Why Is Pancreatic Cancer So Deadly?

Fact checked by Nick Blackmer

• Longtime TV show host Jerry Springer died of pancreatic cancer last week, his family and publicist confirmed.

• Springer, 79, "didn't have cancer for very long," a family friend shared, noting that his illness was "brief."

• A short illness timeline is common among pancreatic cancer patients, since the disease is often diagnosed in later stages and is very difficult to treat.

Longtime TV show host and former mayor of Cincinnati Jerry Springer died of pancreatic cancer last week, his family and publicist confirmed on Thursday.

It’s not yet clear when Springer, 79, was diagnosed with cancer, though a family friend shared that “he didn’t have cancer for very long,” and that his illness was "brief."

This is not the first time that pancreatic cancer has been making headlines in recent years—celebrities and politicians such as Alex Trebek, Ruth Bader Ginsburg, and John Lewis also died of pancreatic cancer.

As brief as Springer’s cancer diagnosis was, experts explained that a short illness timeline is often common with pancreatic cancer in particular.

It’s incredibly difficult to find pancreatic cancer in its early stages, so most people are diagnosed after the cancer has already progressed to some degree. There is also a lack of effective screening and treatment options for many people.

“[The cancer is] in an organ that’s close to a lot of blood supply, so it frequently leaves the pancreas,” Adam Templeton, MD, medical director of the Digestive Health Center at the University of Washington School of Medicine, told Health. “[It] can quickly go from being something that’s really small, to all of a sudden being in a lot of different places, which makes it really hard to treat.”

Here’s what experts had to say about why pancreatic cancer is so dangerous, who’s most at risk, and how more awareness about the disease can prompt change.

Pancreatic Cancer Spreads Quickly and Is Hard to Spot

The pancreas is a small organ that sits in the abdomen near the stomach, gallbladder, liver, and small bowel, and is responsible for digestion and making hormones.

There are two different types of pancreas cells that handle either digestion or blood sugar control—exocrine cells and endocrine cells—and both types of cells can lead to cancer, though tumors in the exocrine cells, or those that aid in digestion, tend to be more aggressive and deadly, Timothy Frankel, MD, associate professor of surgery at University of Michigan, told Health. 

Springer’s family has not yet said which type of pancreatic cancer he had.

“One of the things that is really interesting about pancreas cancer is that it's not such a common cancer, but it is the third leading cause of cancer deaths in the United States,” Felice Schnoll-Sussman, MD, director of the Jay Monahan Center for Gastrointestinal Health at NewYork-Presbyterian Weill Cornell Medical Center, told Health. “Only a small amount of patients with pancreas cancer are alive five years after their diagnosis.” According to the American Cancer Society, the five-year relative survival rate for pancreatic cancer is 12%.

The reason for this, ultimately, is that most people who get diagnosed with pancreatic cancer don’t know they have it until their cancer has already progressed, experts explained. And this later-stage cancer is often very difficult to treat.

Pancreatic cancer spreads fast, Dr. Frankel said, which in part explains why it’s so difficult to get an early diagnosis. Even when the tumor is small, he said, it can start to spread, or metastasize, throughout the body.

“It’s usually discovered after it’s already spread from the original tumor to elsewhere in the body,” Dr. Frankel said. “And once that happens, then surgery—which is really the only curative option for pancreas cancer—is no longer an option.”

The other reason that pancreatic cancer is oftentimes detected late is that people often don’t experience or don’t notice symptoms of the illness at first, experts explained.

“The signs can actually seem like many other things, and they can be very, very subtle,” Dr. Schnoll-Sussman said. “There aren’t often signs and symptoms of pancreas cancer that 100% point to the pancreas.”

Jaundice, or yellowing of the skin and eyes, is sometimes a sign of pancreatic cancer, though not all patients will experience this, Dr. Schnoll-Sussman explained. Other symptoms include belly pain, nausea, vomiting, weight loss, loss of appetite, or even sometimes diabetes onset, she added.

