The Devastating Truth Behind the Lethality of Pancreatic Cancer

Popular game show host and television personality, Alex Trebek, passed away on Sunday after bravely battling stage 4 pancreatic cancer for over a year. Although the cause of death hasn't been disclosed yet, the news has left fans and supporters mourning his loss. The “Jeopardy!” host revealed his diagnosis publicly in March 2019, garnering widespread support and admiration for his resilience and courage. Sadly, his death comes just a few months after other prominent figures like Supreme Court Justice Ruth Bader Ginsburg and US Rep. John Lewis succumbed to pancreatic cancer as well.

Pancreatic cancer is the third most common cause of cancer-related deaths in the United States, following lung and colorectal cancers. According to the National Cancer Institute, it caused over 45,000 deaths in the country in 2020 alone. Despite being relatively rare in comparison to other cancers, pancreatic cancer has a very high mortality rate, with almost 95% of all cases resulting in death. One of the primary reasons for this is the absence of noticeable symptoms at early stages, when the cancer is most treatable. By the time most patients experience abdominal pain or jaundice, the tumor has already advanced significantly. Unfortunately, there are no general screening methods available either.

It's clear that pancreatic cancer remains a significant public health concern, and much more research and innovation are needed in this area.

In breaking news, Ruth Bader Ginsburg has received treatment for cancer in the pancreas. Pancreatic cancer affects men slightly more than women, with a higher risk associated with tobacco use. This link was even more apparent in the past when men smoked more than women. Currently, the lifetime risk of developing pancreatic cancer is 1 in 63 for men and 1 in 65 for women. There is also a difference in the incidence of pancreatic cancer among different races, with African-Americans at a higher risk than white Americans. The exact reason for this is unclear, but it is thought to be due to factors such as higher rates of smoking and diabetes in men or obesity in women.

The pancreas is a vital organ, situated deep in the abdomen, serving both the digestive and endocrine systems. It produces hormones to regulate the body and digestive enzymes to break down food. Pancreatic cancer can be classified into two types: exocrine tumors and endocrine tumors. Exocrine tumors, which are more common, tend to be more aggressive than neuroendocrine tumors, as in the case of Steve Jobs. However, should they be identified early, surgery is an effective treatment option.

A recent study has found that diabetes may be an early warning sign of pancreatic cancer, especially in individuals over the age of 50. Therefore, if you experience symptoms of diabetes, it is a good idea to consult your doctor promptly.

Neuroendocrine tumors have a considerably higher five-year survival rate, ranging from 50% to 80%, in contrast to adenocarcinoma, which has less than 5%. If left unchecked, more advanced tumors possess a greater risk of recurrence and can spread to the liver, as per the Montefiore-Einstein Center for Cancer Care's director and pancreatic cancer expert, Dr. Steven Libutti, located in the Bronx. The National Cancer Institute states that pancreatic cancer could only be controlled by surgery and treated before its spread. Otherwise, its effects on patients are tackled via palliative care.

Two drugs, approved in 2011, have been successful in aiding patients with pancreatic neuroendocrine tumors. They are believed to inhibit the blood supply and metabolism of tumor cells, an improvement compared to chemotherapy, which was the standard of care a year before, as mentioned by Dr. Michaela Banck, a medical oncologist located in New York, who treats neuroendocrine tumor patients. One of the drugs, Afinitor (Everolimus), manufactured by Novartis, got FDA approval to treat pancreatic neuroendocrine tumors and prevent transplant rejection. However, it has potentially serious side-effects: lung or breathing problems, infections, and acute renal failure, which may result in death.

A blood test holds promise in detecting cancer before symptoms develop. Jobs, who had undergone surgery in 2004 to remove his tumor, remained alive for seven years following treatment, aligning with average survival rates for those with similar kinds of tumors, per Libutti. Survival rates could increase if pancreatic cancers are detected sooner. Yet, it also depends on variations in the aggressiveness of the tumors, which could result in a recurrence due to even aggressive tumor cells left behind after surgery.

Jobs notably underwent a liver transplant in 2009, which, according to Dr. Maged Rizk, the director of Cleveland Clinic's Chronic Abdominal Pain Center and a specialist in gastroenterology and hepatology, is cutting-edge treatment when neuroendocrine tumors spread. It has no tangible proof to support its use as a cure for this rare cancer type. Immunosuppression drugs may also result in faster cancer growth. Studies conducted in Europe revealed disease recurrence for the majority of liver transplant patients diagnosed with this tumor type.

Pancreatic cancer is often diagnosed in later stages due to the lack of symptoms produced by small tumors. Adenocarcinomas can cause severe back pain as they grow and obstruct liver ducts. Some neuroendocrine tumors may produce insulin, leading to low glucose levels as an initial symptom, but most do not produce hormones. Former President Jimmy Carter's family was significantly impacted by this disease, highlighting the importance of research to better understand tumor growth and spread. The American Cancer Society is currently focused on improving treatments, such as targeted therapies and immune therapy, as well as enhancing surgery and radiation therapy. Clinical trials are exploring pathways to combat pancreatic cancer that evade normal processes. The future of medicine for pancreatic cancer treatment will leverage genetic information to personalize treatment based on the patient's tumor type. The genomic era will bring a revolutionary difference to medicine, according to Banck. It is worth noting that Dr. Steven Libutti holds the title of Director of the Rutgers Cancer Institute of New Jersey and Senior Vice President of Oncology Services at RWJBarnabas Health.