A close-up of Alex Trebek

Television has changed a lot in the last few decades. Shows, channels, even whole broadcasting companies have come and gone. And that’s to say nothing of changes in format, content, and timing. But there have been some constants. Certain faces, theme songs, and shows that people could go back to again and again when they needed something familiar. And for 37 years, Alex Trebek was one of those faces.

CNN reports that Trebek started his career in journalism before transitioning into the role of gameshow host. He was at it a few years before he was asked to host a revival of the show "Jeopardy." Along with "Wheel of Fortune" and "The Price is Right," "Jeopardy" would go on to define evening television through the 80s, 90s, and early 2000s.

Sadly, however, even the familiar must come to an end. For "Jeopardy," that end came on November 08, 2020. A tweet from the show’s official account announced that Alex Trebek had died in his home, surrounded by family and friends. Though no cause of death was officially stated, it is widely believed that he died as a result of pancreatic cancer.

What is the pancreas?

Doctor holding an anatomical model of the pancreas

In 2019 Trebek announced that he had been diagnosed with stage 4 pancreatic cancer (via CNN). Stage 4 diagnoses are generally quite serious, as it means the cancer has spread from the original source to other parts of the body (via Cancer.Net). With pancreatic cancer, the outlook is rarely optimistic. This is because, as the American Cancer Society explains, pancreatic cancer is very hard to catch early on. The pancreas is located deep in the abdomen, specifically behind the stomach, and it produces our digestive fluid and the hormones we use to process the sugars we eat (via the Mayo Clinic). So while this placement near the stomach makes it easy for the pancreas to do its job, it makes it hard for doctors to detect tumors when they’re small. Complicating matters even further, the American Cancer Society explains that symptoms often don’t show up until the cancer is fairly advanced. And even then, some patients don’t experience symptoms at all until they’re well in to Stage 4.

Symptoms and risk factors

A man with jaundiced eyes

With pancreatic cancer, symptoms may not show up until the cancer is in its later stages (via Mayo Clinic). Some symptoms are fairly generic and could be attributed to other conditions, including fatigue, appetite changes or unexplained weight loss, and itchy skin. But other symptoms are somewhat unique, and when they occur together, they tend to point to pancreatic issues. These include light stools and dark urine, abdominal pain that spreads to the back, blood clots, yellowing or jaundice of the skin and the whites of the eyes, and a new diabetes diagnosis or a standing diabetes issue that suddenly becomes much more difficult to control.

Many of these symptoms also tie into some of the risk factors for pancreatic cancer, which include a high body weight and a pre-existing diabetes diagnosis, according to the American Cancer Society. Other risk factors include aging — the average age of diagnosis is 70 — tobacco use, family history or genetic issues, and exposure to chemicals commonly used in dry cleaning and metal working.

Testing and diagnosis

A patient receiving an MRI

Even if a patient is not showing symptoms, doctors may suspect pancreatic cancer or want to rule it out as a possibility. In these situations, the Mayo Clinic says there are several options they can use to secure — or rule out — a diagnosis. They range from non-invasive to procedures that patients may have to go under anesthesia for. The least invasive of these options are external body scans. These include CT scans, MRIs, and PET scans. External ultrasounds aren’t generally as helpful because of where the pancreas is located. If a doctor wants to perform an ultrasound, they are more likely to order an endoscopic ultrasound. The National Pancreas Foundation describes the process as minimally invasive, though some doctors will put a patient under general anesthesia for its duration. This is to make it easier for the doctor to put a tube down the patient’s throat to perform the ultrasound from inside the patient’s body. The doctor may also take a biopsy at that time by passing a second tube down the endoscopic line to collect a tissue sample.

The Foundation says that a doctor may also perform a fine-needle aspiration, where they use a very fine needle to withdraw pancreatic cells. The Mayo Clinic states that doctors may also perform this test starting from outside the patient’s body and going through the skin. They may also perform bloodwork looking for CA19-9 cells, which are given off by pancreatic cancer tumors.

Hands holding a purple pancreatic cancer ribbon