Steve Jobs and Pancreatic Cancer

Steve Jobs, the visionary co-founder of Apple, died, at age 56 on October 5, 2011. The American CEO of Apple Inc. and former chief executive of Pixar Animation Studios died of complications from pancreatic cancer.

This information is not news, but aside from the technological legacy that Jobs left, his medical case serves as a cautionary tale for the rest of us. As oncologists, we clearly recognize the importance of early screening and detection. This is the only way to increase a patient’s chances for cure, including patients of pancreatic cancer.

Jobs’ battle with cancer

Jobs’ battle with cancer went like this. In October 2003, Jobs was diagnosed with a tumor of the islet cells of the pancreas. Despite his diagnosis, Jobs reportedly did not follow his doctors’ recommendations for receiving mainstream medical intervention for nine months. Instead, he tried a vegan diet, acupuncture, herbal remedies and other treatments that he found online. He also was influenced by a doctor who advised juice fasts, bowel cleansings and other unproven approaches before finally having surgery in July 2004.

According to Jobs’ biographer, Walter Isaacson, “for nine months he refused to undergo surgery for his pancreatic cancer – a decision he later regretted as his health declined.” He eventually underwent a pancreaticoduodenectomy (also called a “Whipple procedure”) in July 2004 that appeared to successfully remove the tumor. Apparently, the cancer later spread to the liver. He received a liver transplant in 2009, which was not necessarily a standard treatment. He then took three medical leaves of absence as Apple’s chief executive before stepping down in August 2011.

Pancreatic cancer – epidemiology

Although pancreatic cancer is a relatively uncommon malignancy as compared to that of the lung or breast, it is a cancer of high mortality as it is ranked as the fourth and sixth leading cause of cancer death, respectively, in the United States and in China. Pancreatic cancer can be categorized by its cells of origin: 1) endocrine cancer and 2) exocrine cancer.

Approximately 95% of pancreatic cancer originates from the exocrine glands (a.k.a. adenocarcinoma). Endocrine pancreatic cancer is much rarer and accounts for less than 5% of tumors of the pancreas. Pancreatic cancer originating from the islet cells of the pancreas is also called neuroendocrine tumor (NET). A pancreatic NET may secrete a variety of peptide hormones, including insulin, gastrin, glucagon, and vasoactive intestinal peptide (VIP), resulting in a myriad of clinical syndromes. However, the pancreatic NET, like the one Jobs had, generally grows more slowly than adenocarcinoma.

For people who have the cancer Jobs had, it is not uncommon to live for years because the cancer grows slowly. Jobs himself lived for 8 years with the disease. On the other hand, adenocarcinoma of the pancreas is a more aggressive disease. Survival is usually measured in months. Ralph Steinman, a cell biologist, was considered a remarkable case because he lived with pancreatic adenocarcinoma for 4 years until he died three days before being named one of three winners for the 2011 Nobel Prize in Medicine.

Risk factors for pancreatic cancer

The only known risk factor for pancreatic NET is heredity. For example, patients with a family history of multiple endocrine neoplasia type 1 (MEN1) are at a high risk for developing pancreatic NET. MEN1 is an autosomal dominant disease characterized with tumors of the parathyroid glands (which occur in nearly all patients by age 50 years), anterior pituitary, and pancreatic islet cells (abbreviated as the “3 P’s”).

On the other hand, there are multiple risk factors for the occurrence of pancreatic adenocarcinoma. These risk factors include cigarette smoking, obesity and physical inactivity, chronic pancreatitis (alcohol-associated or hereditary), and familial history.

Symptoms and treatment possibilities

Patients with pancreatic cancer commonly experience symptoms of abdominal pain, weight loss and/or loss of appetite. If you experience any of these symptoms for an extended period of time, make sure to schedule a checkup. Caught early, all cancers have remarkably good chances of being cured. Additionally, the pancreas is a hormonal hub in the body. If your pancreatic function is compromised, other bodily functions and your state of mind may be affected as well. Talk to your doctor if you think you might be at risk for pancreatic cancer.

If pancreatic cancer is diagnosed, CT scans of the abdomen may reveal a mass in the pancreas, usually at the pancreatic head. For either endocrine or exocrine pancreatic cancer, surgery is the treatment of choice for localized diseases. For tumors that cannot be removed by surgery, a patient may consider chemotherapy with or without radiation for adenocarcinoma. More recently, molecular-targeting medications, evirolimus and sunitinib, have been approved for treatment of metastatic pancreatic NET.

At the end of the day, there is so much that we cannot control in our lives and the world. However, we can make efforts to keep ourselves as healthy as possible. Take care of yourselves, physically, socially, emotionally and spiritually.