Jobs’s Pancreas May Be Removed After Complications (Update1)
Surgery that Apple Inc.’s Steve Jobs may be having to remove his pancreas could be the result of painful side effects from a cancer procedure, or the return of tumors he said were removed five years ago, doctors say.
If Jobs had a so-called Whipple procedure to excise the cancer, parts of his pancreas and other organs were removed. Sometimes, damage from cancer and the surgery can spur side effects, including enzyme leaks, that worsen in time, spurring a decision to remove the entire pancreas, said Robert Thomas, head of surgery at the Peter MacCallum Cancer Centre in Melbourne.
Most often, the pancreas is removed because the cancer has returned, said Andrew Lowy, head of the division of surgical oncology at Moores Cancer Center at the University of California, San Diego. In either case, patients must take insulin, a hormone produced in the organ, for the rest of their lives, along with enzymes to help digestion, the doctors said.
“We have to assume it’s quite likely that his disease may be harder to control, or coming back in a bigger way than we’d like to see,” said Simon Lo, director of the pancreas disease program at Cedars Sinai Medical Center in Los Angeles, in a telephone interview yesterday. “Speculation is dangerous without knowing all the facts, but if I were to guess I’d say this is not a good sign.”
Jobs hasn’t said whether the cancer has returned or spread. Last week Jobs, Apple’s chief executive officer, said he was getting “simple and straightforward” treatment for a hormone imbalance. Yesterday, the computer company said he was taking five months of leave because his “health-related issues” were more complex than he thought.
Most often, the pancreas is removed because the cancer has returned, said Andrew Lowy, head of the division of surgical oncology at Moores Cancer Center at the University of California, San Diego. In either case, patients must take insulin, a hormone produced in the organ, for the rest of their lives, along with enzymes to help digestion, the doctors said.
“We have to assume it’s quite likely that his disease may be harder to control, or coming back in a bigger way than we’d like to see,” said Simon Lo, director of the pancreas disease program at Cedars Sinai Medical Center in Los Angeles, in a telephone interview yesterday. “Speculation is dangerous without knowing all the facts, but if I were to guess I’d say this is not a good sign.”
Jobs hasn’t said whether the cancer has returned or spread. Last week Jobs, Apple’s chief executive officer, said he was getting “simple and straightforward” treatment for a hormone imbalance. Yesterday, the computer company said he was taking five months of leave because his “health-related issues” were more complex than he thought.
2004 Surgery
In 2004 Jobs said he underwent surgery to remove a neuroendocrine islet-cell tumor, a type of pancreatic cancer that can spur production of abnormal levels of hormones. The Whipple procedure can remove the cancer, but sometimes can result in dangerous leakage from the organ, Thomas said.
“Even with excellent surgery, there is an inexorable decline in survival of patients over the years and most patients end up dying of their pancreatic cancer despite having what seems to be effective surgery,” said Thomas, 66, who first performed the Whipple procedure more than 20 years ago.
When enzymes leak from the pancreas, they become toxic for other organs, Thomas said, and “you might have to take the rest of the pancreas out.”
Pancreatic leakage “is the most feared risk and it’s the most common issue” after Whipple operations, said Neil Collier, head of the hepatobiliary pancreatic unit at the Royal Melbourne Hospital in Melbourne. Collier has done about 200 Whipple procedures over 24 years. He wasn’t familiar with Jobs’s case.
Odds of Complications
“You are looking at something like a 40-to-45 percent chance of complications after the operation, so there are certainly reasons why further surgery could be necessary,” Collier said.
Once the pancreas is removed entirely, “you’re on significant doses of insulin, and it’s not easy to manage,” said Thomas, of the McCallum Center. “The person has the risk of severe diabetes.”
Neuroendocrine tumors can affect levels of hormones produced in the pancreas, including insulin and glucagon that help control blood sugar levels, and somatostatin and gastrin that are involved in digestion and other functions.
