Most people with pancreatic cancer die within a year of diagnosis. Even those with small tumors that can be completely removed by surgery usually die within two years, with only about one-fourth living to 5 years.
Steve Jobs, on the other hand, survived 7 years, and he rarely missed a day of work except for two breaks for treatment. Why the difference? Was it money, brains, persistence, or just luck?
The answer is none of the above. Jobs had a rare type of cancer within his pancreas, neuroendocrine cancer, and his medical course was typical for it. He did not have the usual kind of pancreatic cancer, like the kind of that killed Patrick Swayze.
The difference between the two cancer types is significant. Patrick Swayze’s cancer, adenocarcinoma, grows quickly, invades organs, and is treated with radiation, chemotherapy, and occasionally surgery. In spite of treatment, it returns with a vengeance to the pancreatic area or spreads to other areas, rapidly leading to organ damage, pain, and eventual death within a year or two. Neuroendocrine tumors, on the other hand, are slow-growing and poorly invasive, and may persist for years. The average survival of early stage neuroendocrine cancer is 5 – 9 years, but many live for decades.
The difference is due to the fact that neuroendocrine tumors arise in the pancreatic tissues that normally make hormones, the endocrine tissues. These tumors grow slowly and don’t invade organs rapidly. A common problem with neuroendocrine tumors is that they may start to produce hormones leading to symptoms that include diarrhea, bowel cramps, flushing, low blood sugar, high blood sugar, heart irregularities and congestive heart failure. Eventually, though, the tumors increase in size they begin to spread to the liver, leading eventually to liver failure as they replace the normal organ.
Neuroendocrine tumors are treated differently from adenocarcinomas. Surgery is the first line of treatment for an early stage tumor, and is curative about half the time. For some, the tumor is small but the hormone symptoms are incapacitating and require treatment with medicines that block the hormone action.
If the cancer returns, it usually shows up in the liver. If there is a small amount it may be surgically removed; if there is too much cancer in the liver then options are limited. Until recently there was no effective chemotherapy, though two promising new drugs were approved this year. Removing the entire diseased liver and replacing it with an organ transplant is another solution; it is difficult and dangerous, and long-term survival is still under 50%.
Based on this, we can speculate about the course of Steve Jobs’ cancer even without the benefit of medical records. In 2004, he was found to have a tumor on the pancreas, and as he explained in his 2005 commencement address to Stanford, it was a rare type, and he was treated with surgery. He looked healthy for about four years and then began to appear tired and thin. In January 2009 he announced he had a “hormone imbalance” and went on medical leave, and shortly thereafter he had a liver transplant. He probably had a tumor recurrence in the liver that was producing hormones that caused his debilitated condition. Very likely a transplant was his only option; it was a risky choice, but in the end it gave him two additional years.
Steve Jobs was a brave man who exemplifies the cancer survivor: he lived with his cancer, and continued his life’s work in spite of it. And most of the last seven years we even forgot he had cancer.