Why Pancreatic Cancer Is So Deadly


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Television game show host Alex Trebek died Sunday of pancreatic cancer, more than 2 years after he was diagnosed. Emma McIntyre/Getty Images
  • Pancreatic cancer, which took the life of TV personality Alex Trebek, is one of the deadliest cancers.
  • Experts say that’s because it spreads quickly and usually isn’t detected until it’s in later stages.
  • Treatments such as chemotherapy, radiation, and surgery usually only prolong the life for a person with the disease for a short period of time.
  • Right now, there are no effective methods to screen for pancreatic cancer.

Alex Trebek, the popular host of the television show “Jeopardy,” died on Sunday, more than 2 years after he had been diagnosed with stage 4 pancreatic cancer.

Trebek’s death from the disease follows the deaths earlier this year of Supreme Court Justice Ruth Bader Ginsberg, who was diagnosed with the same condition in 2009, and Rep. John Lewis, who died at age 80, 6 months after being diagnosed.

They are just three of the estimated 47,000 people in the United States who will die this year from a cancer that, although rare, is one of the most lethal.

“Pancreatic cancer is one of the most deadly forms of cancers and the fourth leading cause of cancer deaths in the United States,” said Dr. Anton Bilchik, a surgical oncologist, professor of surgery, chief of gastrointestinal research, and chief of medicine at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California.

“This continues to be the most challenging cancer to manage. It is a pernicious disease and most patients are incurable, as was the unfortunate case with Alex Trebek, Ruth Bader Ginsburg, and so many before and after them,” Bilchik told Healthline.

Pancreatic cancer comes in two forms.

Pancreatic adenocarcinoma is the most common type, while pancreatic neuroendocrine tumors are less common.

In the pancreas, cells called exocrine cells form exocrine glands and ducts that make pancreatic enzymes that are released into the intestines to help digest food.

In adenocarcinoma, the most common form of pancreatic cancer, these exocrine cells start to grow out of control in the pancreas. About 95 percent of pancreatic cancer cases are adenocarcinoma.

“It affects somewhere between 50,000 to 60,000 Americans per year. We like to quote about a 1.5 percent lifetime risk of developing pancreas cancer. It’s behind lung cancer and colon cancer,” Dr. Walter Park, director of the Stanford Pancreas Clinic in California, told Healthline.

“It gets its reputation primarily because when people find out they have pancreas cancer, unfortunately the cancer is fairly advanced because there aren’t many symptoms that a patient might have at earlier stages. It’s a relatively silent cancer in its earlier stages,” Park explained.

Part of the reason the cancer is so deadly, experts say, is its ability to spread undetected throughout the body quickly. It also surrounds itself in tough tissue, making it hard to treat.

“Pancreatic cancer makes a lot of scar tissue. The tumor cells create a lot of fibrous tissue around them, which makes it very hard for therapy to get to them. It also makes it very difficult to remove,” Dr. William Cance, chief medical and scientific officer at the American Cancer Society, told Healthline.

“But the real problem is at a very early stage of growth, for reasons we don’t really understand yet, pancreatic cancers have acquired the ability to spread beyond the pancreas to adjacent lymph nodes and then to other organs. We don’t have a good idea why they are so invasive and metastatic,” Cance added.

For a minority of people, the cancer remains in the area of the pancreas. But it is rare for the cancer to remain localized in this way.

Clinicians refer to pancreatic cancer that has spread as a “distant disease.”

“Unfortunately, Alex Trebek, John Lewis, they presented with distant disease. That means that it has spread beyond the pancreas to other sites, particularly the liver or the lung. The cancer itself has acquired the ability not only to invade surrounding tissue but to get into the bloodstream and spread to other organs,” Cance said.

“There’s a 3 percent 5-year survival for when you present with distant disease. Unfortunately, the odds are very much stacked against the patients who present with distant spread of the cancer,” he added.

Often by the time pancreatic cancer is diagnosed, the spread of the disease can make treatment options difficult.

“By the time we learn that a patient has it, it has already spread to multiple organs,” Park said. “Once you get to cancer that has matured and advanced and has a fairly high tumor burden, it’s very hard to treat.”

Chemotherapy, radiation, and surgery are options for treatment but will only benefit or prolong the life of most people with the disease.

“The only curative option is surgical resection, which applies to the minority of patients,” Bilchik said. “Other treatment options include chemotherapy and radiation therapy. Recent studies are showing that some of the newer chemotherapy drugs are more effective.”

Unlike other cancers that use screening for early detection, there are currently no good screening options to detect this cancer.

“Pancreatic cancer is rare, and we don’t have good screening methods that can detect it early and have a measurable change in outcome. Yet. We’ll be getting that as time goes forward,” Cance said.

“The emphasis really needs to be on the development of new therapies that have significant prolongation of life,” he added. “Too frequently in the past there have been new therapies of pancreatic cancer where the survival, the improved survival, is measured only in days. One of the new drugs got a lot of publicity for extending your survival by 11 days. With pancreatic cancer we really need to look for the more dramatic breakthroughs.”

Cance is hopeful that one day cancers that were once lethal like pancreatic cancer could be turned instead into a chronic disease.

“Our goal with a lot of cancers, particularly things like pancreas, is to turn them into a chronic disease so we can manage them. That’s the real goal to let people live high quality of life for longer periods with diseases like pancreatic cancer,” he said.



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