In 2004 Jobs said he underwent surgery to remove a neuroendocrine islet-cell tumor, a type of pancreatic cancer that can spur production of abnormal levels of hormones. The Whipple procedure can remove the cancer, but sometimes can result in dangerous leakage from the organ, Thomas said.
“Even with excellent surgery, there is an inexorable decline in survival of patients over the years and most patients end up dying of their pancreatic cancer despite having what seems to be effective surgery,” said Thomas, 66, who first performed the Whipple procedure more than 20 years ago.
When enzymes leak from the pancreas, they become toxic for other organs, Thomas said, and “you might have to take the rest of the pancreas out.”
Pancreatic leakage “is the most feared risk and it’s the most common issue” after Whipple operations, said Neil Collier, head of the hepatobiliary pancreatic unit at the Royal Melbourne Hospital in Melbourne. Collier has done about 200 Whipple procedures over 24 years. He wasn’t familiar with Jobs’s case.
Odds of Complications
“You are looking at something like a 40-to-45 percent chance of complications after the operation, so there are certainly reasons why further surgery could be necessary,” Collier said.
Once the pancreas is removed entirely, “you’re on significant doses of insulin, and it’s not easy to manage,” said Thomas, of the McCallum Center. “The person has the risk of severe diabetes.”
Neuroendocrine tumors can affect levels of hormones produced in the pancreas, including insulin and glucagon that help control blood sugar levels, and somatostatin and gastrin that are involved in digestion and other functions.
Tumor Recurrence
“The main reason to remove the rest of the pancreas” after a Whipple procedure “would be if the tumor recurred there,” Lowy said. “In garden-variety pancreas cancer that almost never happens. There are rare instances where the tumor could recur locally, and you could go in and try to remove the rest of the pancreas to get rid of the cancer.”
David Metz, associate chief for clinical affairs in the school’s division of gastroenterology at the University of Pennsylvania in Philadelphia, said a return of the cancer isn’t necessarily an early death sentence for Jobs. Some patients with neuroendocrine tumors live 20 years or longer, he said.
“Generally these tumors are slow growing, and occasionally they can be more aggressive and unpredictable,” Metz said in a telephone interview yesterday. He said he has no knowledge of Jobs’s case.
Apple yesterday announced Jobs will take a leave of absence from his job through June. Chief Operating Officer Tim Cook, who filled in for Jobs in 2004, has taken over Apple’s day-to-day operations, the Cupertino, California-based company said in a statement.
‘More Complex’
“During the past week I have learned that my health- related issues are more complex than I originally thought,” Jobs said in the statement.
The type of pancreatic cancer Jobs has said he had can cause symptoms that include weight loss, low blood sugar, and blood pressure changes, said Raji Annaswamy, an endocrinologist at Harvard Medical School in Boston, in a Jan. 5 telephone interview. Annaswamy hasn’t treated Jobs, and said she has no specific knowledge of his case.
Even if the cancer was defeated, the procedure can lead to a digestive condition known as dumping syndrome that causes people to lose weight, Lo, of Cedars Sinai Medical Center, said in a Jan. 5 telephone interview.
“It’s considered one of the most complicated surgeries in the abdomen,” said Lo, who hasn’t treated Jobs and doesn’t know details of his condition. “You’re creating a big hole in that area, and then trying to connect everything back together.”
“The main reason to remove the rest of the pancreas” after a Whipple procedure “would be if the tumor recurred there,” Lowy said. “In garden-variety pancreas cancer that almost never happens. There are rare instances where the tumor could recur locally, and you could go in and try to remove the rest of the pancreas to get rid of the cancer.”
David Metz, associate chief for clinical affairs in the school’s division of gastroenterology at the University of Pennsylvania in Philadelphia, said a return of the cancer isn’t necessarily an early death sentence for Jobs. Some patients with neuroendocrine tumors live 20 years or longer, he said.
“Generally these tumors are slow growing, and occasionally they can be more aggressive and unpredictable,” Metz said in a telephone interview yesterday. He said he has no knowledge of Jobs’s case.
