What killed Steve Jobs?
What killed Apple’s visionary founder and CEO Steve Jobs? Neither his company nor his family have disclosed the cause of death, but medical experts not involved in his care suspect his cancer had returned.
Steve Jobs had battled a rare type of slow-growing pancreatic cancer for more than seven years. Medical experts say his need for a liver transplant two years ago signaled that his cancer had likely returned or spread. They said his death could have been from cancer, his new liver not working, or complications from immunosupressive drugs that prevent organ rejection.
Jobs declared he was cured in 2004, following surgery for a so-called islet cell neuroendocrine tumor. That rare form of pancreatic cancer is considered more treatable than the form of the disease that killed actor Patrick Swayze in 2009.
“Neuroendocrine tumors are uncommon, with only a few thousand cases a year,” Dr. Craig Devoe, a pancreatic cancer expert at North Shore-LIJ Health System in New Hyde Park, N.Y, told HealthDay. Devoe speculated that fewer than 1,000 of these cases strike the pancreas. Overall, there are about 43,000 cases of pancreatic cancer each year, which kills nearly 38,000 people.
Treatment options vary but include chemotherapy, hormone therapy, and surgery to remove the tumor or surrounding tissue.
A liver transplant can cure Jobs’ type of cancer, but “if it were to come back, it’s usually in one to two years,” said Dr. Michael Pishvaian, a gastrointestinal cancer specialist at Georgetown University.
Intensely private, Jobs never revealed whether the cancer had spread to his lymph nodes or liver, or the extent of his surgery. Some doctors speculated he had a Whipple procedure, in which a portion of the pancreas and small intestine, the gallbladder, and in some cases part of the stomach are removed and the remaining organs are reattached to allow for digestion.
Steve Jobs is the Chairman and CEO of Apple Computers Inc. and arguably one of the world’s most successful businessmen today.
He founded Apple in the 1970s, got chased out by his own board of directors, but returned eventually as Apple’s CEO. Since then, he has revolutionized the IT industry with his creations like the MacBook, the iPod and the iPhone.
Since his return, he has brought Apple Computers Inc. from a fledging company to a global force to be reckoned with.
“It’s a big operation” that can lead to digestive difficulties, said Dr. Steven Libutti, director of the Montefiore-Einstein Center for Cancer Care in the Bronx.
“Weight loss when it comes to advanced cancer is never a good thing,” said Dr. Jack Jacoub, a medical oncologist at MemorialCare Cancer Institute at Orange Coast Memorial Medical Center in Fountain Valley. Keeping body weight up and healthy while fighting the disease is key, he added. “We use 10% weight loss as being a negative prognosticator.”
There’s a propensity for the disease to spread from the pancreas to the liver, Jacoub said - which is why many local treatments focus on attacking cancer cells in the liver, including destroying them with heat or surgically removing them.
In some cases, removing a diseased liver entirely and replacing it with a donor liver is an option - but liver transplants aren’t that common among people with this type of pancreatic cancer, Dr. Craig Devoe said in August. Devoe is an an oncologist at the North Shore-LIJ Health System in New Hyde Park, N.Y., who specializes in pancreatic cancer. But a transplant can be done when other options have run out or when the disease has spread to the liver. It’s not typically thought of as a cure.
Jobs was dramatically thinner in the years following the procedure. In January 2009, he attributed those problems to a hormone imbalance and said there was a simple treatment for it. Weeks later, he went on medical leave and then had a liver transplant, which was kept secret for two months.
At the time, Jobs would not say why the transplant was needed, though doctors speculated that the likely explanation was that the cancer had spread to his liver.
People with cancer typically don’t undergo transplant surgeries, but “there is some support for the idea that a liver transplant can be curative” for a neuroendocrine tumor as long as the cancer has not spread beyond the liver, Pishvaian said.
Patients with neuroendocrine tumors that have spread survive on average for seven to eight years, but some patients have lived an additional 20 to 30 years, said Dr. Martin Heslin, cancer surgery chief at Vanderbilt University.
Sadly for Jobs, this was not the case - this past January, he announced his third and final leave of absence, and resigned in August, CBS News reported.
Pancreatic Neuroendocrine Tumors
The majority of neuroendocrine tumors can be divided into two classes: carcinoid and pancreatic neuroendocrine tumors. Neuroendocrine tumors that arise in the pancreas are called “pancreatic neuroendocrine tumors” or “islet cell tumors.” Pancreatic neuroendocrine tumors can include: nonfunctional tumors, insulinomas, glucagonomas, gastrinomas, VIPomas, somatostatinomas, GHRHomas, and other less frequent tumors.
Pancreatic neuroendocrine tumors are usually indolent (slow-growing) by nature and develop over the course of many years. Pancreatic neuroendocrine tumors are usually more indolent, with better prognosis than adenocarcinoma of the pancreas (Carriaga & Henson, 1995). However, aggressive, fast growing pancreatic neuroendocrine tumors exist and different types of pancreatic neuroendocrine tumors exhibit different clinical courses and growth rates (Metz & Jensen, 2008).
Since neuroendocrine tumor cells are derived from neuroendocrine cells, many of these tumor cells can behave like cells they originated from and can secrete a variety of functional hormones and chemicals (Metz & Jensen, 2008). Pancreatic neuroendocrine tumors secrete Chromogranin A which can be used as a diagnostic and prognostic tool (Norton, Kivlen, Li, Schneider, Chuter, & Jensen, 2003). A functioning pancreatic neuroendocrine tumor secretes biologically active hormones causing a characteristic clinical syndrome. Non-functioning pancreatic neuroendocrine tumors do not cause a characteristic clinical syndrome.
Functioning pancreatic neuroendocrine tumors can hyper-secrete (over produce) substances such as gastrin, insulin, glucagon, vasoactive intestinal peptide (VIP), and somatostatin, resulting in a characteristic clinical syndrome (Tomasseti, Migliori, Lalli, Campana, Tomassetti, Corinaldesi, 2001).