As the longtime host of the television game show Jeopardy!, Alex Trebek has been used to providing answers to contestants. Unfortunately, the 78-year-old Trebek has a diagnosis that still has many, many more questions than answers.
With the following video, Trebek announced that he has been diagnosed with stage IV pancreatic cancer:
A Message from Alex Trebek: pic.twitter.com/LbxcIyeTCF
— Jeopardy! (@Jeopardy) March 6, 2019
This is a very, very tough diagnosis. According to Cancer.net, each year in the United States, approximately 55,000 adults will be diagnosed with pancreatic cancer and approximately 44,000 will die from the disease. That makes it the fourth leading cause of cancer death, accounting for 7% of all cancer deaths. According to the American Cancer Society, data from the National Cancer Institute (NCI) show that five years after diagnosis only 9% of patients have remained alive.
To make matters worse, Stage IV is the most advanced stage of pancreatic cancer, meaning that the cancer has spread well beyond the pancreas to other more distant parts of the body such the liver, the peritoneum (which is the lining of the abdominal cavity), the lungs, or the bones. The higher the stage, the more the cancer has spread. As the American Cancer Society delineates, Stage 0 is the earliest stage when the cancer is is still at just the top layers of the cells lining the pancreatic ducts. Stage I cancer has invaded deeper into the rest of the pancreas but the tumor is still less than 4 cm across in size and has not spread to any lymph nodes. Stage II is when the cancer is either larger than 4 cm across or has spread to no more than three nearby lymph nodes. In Stage III cancer, the cancer has spread to four or more lymph nodes or has invaded nearby blood vessels.
The more advanced the stage, the harder it is to treat pancreatic cancer. As you can imagine, it is a lot easier to get rid of cancer if it is just a single small mass. The further it has spread the more difficult it is to keep track of and remove every cancerous cell from the body.
A major problem with pancreatic cancer is that patients tend to get diagnosed at later stages, frequently being diagnosed at stage IV. That’s because you can’t regularly directly see or touch your pancreas. If you somehow can, something is seriously wrong with your body and you should see a doctor immediately. Instead, typically your pancreas is tucked deep inside your abdomen, packed in by your liver, gallbladder, stomach, intestines, and spleen. Therefore, a tumor can grow silently for a while without producing symptoms.
Symptoms tend to emerge only after the cancer has spread enough to affect other structures. For example, you may feel belly or back pain because the tumor has gotten so big that it is pressing on other structures. Or you may develop jaundice (yellowing eyes and skin), dark urine, greasy stools, or itchy skin because your liver is affected and can no longer properly process bilirubin. Or you may have nausea, vomiting, or loss of appetite, again because the cancer has spread beyond your pancreas.
When the cancer is still confined to the pancreas or has spread no further than nearby lymph nodes, a cure is still possible if you can essentially get rid of all the cancer cells. Since your pancreas is nestled in with other structures, removing any mass from your pancreas is no small feat. It typically entails removing at least part of your pancreas, your gallbladder, your bile ducts, and part of your intestine and then reattaching everything that is left, clearly a major surgical procedure. The most common version of this is called a Whipple procedure as shown by this video from the Mayo Clinic:
The procedure is named after the surgeon Dr. Allen Whipple who had refined the procedure in the 1930’s and not Mr. Whipple of the Charmin toilet tissue commercials. There are other variations of this procedure. Removing and messing around with these parts of your digestive system can wreak all kinds of havoc with your digestion.
Even if the tumor is successfully removed, doctors will frequently administer chemotherapy (gemcitabine is commonly used alone or with other drugs) with or without radiation therapy. This is to try to kill any remaining cancer cells that can’t be readily seen. Otherwise, remaining cancer cells could then continue to grow. This is why close and frequent follow-up with your doctor is essential after surgery to check if you are indeed tumor free and have been cured.
Once the cancer has reached stage IV and spread well beyond the pancreas, cure is no longer possible. This doesn’t mean give up, because when pancreatic cancer has spread distantly, the goal shifts from trying get rid of all the cancer cells to trying to extend life and reduce the effects of the cancer as long as possible. This may involve a combination of chemotherapeutic drugs and radiation. Surgery may also help relieve symptoms caused by the tumor blocking vital structures. According to Cancer Research UK, the median survival for those with Stage IV pancreatic cancer is just 2 to 6 months.
There is a desperate need for more research about pancreatic cancer because so many questions remain and the currently available answers are not good. Will scientists someday be able to develop a reliable way to screen for pancreatic cancer? Will there someday be a better way of removing cancer from the pancreas that doesn’t cause so much disruption to the body? Will someone develop more targeted chemotherapeutic agents that can more selectively kill pancreatic cancer cells while doing less damage to the rest of the body? Similarly, will someone develop a way of specifically targeting radiation therapy without harming the surrounding structures? Will the odds of survival someday be better?
Indeed, many questions remain, including what will happen to Trebek. For now, he will remain the face of Jeopardy! That means we could continue to see moments like these:
Trebek does face very tough odds. But odds calculated from a population do not necessarily apply to every single individual. A given individual could potentially do worse or do better than stated odds. Maybe his remaining in the public eye will raise more awareness of pancreatic cancer, which someday, hopefully, could help bring more urgently needed answers on how to better address this major killer.