It Sounds Like Good News, but Alex Trebek’s ‘Near Remission’ for Pancreatic Cancer Isn’t Typical

UPDATE: Alex Trebek died November 8, 2020, more than a year after he was diagnosed with stage four pancreatic cancer. He was 80.

In March 2019, “Jeopardy” game show host Alex Trebek announced he had stage 4 pancreatic cancer – the same disease that killed Aretha Franklin. In May, Trebek said he was in near remission, with his response to treatment labeled a miracle.

But we urge caution in seeing this news as a “remission.” Complete responses to chemotherapy are rare when treating pancreatic cancer, and unfortunately usually short-lived. Despite Trebek's optimistic report, it is critical to have a realistic view of typical outcomes.

Vague Symptoms Make Detection Difficult

Pancreatic cancer is rare, but it has a high fatality rate. Although the disease only accounts for 3 percent of all cancers in the United States, it is responsible for 7 percent of cancer deaths.

What makes pancreatic cancer so dangerous is that it is difficult to detect until the disease has spread. The pancreas sits deep in the body, behind the abdomen. Small tumors can't be found during routine physicals, and currently, there are no screening tests, like there are for breast or colon cancers. People may have vague complaints, such as abdominal pain, weight loss or generalized weakness, but this varies, and the discomfort is often attributed to other physical ailments.

We know that smoking causes lung cancer, but we don't yet know what increases the risk of developing pancreatic cancer. A family history of pancreatic cancer is one indicator, but even knowing this, it is difficult to monitor or try to prevent the development of the disease.

Unfortunately, it's when the disease has grown, with tumors that cause complications in the pancreas, or when cells have migrated to other organs, that doctors can make a diagnosis. At that point, as with Trebek, the disease is advanced. Signs of advanced pancreatic cancer include jaundice, due to a tumor blocking the bile duct, or progressive liver failure, due to cancer cells entering the liver from the pancreas.

What Pancreatic Cancer Treatment Can Provide

When treating pancreatic cancer, oncologists focus on tumor removal, when possible, combined with chemotherapy and radiation. But, even when the tumor doesn't appear to have gone beyond the pancreas and imaging shows no evidence of disease, cancer may still have spread at a microscopic level. Once cancer has spread to other organs, for most people who have stage 4 pancreatic cancer, cures are not possible.

Although the current long-term survival rate for pancreatic cancer is grim, exceptions exist.  For those patients with disease that can be removed, known as “resectable,” the average survival is around three years.  One in four such people will survive to five years, at which point we usually expect that these lucky few will not die of pancreatic cancer. While this is true for patients with adenocarcinoma of the pancreas (95% of cases), patients with neuroendocrine tumors of the pancreas may experience much longer survival and cures.

The prognosis for pancreatic cancer is challenging, but research is always evolving. The best treatment outcomes are found at hospitals with multidisciplinary teams that focus on treating and managing this disease. These centers have medical, surgical and radiation oncologists who can combine their expertise to develop a strategy.

Another step patients with pancreatic cancer can take is to participate in clinical trials. This research is designed to help people live longer and achieve breakthroughs in treatment.

We wish Alex Trebek all the best as he continues his cancer treatment. At the same time, we urge caution in declaring an early victory over this deadly disease.