Pancreatic cancer, the “silent killer,” often difficult to diagnose early.

Known as the “silent killer,” pancreatic cancer has a five-year-survival rate of less than 10%. It is one of the least understood cancers among the general public.

Within the past year, civil rights hero Rep. John Lewis and “Jeopardy!” host Alex Trebek were diagnosed 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 cancerrelated deaths,” said Dr. Laith Abushahin, an oncologist at the 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, the National Cancer Institute says.

Who gets pancreatic cancer?

According to the American Society for Clinical Oncology, about 56,770 adults were diagnosed with the disease 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 people with genetic and hereditary considerations, those with a history of smoking and people who are overweight have a heightened risk of pancreatic cancer, the cancer institute says. People 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, the oncology society says, because of a lack of cost-effective screenings that can reliably detect pancreatic cancer for people without any symptoms.

“What makes it so challenging is there is no early detection,” said Julie Fleshman, president and CEO of Pancreatic Cancer Action Network.

What are the symptoms?

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

Symptoms tend to be nonspecific, such as stomach pain or nausea. Additional common symptoms include jaundice, light-colored stool, dark urine, loss of appetite and weight loss for unknown reasons.

What is stage 4 pancreatic cancer?

Lewis and Trebek were diagnosed with stage 4 pancreatic cancer.

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

How do you treat it?

The five-year survival rate for pancreatic cancer is 9%, according to the oncology society. The rate decreases as the cancer 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 5 patients are surgical candidates.”

For at-risk patients, the best way to detect it early on, said Abushahin, is to undergo 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.”

Pancreatic cancer is often difficult to diagnose early – which can make it difficult to treat.