In Apple's announcement of founder Steve Jobs' death, at age 56, Apple officials did not mention a specific cause of death, but the visionary digital leader had been battling pancreatic cancer since 2004.
Pancreatic cancer is one of the faster spreading cancers; only about 4% of patients can expect to survive five years after their diagnosis. Each year, about 44,000 new cases are diagnosed in the U.S., and 37,000 people die of the disease.
The pancreas contains two types of glands: exocrine glands that produce enzymes that break down fats and proteins, and endocrine glands that make hormones like insulin that regulate sugar in the blood. Jobs died of tumors originating in the endocrine glands, which are among the rarer forms of pancreatic cancer.
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In 2004, Jobs underwent surgery to remove the cancer from his pancreas. In 2009, after taking another leave of absence from Apple, Jobs had a liver transplant in an effort to retain as much of his organ function as possible after his cancer had spread beyond the pancreas. In January, he took a third leave from the company before resigning as CEO in August.
"I have always said if there ever came a day when I could no longer meet my duties and expectations as Apple's CEO, I would be the first to let you know," Jobs wrote in a letter to the Apple board of directors on August 24. "Unfortunately, that day has come."
According to experts, Jobs' was an uphill medical battle. "He not only had cancer, he was battling the immune suppression after the liver transplant," Dr. Timothy Donahue of the UCLA Center for Pancreatic Disease in Los Angeles, who had not treated Jobs, told MSNBC.com. He noted that most patients who receive liver transplants survive about two years after the surgery.
Standard treatments for pancreatic cancer include the common tumor-fighting strategies — surgery, chemotherapy, radiation and, most recently, targeted anticancer drugs that may slightly extend patients' lives. In 2005, the Food and Drug Administration approved erlotinib, a drug that specifically targets growth factors found on cancer cells, for the treatment of patients with advanced pancreatic cancer who are receiving chemotherapy. The drug has been shown in trials to improve overall survival by 23% after a year when added to routine chemotherapy. The tumors in patients being treated with erlotinib and chemo also develop more slowly than those in patients receiving chemotherapy alone.
The Long, Extraordinary Career of Steve Jobs
Because of the poor prognosis of pancreatic cancer, however, many patients elect to try alternative therapies, including a popular therapy known as the Gonzalez regimen, which involves fighting pancreatic tumors with pancreatic enzymes. Patients on the Gonzalez regimen also take a large number of nutritional supplements, including vitamins and minerals such as magnesium citrate, along with coffee enemas performed twice a day.
The treatment's developer, Dr. Nicholas Gonzalez of New York, has claimed that the use of pancreatic enzymes is a powerful way to suppress the growth of advanced pancreatic cancer cells. But a study published in the Journal of Clinical Oncology in 2009, which compared groups of patients on the Gonzalez regiment to patients on standard chemotherapy treatment, found that those on chemo survived for a median of 14 months while those on the alternative therapy survived for a median of only 4.3 months.
Jobs is not reported to have tried the Gonzalez regimen, but he is known to have suscribed to alternative therapy. In a 2008 story, Fortune reported that Jobs initially tried to treat his tumor with diet instead of surgery, soon after he was diagnosed in 2004. In January, Fortune reported that he had also made a hush-hush trip to Switzerland in 2009 for a radiation-based hormone treatment. The exact details aren't clear, but the University Hospital of Basel in Switzerland is known for its special form of treatment for neuroendocrine cancer, which is not available in the U.S.
Whether these treatments helped to extend Jobs' life or improve the quality of his last days isn't clear. But cancer experts expressed surprise that Jobs survived as long as he did, continuing to fight his disease. Other pancreatic cancer patients typically aren't as fortunate. Another high-profile patient, actor Patrick Swayze, managed to live for 20 months after his diagnosis, taking advantage of chemotherapy treatments. But, overall, patients' median survival is generally only five months.
VIDEO: Steve Jobs' Career at Apple (in Two Minutes)
Jobs lost his battle with cancer at a time when researchers are constantly pushing the boundaries of treatments, particularly with antitumor agents that can home in on abnormally growing cells with increasing precision. In the end, his cancer proved too advanced to rein in with even the most innovative technologies.
"Apple has lost a visionary and creative genius, and the world has lost an amazing human being," Tim Cook, Jobs' successor at Apple, wrote to employees on Wednesday. "Steve leaves behind a company that only he could have built, and his spirit will forever be the foundation of Apple."
Showing posts with label Pancreatic cancer. Show all posts
Showing posts with label Pancreatic cancer. Show all posts
Wednesday, October 5, 2011
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.
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.
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