But it’s easy for patients to write these symptoms off, or for pancreatic cancer signs to be confused with irritable bowel disease, gallbladder issues, or something else, she added.

Besides the related symptoms, the actual tumor in the pancreas is also challenging to spot for both the patient and the healthcare professionals.

“It’s not like breast cancer or prostate cancer, where it impacts things that people might see or feel,” Dr. Templeton explained. “And a lot of our typical imaging has a hard time visualizing the pancreas cancer. So it’s not like an abdominal ultrasound would necessarily pick up on things.”

Related:How I Knew I Had Pancreatic Cancer in My 30s—and What the Journey Has Been Like

How Do You Know If You’re High Risk, and What Can You Do About It?

As difficult as it is to find pancreatic cancer in earlier stages, it can certainly be done, Dr. Schnoll-Sussman said. Though they’re a small percentage, people do survive the diagnosis, she added.

One of the best ways to do this is through screenings, again, because of how difficult it is to notice the tumor or its symptoms in early stages. But unlike breast cancer or colon cancer, there’s no recommendation for screening the general population for pancreatic cancer.

“Right now, there are no so-called early detection tests,” Dr. Frankel said. “There are some relatively invasive tests to check for new pancreas cancers and because they are relatively invasive, we sort of reserve those for people who are at the highest risk.”

Those at high risk would mean people with a strong family history of pancreatic cancer, or those with a known genetic risk, experts agreed.

The BRCA1 and BRCA2 genes—typically associated with breast cancer—can also increase a person’s risk of pancreatic cancer, Dr. Schnoll-Sussman explained. There are also some genetic mutations specific that make a person more susceptible to pancreatitis and pancreatic cancer, she said.

“If you were to be part of a family, and had multiple family members that had pancreas cancer—especially if [they had] pancreas cancer at a young age—you should speak to your physician,” Dr. Schnoll-Sussman said. “We would do genetic testing on that individual to look for one of these types of mutations.”

Besides specific genetic risk factors, some specific groups of people are more likely to have pancreatic cancer, though it’s not completely clear how they’re linked. Pancreatic cancer is more commonly seen in Black Americans, people who smoke, men, older people, and those who are overweight. Some research has found that it’s on the rise in younger women as well.

People can speak to their doctor about getting screened for pancreatic cancer, specifically if they have an elevated risk due to family history. This usually involves imaging, Dr. Schnoll-Sussman said, such as a CAT scan or an MRI.

And if pancreatic cancer is detected, doctors will determine if they can remove the tumor surgically or not. If the cancer hasn’t spread significantly, said Dr. Frankel, doctors may be able to remove the tumor. But depending on where the tumor is, that surgery can be incredibly invasive, Drs. Templeton and Schnoll-Sussman said.

Doctors may also give chemotherapy to pancreatic cancer patients both with and without surgery. There are currently two immunotherapy options for some kinds of pancreatic cancer, and others are currently in clinical trials.

“Unfortunately, all of the therapies that we currently have are relatively ineffective,” Dr. Frankel said. “Lung cancer, melanoma, kidney cancer—we now have immune based therapies where we're actually curing patients, and often extending life significantly. No such therapy exists for pancreas cancer.”

More Research to Improve Prognosis in the Future

As difficult as a pancreatic cancer diagnosis is, it’s not all “doom and gloom,” Dr. Templeton said.

Research for therapies is currently ongoing, he said, as are advances in genetics so that patients can receive targeted treatments, Dr. Schnoll-Sussman added.

Historically, Dr. Frankel added, research for pancreatic cancer has been underfunded. And more attention on the disease certainly doesn’t hurt efforts to find new advances in therapies.

This public discussion about pancreatic cancer is also important because it can be a catalyst for learning more about how to recognize possible symptoms, experts agreed. People suspecting that something’s wrong could lead to earlier diagnoses and better survival rates.

“You really have to know your body, you have to really understand yourself. If something is changing in you, you can’t die of fear,” Dr. Schnoll-Sussman added. “Some patients will get very lucky and find these diseases early, but it’s only the patients who present early.”

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Read the original article on Health.