pancreatic cancer

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Steve Jobs’ Cancer: Major New Progress, But Still Fatal


Why did Steve Jobs have to die? What do scientists still not know about the type of cancer that he had? What might have saved him? These were the plaintive questions swirling in my head this morning.

I put them to Dr. Matthew Kulke, director of the carcinoid and neuroendocrine tumor program at the Dana-Farber Cancer Institute. Our conversation is below, but here’s my takeaway:

In fact, there has been very good news in the past year about the rare type of tumor that affected Steve Jobs, a pancreatic neuroendocrine tumor. For the first time in a generation, there are new treatments available, ‘targeted’ therapies that differ from conventional chemotherapy. But like many other forms of cancer, the disease is still not curable once it has spread. So early detection is key, and there’s hope for improved targeted therapies in coming years.

Dr. Matthew Kulke: “I think the main point, and perhaps the good that can come out of all the publicity about Mr. Jobs, is in awareness of these tumors. Not everyone is aware of them, and early diagnosis and awareness could be very helpful in identifying people early, at which time they can still be cured. The other important point is that with recent developments, even for people where they have spread beyond the point where surgery is helpful, there are now effective treatments for the first time in decades.

‘This is still a fatal disease, even though people can often live for years with it right now.’

(Dr. Kulke said he could not discuss Steve Jobs’ treatment specifically.)

There are really two different types of cancer that can arise in the pancreas. The most common is what people know of as pancreatic cancer, and that is quite a challenging disease to treat. What Mr. Jobs had is a more unusual type of cancer, which is a pancreatic neuroendocrine tumor. And these tumors, we think, arise from the islet cells in the pancreas — the cells that make hormones. And they do behave in a different way from the more common type of pancreatic cancer.

How? Continue reading

Steve Jobs: How To Live Before You Die

Here’s Jobs giving the commencement speech at Stanford in June 2005, shortly after his first surgery for pancreatic cancer, when he thought, or at least he said, that everything was fine.

The address is funny, wise and exceedingly sobering (how many graduation speakers tell 20-year-olds: “Your time is limited”).

Here’s Jobs on death as a motivating force:

“Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life, because almost everything — all external expectations, all pride, all fear of embarrassment or failure — these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking that you have something to lose. You are already naked — there is no reason not to follow your heart.”

(Hat tip to Tina Barseghian at MindShift, with a great tribute to Jobs today.)

What’s Wrong With Steve Jobs?

With Apple’s Steve Jobs back on leave to “focus on his health,” medical speculation is rife. The Los Angeles Times reports here that experts say the decision “was probably triggered either by an infection, a rejection episode related to his recent liver transplant or, most likely, a recurrence of his pancreatic cancer.”

But all cautioned that these are just educated guesses because so few details about his medical condition have been made public. “If we don’t know more, it is all speculation,” said Dr. Heinz-Josef Lenz, a gastrointestinal oncologist at USC’s Norris Comprehensive Cancer Center. “But we worry the tumor is back.”

Here in Boston, our friends at Celebritydiagnosis.com report here that:

The medical specifics of Jobs’ current medical condition were not revealed but, as we reported, Jobs underwent a liver transplant in June 2009. He also underwent treatment for an islet cell neuroendocrine tumor in 2004. This bit of health news is frequently reported as him having had pancreatic cancer, but as we have reported on several occasions, these are two completely different tumors. Although they both originate in pancreatic cells, the cells look and function differently, and have different prognoses.

Check out their earlier article setting the record straight that Jobs did not have “pancreatic cancer.”

All informed speculation welcome — news reports today talk about Apple having a deep bench, but still…

Pancreatic Cancer Kills: How One Survivor Copes

Loie Williams

Most people die from pancreatic cancer: Loie Williams survived.

What would you do if you found out you had one of the most lethal forms of cancer? Listen to the story of Loie Williams, who was diagnosed with pancreatic cancer at age 51, and just celebrated five years cancer-free this spring. She was interviewed by Dr. Annie Brewster, a Boston internist who started her own project recording patients and their families in the throes of coping with disease.

CommonHealth will periodically run “Listening To Patients” posts, in which we report the stories of individuals and how they deal with their illness. Here, Dr. Brewster speaks to Ms. Williams, of Newton, who, in 2005, noticed a very subtle fullness on the left side of her abdomen and reported it to her doctor. She was diagnosed with pancreatic cancer and underwent surgery and extensive chemotherapy.

Ms. Williams is incredibly lucky. Most people do not survive pancreatic cancer. On average, says Dr. Brewster, individuals with this disease survive 4-6 months after diagnosis, and only about 6% make it to five years. Early diagnosis is rare, as symptoms can be very subtle, or even nonexistent. All too often, the cancer is locally advanced or has spread outside of the pancreas by the time it is found, and surgery, the only curative treatment, is no longer an option. Even with surgery, prognosis is poor, with five year survival rates ranging from 10-30%.

Everyone copes with illness differently. For Ms. Williams, focusing on the positive was the key. She didn’t want to hear or think about the severity of her condition. In her words, “I protected myself by not knowing.” She chose not to read a lot about her cancer, and intentionally avoided the Internet. She decided she was going to get better (one mode of coping is riding in the Pan-Mass Challenge and, except in rare and fleeting moments, she did not allow herself to consider other options — like an early death. In talking to her young son, Ms. Williams decided to tell him that everything would be fine, even though she was well aware of the grim statistics.

Listen to her story and let us know how you, or someone you care for, coped with a bad cancer.

You can also listen to her husband, Wayne Welch, a pilot for American Airlines, and their son Chris, an incoming freshman at George Washington University, talk about their experiences.