Alex Trebek is putting on a brave face
When Alex Trebek, the popular host of the perennial television game show, “Jeopardy!” announced that he had been diagnosed with Stage IV pancreatic cancer, he vowed to beat the low survival rate of the disease. In an announcement to viewers recently, he joked that he had to beat the statistic because he is bound to his Jeopardy contract for three more years.
But, while that is a brave and noble sentiment, he has a difficult road ahead, according to oncologist Jennifer Crook, MD, medical director of Cape Cod Healthcare Cancer Services.
“We do have treatments for pancreatic cancer and even in the metastatic setting we have treatments that work that can extend someone’s survival, ameliorate symptoms, and benefit their quality of life,” Dr. Crook said. “But to use terms like ‘I’m going to beat this’ would suggest a cure or long-term survival and that’s not really something that we see with this disease, or really with almost any metastatic cancer.”
When someone is diagnosed with Stage IV cancer, also called metastatic disease, treatment usually shifts gears from treatment for cure to treatment for benefit, she said. The typical person with metastatic disease, particularly with pancreatic cancer, has multiple sites of metastases involving multiple organs, so it’s a more widespread problem than a single tumor, she added.
According to the American Cancer Society, people with Stage IV pancreatic cancer, usually have about a three percent five-year survival rate. The median survival rate for those with Stage IV pancreatic cancer is two to three months, if they opt not to do treatment. But even those who do decide to undergo treatment usually only buy a little more time. The median survival for that group is about eight months.
“That is an average, so when I am meeting somebody initially, I always emphasize that there are people who do worse than that and there are people who do better,” Dr. Crook said. “All of us in oncology can probably name several patients who far exceeded our expectations. But that’s what the statistics look like, so it’s a pretty difficult disease.”
No Current Screening
Unfortunately, about 50 percent of all pancreatic cancers are diagnosed at Stage IV, she said. There is currently no screening that has been proven to save lives, because it is an aggressive and fast-growing cancer. The best approach to pancreatic cancer screening is actively being studied in clinical trials, and patients at risk are currently best served by clinical trial enrollment.
One of the biggest difficulties with detecting pancreatic cancer early is that, in most cases, symptoms are initially vague. The times that it is caught early usually occur by accident during screening for another illness or problem.
Symptoms of pancreatic cancer include:
- Fatigue Appetite loss
- Weight loss
- Abdominal pain or bloating
“The development of symptoms also depends on where in your pancreas the tumor originates,” Dr. Crook said. “If it originates in the pancreatic head, those tumors tend to be more symptomatic because they block bile ducts and are located near nerves, so they cause more pain. If the tumor grows in the tail of the pancreas, a tumor could grow quite large before symptoms develop.”
If the cancer is caught early, the best treatment is to use a tri-modality approach of surgery, chemotherapy and radiation. It is especially effective with Stage I cancer. Those with Stage II and Stage III cancer would also have the same treatment, unless their tumor is too big or it involves blood vessels. For those patients, treatment would be a combination of chemotherapy and radiation first to shrink the tumor and then surgery to remove it.
“There are different ways that you can coordinate those three things but the best outcomes, we think, are in people who get all three modalities,” Dr. Crook said. “If someone is diagnosed with metastatic disease, those folks generally are treated with chemotherapy, alone, because once it has spread there is not a lot of benefit to either operating or even radiating.”
At that point, Dr. Crook begins to talk about hospice care. By definition, hospice is designed for those who have less than six months to live. Those with Stage IV pancreatic cancer are an obvious fit right from the start, but if they do choose to do treatment, they don’t qualify for hospice. In that case, Dr. Crook refers patients to palliative care. Palliative care offers most of the same benefits of hospice, and patients can still seek treatment.
A Rare Disease
The only good news about pancreatic cancer is that it is a relatively rare diagnosis. About 56,000 people, or less than 1 percent of the U.S. population, will be diagnosed each year, compared to 14 percent of women who will be diagnosed with breast cancer.
Risk factors for pancreatic cancer include:
- A family history of pancreatic cancer
- Inherited genetic mutations
- Lack of physical activity
- A history of chronic pancreatitis
“The thing to emphasize is to go to your primary care physician if you have any GI symptoms that are persistent and to make the lifestyle changes that you can do to lessen your risk, like maintaining a healthy body weight, regular exercise, a low-fat diet and not smoking,” Dr. Crook said. “If you do those things, you are lowering your risk for many additional types of cancer too, and you also lower your risk for heart disease.