Apple yesterday announced Jobs will take a leave of absence from his job through June. Chief Operating Officer Tim Cook, who filled in for Jobs in 2004, has taken over Apple’s day-to-day operations, the Cupertino, California-based company said in a statement.
‘More Complex’
“During the past week I have learned that my health- related issues are more complex than I originally thought,” Jobs said in the statement.
The type of pancreatic cancer Jobs has said he had can cause symptoms that include weight loss, low blood sugar, and blood pressure changes, said Raji Annaswamy, an endocrinologist at Harvard Medical School in Boston, in a Jan. 5 telephone interview. Annaswamy hasn’t treated Jobs, and said she has no specific knowledge of his case.
Even if the cancer was defeated, the procedure can lead to a digestive condition known as dumping syndrome that causes people to lose weight, Lo, of Cedars Sinai Medical Center, said in a Jan. 5 telephone interview.
“It’s considered one of the most complicated surgeries in the abdomen,” said Lo, who hasn’t treated Jobs and doesn’t know details of his condition. “You’re creating a big hole in that area, and then trying to connect everything back together.”
Thousands of Patients
Neuroendocrine islet-cell tumors are found in about 2,000 to 3,000 people in the U.S. annually, making them about 10 times less common than other pancreatic cancer, according to pancreatica.org, a cancer information Web site maintained by the Lorenzen Cancer Foundation in Monterey, California.
An Apple spokesman, Steve Dowling, declined to comment, citing Jobs’s statement yesterday as the company’s response.
Speculation about Jobs’s health surfaced in June after he appeared thinner at Apple’s conference for developers. The company said at the time that he was suffering from a “common bug” and declined to elaborate. The speculation persisted as he continued to appear frail at company events. Investors punished the company’s shares with each report of Jobs’s ill health.
Neuroendocrine islet-cell tumors are found in about 2,000 to 3,000 people in the U.S. annually, making them about 10 times less common than other pancreatic cancer, according to pancreatica.org, a cancer information Web site maintained by the Lorenzen Cancer Foundation in Monterey, California.
An Apple spokesman, Steve Dowling, declined to comment, citing Jobs’s statement yesterday as the company’s response.
Speculation about Jobs’s health surfaced in June after he appeared thinner at Apple’s conference for developers. The company said at the time that he was suffering from a “common bug” and declined to elaborate. The speculation persisted as he continued to appear frail at company events. Investors punished the company’s shares with each report of Jobs’s ill health.
‘A Mystery’
On Jan. 5, Jobs, who turns 54 in February, said the reason for his weight loss “has been a mystery to me and my doctors.”
“After further testing, my doctors think they have found the cause -- a hormone imbalance that has been ‘robbing’ me of the proteins my body needs to be healthy,” he said in the Jan. 5 statement. The remedy “is relatively simple and straightforward,” he wrote.
Jobs is a vegetarian and is skeptical of mainstream medicine, Fortune reported last year. He delayed cancer surgery for nine months while he followed alternative treatments, the magazine reported in March.
Jobs, who co-founded Apple in 1976, said in his Jan. 5 statement that he lost weight throughout 2008.
On Jan. 5, Jobs, who turns 54 in February, said the reason for his weight loss “has been a mystery to me and my doctors.”
“After further testing, my doctors think they have found the cause -- a hormone imbalance that has been ‘robbing’ me of the proteins my body needs to be healthy,” he said in the Jan. 5 statement. The remedy “is relatively simple and straightforward,” he wrote.
Jobs is a vegetarian and is skeptical of mainstream medicine, Fortune reported last year. He delayed cancer surgery for nine months while he followed alternative treatments, the magazine reported in March.
Jobs, who co-founded Apple in 1976, said in his Jan. 5 statement that he lost weight throughout 2008.
To contact the reporter on this story: John Lauerman in Boston at jlauerman@bloomberg.net; Jason Gale in Singapore at j.gale@bloomberg.net Last Updated: January 15, 2009 10:02 EST
No comments:
Post a Comment