After Trebek’s death, examining pancreatic cancer survival
The death of television game show icon Alex Trebek from pancreatic cancer earlier this month dashed the hopes of many of his Jeopardy! fans who hoped he would beat the odds that were heavily stacked against him.
The diagnosis of pancreatic cancer is grim and just 3 percent of patients with metastasized pancreatic cancer (which is usually when it’s discovered) survive for five years, according to the American Cancer Society. Trebek did live more than 18 months after his March 2019 diagnosis, which is longer than most patients, said Cape Cod Healthcare oncologist Peter Ward, MD.
“Sadly, pancreatic cancer is not only a difficult cancer to detect early, it’s a difficult cancer to treat, as well,” he said.
If there is any takeaway from Trebek’s tragic death, it’s that people should know their family medical history, in order to detect cancers of all types as early as possible, Dr. Ward said. While there have been few advances in the area of pancreatic cancer, there is hope that genetic research will yield some answers, he said.
“As we learn more about the genetics of all different types of cancer, familial disposition to cancer can lead to genetic counseling, which would lead to regular screening (for certain types of cancer),” he said.
Research into genetic predisposition to pancreatic cancer is ongoing and has revealed a few clues to aid in earlier diagnosis, according to Dr. Ward. Within the past 10 years, researchers have found that patients who harbor mutations in the BRCA1 or BRCA2 genes - more commonly known to raise a woman’s risk of breast cancer – may also be at higher risk of pancreatic cancer.
This information, along with more genetic breakthroughs, may lead to better screening for people who may be genetically predisposed to pancreatic cancer.
“There’s no good screening for the average person, but patients who have first-degree relatives that had pancreatic cancer could be put through a screening process,” said Dr. Ward. “This is generally done by a gastroenterologist using an MRI and endoscopic ultrasound.”
The pancreas is located in the abdomen and helps aid digestion and the regulation of blood sugar levels in the body. It is a hard organ to access, which is what makes it hard to treat, Dr. Ward said. Pancreatic tumors usually go unnoticed until the cancer has spread to other organs, which is why it is so deadly and hard to treat. Surgical removal of the tumor is typically the best chance for survival, but about 70 percent of patients who go through surgery have a relapse of their disease, he said.
Diagnosis and Treatment
Patients are generally diagnosed after complaining of unexplained weight loss, jaundice, and persistent abdominal pain. Trebek reportedly sought help after complaining of ongoing stomach pain.
“Unfortunately, when someone is presenting with these things, it’s generally fairly advanced,” Dr. Ward said. “Patients can often present with disease that has already spread to the liver.”
While there is a blood test, known as CA 19-9 tumor marker test, that can be used for pancreatic cancer, it “has a lower sensitivity,” so that a negative test wouldn’t necessarily rule out the disease, Dr. Ward said.
Blood tests for cancer, in general, are in clinical trials and will hopefully be available in the near future, he said.
“Our hope is that we will have a blood-based DNA screening test for cancer in the next five years.”
Patients whose pancreatic tumors are too large for surgical removal are referred for chemotherapy treatment in order to shrink the tumor so that surgery is possible. The chemotherapy cocktail that is used for the treatment of pancreatic cancer is relatively strong and best tolerated by patients who are under the age of 75. Older patients (Trebek was 79 when he was diagnosed) are generally not given the drug because their bodies cannot tolerate it, he said.
“The real hope for the future is targeted therapies,” that are specific to tumor types and therefore more effective, he said.
According to the American Cancer, risk factors for pancreatic cancer include:
- Tobacco use
- Being overweight
- Chronic pancreatitis
- Workplace exposure to certain chemicals (used in dry cleaning and metal working)