Stephen Pereira, Professor of Hepatology & Gastroenterology at UCL and Honorary Consultant Gastroenterologist in PancreaticoBiliary Medicine at University College Hospital and The Royal Free Hospital. The research interests of the Centre for HPB Cancer within the UCL Division of Medicine concentrate on the pathogenesis, diagnosis and treatment of biliary tract and pancreatic cancer, as well as the benign conditions primary sclerosing cholangitis and autoimmune pancreatitis. These conditions represent a significant number of patients referred for specialist opinion to UCLH and the Royal Free Hospitals, and the activity of my research group at the Royal Free campus is linked closely with the clinical HPB service at the two sites.
Early detection is critical to improving survival in pancreatic ductal adenocarcinoma by making interventional strategies more successful. However, positive identification of early tumours is made more challenging by pre-malignant conditions from which cancers arise, but where the transformation rate is low, and biomarker studies utilising retrospective cohorts in late-stage disease. Biomarker panels which identify early cancers and stratify precursor lesions that need treatment from those that do not would be expected to extend life and reduce unnecessary interventions. In recent years, a variety of novel biomarkers from body fluids, including blood, urine, saliva, breath, pancreatic juice and stool, have been reported. With advances in high throughput techniques and “omics” analyses, various circulating biomarkers, such as circulating tumour cells, metabolites, cell-free DNA, noncoding RNA, and exosomes, have been widely studied and show promising diagnostic value. Collaborative large-scale studies are required to test the clinical validity and applicability of potential biomarkers in ‘at-risk’ populations in primary and secondary care.