Rare Pancreatic Cancer that took Steve Jobs

Steve Jobs has battled a rare form of pancreatic cancer for years, undergoing a series of aggressive treatments, including a liver transplant, and surviving longer than many others with the disease. After a long batter with this aggressive cancer he passed leaving behind a legacy that will last a lifetime.

Job's decided to step down as Apple's CEO, however, signals that his disease — kept in check for more than seven years — is advancing beyond doctors' ability to control it, experts say.
While no one can say how Jobs will fare, "I suspect we will not be talking about years" of additional survival, says Zev Wainberg, a gastrointestinal oncologist with UCLA's Jonsson Cancer Center with no personal knowledge of the case.
Jobs suffers from a pancreatic neuroendocrine tumor, which accounts for only about 5% of the 43,000 pancreatic cancers diagnosed each year, and is generally more curable than more common types of pancreatic cancer, says Margaret Tempero, a pancreatic cancer expert at the University of California-San Francisco and former president of the American Society of Clinical Oncology. Patients with the most common of pancreatic cancer forms often live less than a year, says Tempero, who has not treated Jobs.

Neuroendocrine tumors, which arise in hormone-producing cells of the pancreas, typically grow much more slowly, allowing patients to live at least two or three years, says Wainberg, who hasn't treated Jobs.
Unless the disease is completely eradicated, however, the cancer eventually takes a turn for the worse, growing much more quickly, Wainberg says.
"People can co-exist with this disease for years," says Richard Goldberg, an expert in neuroendocrine tumors at the University of North Carolina-Chapel Hill, who has not treated Jobs. If the liver begins to fail, however, "people can go downhill pretty quickly. When you hit the wall, you hit the wall."
Only about 10% of people with metastatic disease — cancer that has spread around the body — survive this type of tumor, Goldberg says.
With Jobs' work ethic and strong love of his job, doctors say his decision to resign as Apple CEO suggests that he must be feeling very ill.
"Given his will to dominate, you'd have to speculate that he must not be doing well," says James Abbruzzese, a pancreatic cancer expert at Houston's M.D. Anderson Cancer Center. Abbruzzese, one of the USA's leading pancreatic cancer specialists, consulted on Jobs' care early in the course of his treatment, but has not participated in Jobs' treatment in several years.
Jobs has undergone aggressive treatment for the cancer, which he first acknowledged in 2004. Jobs had surgery to treat the original cancer, then underwent a liver transplant in 2009.
That suggests that his original tumor had spread from his pancreas to his liver, in spite of surgery to remove it, says Tempero.
Liver transplants for this kind of tumor are "occasionally successful, but it's a real long shot," Tempero says.
Patients who receive organ transplants must take drugs to prevent the body from rejecting the new organ, Tempero says. But because these drugs also suppress the immune system, they can allow the original cancer to re-emerge and attack either the new liver or other organs.
In rare cases, a liver transplant may cure the patient's cancer, if it hasn't spread around the body, Abbruzzese says.
More often, the transplants helps restore normal liver function, giving patients a few more years with a better quality of life, Abbruzzese says.
The fiercely private Jobs has said relatively little about his health problems, although he did acknowledge his bout with cancer during a commencement speech at Stanford University. "No one wants to die," he said. "And yet death is the destination we all share. No one has ever escaped it."
Actor Patrick Swayze died of the more common type of pancreatic cancer in 2009, as did opera star Luciano Pavarotti in 2007. Supreme Court Justice Ruth Bader Ginsburg also has had pancreatic cancer.
Doctors don't know what causes neuroendocrine tumors, Abbruzzese says.
The most common types of pancreatic cancer, however, are linked to smoking and obesity, and possibly to a diet filled with red meat and fat. Those at greater risk include men, African-Americans, people older than 50, diabetics and those with a family history of pancreatic cancer. Chronic inflammation of the pancreas and exposure to certain chemicals also can cause the disease.
Scientists are actively studying ways to find the disease earlier, when it might be more curable, by looking at families in which several people have developed the cancer. Researchers also are searching for genes that may be involved. In January, scientists at Johns Hopkins University in Baltimore announced that they had deciphered the genetic code, or genome, of neuroendocrine tumors, which they hope will lead to better treatments.
Tempero notes that the Food and Drug Administration approved two new drugs for neuroendocrine tumors, sunitinib and everolimus, this year.
"Apple is in incredible shape, and you could say that Jobs has changed many of our lives for the better," Goldberg says. "I'm sorry to see him affected by this; it only redoubles my resolve to improve on the treatments we have."


Steve Jobs suffered a very rare type of cancer and lived and suffered with it for years. I hope his family and friends can find peace knowing that he is no longer suffering.