A Medical Gamble
Begley, Sharon, Newsweek
Byline: Sharon Begley; Sharon Begley writes about science and health for Newsweek.
Cancer in the pancreas doesn't have to be a death sentence. How Steve Jobs tried--but failed--to beat the odds.
Steve Jobs was right to be optimistic when, in 2004, he announced that he had cancer in his pancreas: for although cancer of the pancreas has a terrible prognosis (half of all patients die within 10 months of the diagnosis), cancer in the pancreas is not necessarily a death sentence. The difference is that pancreatic cancers arise from the pancreatic cells themselves; this is the kind that killed actor Patrick Swayze in 2009. But cancers in the pancreas, called neuroendocrine tumors, arise from islands of hormone-producing cells that happen to be in that organ.
Jobs learned in 2003 that he had an extremely rare form of this cancer, an islet-cell neuroendocrine tumor. As the name implies, it arises from islet cells, the specialized factories within the pancreas that produce and secrete insulin, which cells need in order to take in glucose from the food we eat. Unlike pancreatic cancer itself, with neuroendocrine cancer "if you catch it early, there is a real potential for cure," says cancer surgeon Joseph Kim of City of Hope, a comprehensive cancer center in Duarte, Calif. But although neither Apple nor those close to Jobs were willing to discuss the treatments he elected or the course of his disease, interviews with experts on neuroendocrine tumors suggest that some of the choices he made did not extend his life, and may have shortened it.
The cancer was detected during an abdominal scan in October 2003. He reportedly had the scan--which is seldom done, much less advised, as a routine part of a physical--because he had a history of gastrointestinal problems, but he may have also been experiencing symptoms, most likely gastrointestinal ones. Those tend to arise from the hormone that the particular neuroendocrine tumor produces, explains medical oncologist Matthew Kulke of Dana-Farber Cancer Institute in Boston. In Jobs's case, that was insulin. The main effect of high insulin levels is very low blood sugar, which can lead to shakiness, cold sweats, nausea, vomiting, and neurological changes, such as impaired judgment, moodiness, irritability, apathy, and confusion.
There is virtually no debate about the best treatment. "It has long been held that surgery can lead to very long-term survival," says Kim. In a 2010 analysis of cancer registries, he and colleagues found that patients with neuroendocrine cancer who were eligible for surgery (those whose cancer has not spread beyond the pancreas) "can have outstanding outcomes," living for many more years. In part, that is because neuroendocrine cancers tend to be quite slow-growing: even those that have been present for years, and in some cases decades, often stay safely confined to the pancreas. In fact, this kind of cancer can be so indolent that patients often die with it than from it. Although an estimated 2,000 to 3,000 people in the U.S. are diagnosed every year with neuroendocrine tumors of the pancreas, autopsies find the disease in hundreds more--people who were apparently not harmed by the cancer.
Despite the expert consensus on the value of surgery, Jobs did not have surgery right away. He spent nine months on "alternative therapies," including what Fortune called "a special diet." But when a scan showed that the original tumor had grown, he finally had it removed on July 31, 2004, at Stanford University Medical Clinic. In an email to Apple employees, Jobs said his form of cancer "can be cured by surgical removal if diagnosed in time (mine was)," and told his colleagues, "I will be recuperating during the month of August, and expect to return to work in September." Jobs's upbeat report was not unrealistic: most patients diagnosed with neuroendocrine tumors in the pancreas live at least another 10 years.
Not that the surgery was a walk in the woods. …