Why pancreatic cancer is so deadly

Pancreatic cancer isn’t selective. The disease can strike anyone, and it’s often discovered at an advanced stage, making it one of the deadliest cancers. In March 2019, television icon and “Jeopardy!” host Alex Trebek announced that he had stage 4 pancreatic cancer. He sought treatment but died of the disease in November 2020.

According to the American Cancer Society, more than 48,000 people are also expected to die of pancreatic cancer this year. It has one of the lowest survival rates for cancer, with 20% of patients living to one year with the disease, on average, and 10% of patients living to 5 years. For patients with advanced disease, those numbers are lower.

“More than 60,000 patients are diagnosed every year and it’s the third leading cause of cancer-related deaths in the U.S.,” says Dr. Igor Medic, a board-certified medical oncologist affiliated with Sharp Grossmont Hospital.

“To our knowledge, pancreatic cancer is sporadic in the majority of cases — in other words, it’s not gene-related,” he says. “However, about 5% to 10% of individuals have a family history of the disease. There are multiple genes implicated with hereditary pancreatic cancer; the most well-known is the BRCA gene.”

Not easy to detect
Pancreatic cancer is aggressive and tends to spread silently. The pancreas is located deep inside the body and sits across the back of the abdomen behind the stomach, so it can’t readily be felt or seen by health care providers during a checkup.

Also, there are usually no symptoms until the disease is at an advanced stage, and there’s no early detection method as with other cancers such as breast, colon or prostate.

“At this point, there is no screening in the general population,” says Dr. Medic. “In familial pancreatic cancer, when we know there is a predisposing gene, screening is recommended and often performed. This is done with MRI imaging and endoscopic gastroenterology procedures that allow us to see the digestive anatomy and to investigate any abnormalities.”

Warning signs of pancreatic cancer
“Quite often, symptoms of abdominal pain or jaundice occur once the disease is in its advanced stages,” he says. As the cancer spreads, it frequently goes to the liver causing yellowing of the eyes and skin (jaundice).

Other symptoms include:

• Dark urine

• Light colored or greasy stools

• Itchy skin

• Pain in the belly or back

• Weight loss and poor appetite

• Nausea and vomiting

• Gallbladder or liver enlargement

• Diabetes — in rare instances, pancreatic cancer can lead to changes in blood sugar levels and diabetes

Possible causes
Besides a family connection, there are other known risk factors. Dr. Medic says, “Smoking increases risk and that alone accounts for 25% of all cases. Heavy alcohol drinkers are at higher risk, and numerous studies cite links between high body mass and lack of physical activity.” Chronic inflammation of the pancreas, known as pancreatitis, is another risk factor.

One unusual implication involves blood type. “The ABO blood group type may have a connection with this cancer. Compared with blood group O, individuals with non-O group — type A, AB or B — might be more likely to develop pancreatic cancer,” Dr. Medic says.

Treating pancreatic cancer
A pancreatic cancer diagnosis and the side effects sometimes caused by treatments can take an enormous toll on a person’s physical and emotional well-being. Patients should work closely with their health team to determine the best course of treatment, which can range from surgery to chemotherapy, but much depends on the type and stage of the cancer.

“The mainstay of therapy is complete resection (removal) of the tumor, which is the only curative intervention,” says Dr. Medic. “However, the majority of patients present with advanced cancer and can’t be resected. In those cases, chemotherapy is frequently used to control the progression of the disease.”

He adds that, “Patients need much intensive care and support from both their physician and their family. While we want to treat the disease with all means possible, quality of life is just as important.”

“Immense research is currently evolving. Various new molecular therapies and immunotherapies are being tested. We are all eagerly awaiting results of these studies, that could significantly change the outcomes for the better,” he says.

For the news media: To talk with Dr. Medic about pancreatic cancer for an upcoming story, contact Erica Carlson, senior public relations specialist, at erica.carlson@sharp.com.