CHARLOTTE – In a year filled with loss, the passing of Alex Trebek from pancreatic cancer has been a blow for many who have welcomed him into their homes nightly as the host of Jeopardy. When Trebek shared his diagnosis with the world in March of 2019, he announced he had stage IV disease, giving him only an 18% chance of surviving another year.
Unfortunately, Trebek’s experience is the norm and not the exception when it comes to diagnosing and treating pancreatic cancer: nearly 80% of patients have stage IV disease at the time of diagnosis. A 6” gland located behind the stomach and near the liver and small intestine, the pancreas is responsible for secreting hormones like insulin and glucagon to regulate blood sugar and secreting hormones that aid in the digestion of food. Because it is tucked away in the abdomen behind several large organs and patients don’t tend to exhibit symptoms early on, it can be exceptionally difficult to detect.
“Pancreatic cancer has sometimes been referred to as a ‘silent’ disease,” says Emily Bellis, Oncology PA at Novant Cancer Institute Matthews. “Many of the symptoms patients experience in early disease onset are mild and vague, including abdominal or mid-back pain, loss of appetite, weight loss, jaundice, nausea, stool changes, early satiety, or a recent diagnosis of diabetes,” continues Bellis. “Many patients ignore symptoms early on because they are mild and non-specific.” This was true for Trebek, who experienced only a persistent stomach ache before his diagnosis, which he didn’t recognize as a potential symptom of a more serious disease.
Unfortunately, pancreatic cancer is also a notoriously difficult form of cancer to treat. Early stage pancreatic cancer can be treated surgically, but because the majority of patients are stage IV at the time of diagnosis, surgery is only possible for about 20% of pancreatic cancer patients. “If surgery is not possible, radiation and/or chemotherapy can be used to shrink the cancer, decrease a patient’s symptoms and prolong life,” says Bellis. “Unfortunately, only about 5% of patients with pancreatic cancer beat the disease.”
As with all cancers, early detection means better outcomes. “There are certain risk factors that put people at higher risk for pancreatic cancer,” says Bellis. “A diet high in red meats and processed meats can put an individual at increased risk. Obesity is also a factor. Obese people have a 20% increased risk of developing pancreatic cancer as compared to people at a normal weight. African Americans and Ashkenazi Jews also have a higher incidence of pancreatic cancer. Slightly more men are diagnosed with pancreatic cancer than women. Smoking also increases a person’s risk of developing pancreatic cancer. 20-30% of pancreatic cancers are thought to be attributable to smoking. Having a history of chronic pancreatitis also increases a person’s risk along with a long-standing history (>5 years) of diabetes.”
But the most important factor by far is family history. People with multiple first degree relatives who have had pancreatic cancer or any relatives diagnosed before the age of 50 are at increased risk of developing the disease. “Approximately 10% of pancreatic cancers are hereditary, which means the individual has inherited a mutation that increased their risk to getting pancreatic cancer,” says Bellis. “The BRCA mutation is one of the gene mutations that can be associated with a higher risk of pancreatic cancer. If someone is concerned because of a known family history of pancreatic cancer, they can meet with a genetic counselor to discuss the next steps and what might be recommended.”
If you are having concerning symptoms, your doctor may recommend an endoscopic ultrasound or MRI, but for individuals who are not at increased risk, there’s no equivalent screening routine to a mammogram or colonoscopy for pancreatic cancer. “None of the tests that are available have proven to lower one’s risk of dying from the disease,” says Bellis.
Trebek responded exceptionally well to chemotherapy, announcing in May of 2019 that some of his tumors had shrunk to half their previously observed size. After nearly 18 months fighting pancreatic cancer, Alex Trebek died in his Los Angeles home on November 8, 2020, at the age of 80. His final episode of Jeopardy, taped on October 29 in the wake of surgery related to his cancer treatment, will air on Christmas Day.