Rep. John Lewis and Alex Trebek have pancreatic cancer. What are symptoms, treatments? – USA TODAY

Posted By on January 3, 2020

Known as the "silent killer," pancreatic cancerhas a five-year-survival rate of less than 10%. Itisone of the least understood cancers among the general public.

Within the past year,civil rights hero Rep. John Lewis and "Jeopardy!" host Alex Trebek werediagnosed with stage 4 pancreatic cancer.

The disease affects the pancreas, the small organ in the upper part of the backside of the abdomen between the stomach and the spine that is responsible for digesting food and regulating blood sugar levels.Although it accounts for only 3% of cancers, it causes 7% of cancer deaths, according to the American Cancer Society.

"Despite pancreatic cancer not necessarily being a prevalent one, it is responsible for a large amount of cancer-related deaths," said Dr. Laith Abushahin, an oncologist atthe Ohio State University James Comprehensive Cancer Center.

The majority of pancreatic cancers take place in cells that help digest food, known as the exocrine pancreas cells, per the National Cancer Institute (NCI).

According to the American Society for Clinical Oncology (ASCO),about 56,770 adults were diagnosed with pancreatic cancer in 2019. The incidence rate is 25% higher in black people than white people. Ashkenazi Jews also are at higher risk for pancreatic cancer, said Abushahin.

Aside from individuals with genetic and hereditary considerations, individuals with a history of smoking and individuals who are overweight have a heightened risk of pancreatic cancer, according to the NCI.

Individuals with pancreatitis,inflammation of the pancreas often caused by excess alcohol consumption, are also at higher risk for pancreatic cancer, Abushahin said.

It is often difficult to diagnose early, theASCOsays, because of a lack of cost-effective screenings that can reliably detect pancreatic cancer for people without any symptoms.

Stage 4 pancreatic cancer diagnosis: Expressions of support, faith for Rep. John Lewis abound

As a result, it is not often found until later stages of the disease.

"What makes itso challenging is there is no early detection," said Julie Fleshman, president and CEO of the advocacy organizationPancreatic Cancer Action Network (PanCAN). "Usually by the time it is diagnosed, it is late stage and more difficult to treat."

Trebek went to a doctor after experiencing persistent stomach pain, which led to his diagnosis,according to a PSA he released with theWorld Pancreatic Cancer Coalition.

Symptoms tend to be nonspecific, such as stomach pain or nausea.

Alex Trebek on pancreatic cancer battle: 'It's wearing on me ... but I just have to stick with it'

Additional common symptoms, according to the NCI, include jaundice the yellowing of the eyes or skin light-colored stool, dark urine, loss of appetite and weight loss for unknown reasons.

Lewis and Trebek were diagnosed with stage 4 pancreatic cancer.

At stage 4, the cancer is metastatic meaning it has spread outside of the pancreas to other parts of the body and it's more challenging to control and treat, saidRobert Glatter,an emergency physician at Lenox Hill Hospital in New York City.

Fifty to 60% of individuals diagnosed with pancreatic cancer have metastasis.

The five-year survival rate for pancreatic cancer is 9%, according to the ASCO. The rate decreases as the cancer progresses and metastasizes.

When it is detected early, Glatter said, the best course of action is surgery, which increases the five-year rate of survival to 15% to 25%. There is a caveat: "While surgery is the only way to cure pancreatic cancer," Glatter said,"less than 1 in 5patients are surgical candidates."

For at-risk individuals, the best way to detect it early on, said Abushahin, is toundergo more frequent imaging tests for the pancreas to check for abnormalities.

When surgical treatment is infeasible, especially as the cancer progresses outside the pancreas, chemotherapy and radiation may help treat the disease.

"Their overall effect," Glatter cautioned,"is minimal, given disease prognosis and severity."

Who has been diagnosed?

Aside from Lewis and Trebek, many prominent people have been diagnosed with pancreatic cancer. The list includes Apple co-founder Steve Jobs and soul legend Aretha Franklin both of whom were diagnosed with a rare neuroendocrine tumor in the pancreas as well as astronaut Sally Ride, actor Alan Rickman and jazz icon Dizzy Gillespie.

Supreme Court Justice Ruth Bader Ginsberg was diagnosed in 2009, which resulted in a removal of growths from her pancreas and spleen. She underwent three weeks of treatment for alocalized cancerous tumor found onher pancreas this year.

Contributing: Savannah Behrmann, Ken Alltucker

Follow Joshua Bote on Twitter: @joshua_bote

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