Why Stage 4 Pancreatic Cancer Is So Deadly—and Why Doctors Are Still Hopeful

Jeopardy host Alex Trebek, 78, shocked and saddened his fans when he announced yesterday that he has stage 4 pancreatic cancer. Although the 35-year television veteran pledged to beat his cancer, Trebek also acknowledged the “low survival rate statistics for this disease.”

“[J]ust like 50,000 other people in the United States each year, this week I was diagnosed with stage 4 pancreatic cancer,” Trebek said in a video statement. “Now normally the prognosis for this is not very encouraging, but I’m going to fight this and I’m going to keep working.”

A diagnosis of stage 4 pancreatic cancer means that a person’s cancer is no longer contained to just the pancreas and has spread to other organs such as the liver, abdominal cavity, lungs, or bones. According to the American Cancer Society, the five-year relative survival rate for pancreatic cancer that has spread to distant sites is 3%. That means that, compared to someone who does not have the disease, pancreatic cancer patients are about 3% as likely to live for five years.

To learn more about why pancreatic cancer has such a poor survival rate, Health spoke with Ursina Teitelbaum, MD, clinical director of the Penn Pancreatic Cancer Research Center at the University of Pennsylvania Perelman School of Medicine.

One of the biggest challenges to diagnosing and treating the disease, Dr. Teitelbaum says, is that people don’t usually have symptoms until the cancer has spread outside of the pancreas. Even then, symptoms can be vague. “It can feel like heartburn, abdominal pain, or back pain,” she says. Sometimes there may be no symptoms at all until a person develops fatigue, weight loss, abdominal swelling, or jaundice (yellowing of the eyes).

Pancreatic cancer is so likely to spread because it’s nestled deep in the body and “surrounded by a very rich bed of lymph nodes and blood vessels,” says Dr. Teitelbaum. “It’s basically the highway to metastasis.”

Another problem with pancreatic cancer is that there’s not currently a screening test for it. “We don’t have a blood test like the PSA for prostate cancer or a radiology test like the mammogram for breast cancer,” says Dr. Teitelbaum. “So we have no early detection.” That’s why only 10 to 15% of patients are diagnosed while their cancer is still contained in the pancreas.

Unfortunately, once pancreatic cancer spreads, surgical removal is no longer a feasible option for treatment. “Surgery is still really the only way we know how to cure cancer,” she says. “We can do chemotherapy and radiation, and they can help contain and control it, but it’s not usually curative.”

On top of that, Dr. Teitelbaum adds, pancreatic cancer tumors tend to be very resistant to standard chemotherapy—which is one reason why doctors haven’t made as much progress treating them in recent decades as they have other types of cancer.

But the news isn’t all bad, she says. “In 2010 we had a dramatic breakthrough with a new treatment regimen that really revolutionized patient outcomes, and we had another new treatment approved in 2012,” she says. “I used to tell patients that I would measure their life expectancy in months, and now I’m really measuring it in years.”

Those new treatments still involve chemotherapy, but newer drugs are more targeted and effective than older ones. Patients today may also have the opportunity to enroll in a clinical trial and receive chemotherapy coupled with experimental therapies “with the hope of making the chemo work better,” says Dr. Teitelbaum.

Dr. Teitelbaum has not treated Trebek, but she watched his video announcement and is encouraged by his message. “He looks very well, and that’s important,” she says. “He looks very treatable, and I would hope that he would consider a center with a clinical trial opportunity.”

Some patients are hesitant to try chemotherapy, she says, since the treatment has a bad reputation. “But oftentimes, chemo actually makes people feel better,” she says. “An out-of-control cancer feels worse than well-managed chemotherapy, even with the side effects.”

As researchers continue to learn more about pancreatic cancer, they’re making some progress. They know that up to 5% of pancreatic cancer cases are hereditary and can now provide genetic testing to families who may be at risk. And in recent years, they’ve learned that people with a new diagnosis of type 2 diabetes or depression have a higher than average risk of being diagnosed with pancreatic cancer over the next few years.

Identifying at-risk groups is important, says Dr. Teitelbaum, because pancreatic cancer rates are rising in the United States—faster than predicted based on the aging population or other known factors. “We in the field actually consider this an emergency,” she says. “We have to figure out how to detect and treat this, because Alex Trebek is not the first—and will not be the last—well-known person or loved one to be diagnosed.”

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