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It’s too early to celebrate Alex Trebek being a ‘survivor’

Alex Trebek is riding the rollercoaster of cancer. In March, he shocked fans by announcing his Stage IV pancreatic cancer diagnosis. And now, the Jeopardy! host is in “near remission” of advanced pancreatic cancer. His response to the treatment is “kind of mind-boggling,” he says.

“The doctors said they hadn’t seen this kind of positive result in their memory … some of the tumors have already shrunk by more than 50 percent,” Trebek, 78, told People magazine for its June 10 edition. [1]

This is, however, a cautionary tale. There is a stark reality behind the headlines that many failed to acknowledge.

In an interview with ABC’s Robin Roberts, Trebek admitted, “Now, I have the summer months to recuperate and get strong again. I just have to get strong because, as you know, the chemo takes it out of you. I mean I feel so weak all the time, and that’s not a good place to be.” [2]

Complete remission does not equal cure. Tumor shrinkage does not always correlate with longer life. It’s simply too early in the treatment process to celebrate Trebek being a pancreatic cancer survivor.

A May 29 story on the Prevention website notes, at this point, advanced stage pancreatic cancer is basically incurable, “with no exceptions,” adds Dr. Jack Jacoub, a medical oncologist and medical director of MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, Calif.

“Up until the past few years, there were limited options for treatment. Over the past several years, there has been progress though. Shrinkage is uncommon in pancreatic cancer, although we see it,” Dr. Jacoub says. “The cancer cells remain, and the cancer would eventually recur. He will not be cured of cancer, but he may live longer than expected.” [3]

‘Not so common to see tumor shrinkage’

However, recent advances in chemotherapy have made significant improvements in pancreatic cancer treatment, especially considering:

  • Symptoms do not appear early on
  • There are no routine screening tests yet
  • Pancreatic cancer is often detected at a late stage
  • Late-stage cancers are generally harder to treat

The Pancreatic Cancer Action Network states the more cancer spreads, the more challenging treatment becomes. Surgery is the best option for the long-term survival of pancreatic cancer, however, if Stage IV cancer has spread to different parts of the body, it most likely cannot be removed by surgery.

A dense tissue layer, called the stroma, surrounds pancreatic tumors. This makes it hard for treatment to reach the tumor. [4]

“I think that the positive response that has been achieved here does happen in patients,” says Dr. Allyson Ocean, a medical oncologist at New York-Presbyterian and Weill Cornell Medicine. “I’d have to say it’s not so common to see tumor shrinkage like that, but we are seeing this more and more with the chemotherapy regimens that have been developed over the past decade.” [5]

Also, it is crucial to understand diagnosis and survival in terms of the American Cancer Society. Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. They can’t tell how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.

Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had specific type of cancer, but they can’t predict what will happen in any particular person’s case.

5-year survival rate for pancreatic cancer

Stage IV cancer is termed “distant” by the National Cancer Institute, which maintains the Surveillance, Epidemiology, and End Results (SEER) database that the American Cancer Society relies on to provide survival statistics for different types of cancer. [6]

In the United States, the SEER database tracks 5-year relative survival rates for pancreatic cancer based on how far cancer has spread:

Localized: There is no sign that cancer has spread outside of the pancreas. This includes Stage 0, I, and IIA cancers.

Regional: Cancer has spread from the pancreas to nearby structures or lymph nodes. This includes mainly Stage IIB and III cancers.

Distant: Cancer has spread to distant parts of the body such as the lungs, liver, or bones. For pancreatic cancer, this includes Stage IV cancers.

According to the SEER database, the 5-year survival rates for pancreatic cancer are less than encouraging:

Localized – 34%

Regional – 12%

Distant – 3%

Nonetheless, progress is being made in identifying factors associated with pancreatic cancer. Researchers know that up to 5% of pancreatic cancer cases are hereditary, and they’ve learned that people with a new diagnosis of type 2 diabetes or depression have a higher than average risk of being diagnosed with pancreatic cancer over the next few years.

“We in the field actually consider this an emergency,” Dr. Ursina Teitelbaum tells Health. She is the clinical director of the Penn Pancreatic Cancer Research Center at the University of Pennsylvania Perelman School of Medicine told Health. “We have to figure out how to detect and treat this because Alex Trebek is not the first – and will not be the last – well-known person or loved one to be diagnosed.” [7]

 

Citations

  1. Gillian Telling. Alex Trebek Reveals Some of His Tumors Have Shrunk by 50 Percent: ‘It’s Kind of Mind-Boggling.’ https://people.com/health/alex-trebek-pancreatic-cancer-near-remission/
  2. Michele R. Berman, MD, and Mark S. Boguski, MD, PhD. How Alex Trebek is Managing Grim Cancer Diagnosis. https://www.medpagetoday.com/blogs/celebritydiagnosis/80439
  3. Korin Miller. Alex Trebek Is in “Near Remission” From Stage 4 Cancer—but What Does That Mean? https://www.prevention.com/health/health-conditions/a27629016/alex-trebek-pancreatic-cancer-near-remission/
  4. Pancreatic Cancer Action Network. Stage IV Pancreatic Cancer. https://www.pancan.org/facing-pancreatic-cancer/diagnosis/staging/stage-4/
  5. Marty Munson. Alex Trebek Makes a Head-Turning Update About His Cancer Diagnosis. https://www.menshealth.com/health/a27630477/alex-trebek-pancreatic-cancer-update-tumor-shrinkage/
  6. American Cancer Society. Survival Rates for Pancreatic Cancer. https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html
  7. Amanda MacMillan. Why Stage 4 Pancreatic Cancer Is So Deadly – and Why Doctors Are Still Hopeful. https://www.health.com/condition/cancer/stage-4-pancreatic-cancer