC using diagnostic biomarkers include the detection of microRNA (miRNA) in serum and circulating tumour cells. Both these modalities, although in their infancy and yet to be widely accepted into routine clinical practice, possess merit in the early detection of PC. We reviewed over 300 biomarkers with the aim to provide an in-depth summary of the current state-of-play regarding diagnostic biomarkers in PC (serum, urinary, salivary, faecal, pancreatic juice and biliary fluid).

Keywords: Pancreatic cancer, Cancer, Biomarkers, Diagnostic, Review

Core Tip: Circulating biomarkers are an attractive method for pancreatic cancer (PC) diagnosis. Over 300 biomarkers are presented in this review, however no gold standard biomarker exists. While carbohydrate antigen 19-9 possesses modest sensitivity in PC diagnosis, a lack of specificity is a limitation for its use. More recent studies have shifted towards the concept of a liquid biopsy along with measuring expression of RNA based markers in different mediums. Panels comprising multiple candidate biomarkers have emerged, demonstrating modest diagnostic value. Further studies are required to validate these findings, along with assessment in an asymptomatic population to determine their value in screening.