Jobs battles with rare pancreatic cancer, privacy

Steve Jobs has battled a rare form of pancreatic cancer for years, undergoing a series of aggressive treatments and surviving longer than many others with the disease.

Jobs, 56, has a pancreatic neuroendocrine tumor. This kind of tumor accounts for only about 5% of the 43,000 pancreatic cancers diagnosed each year, and is generally more curable than more common types of pancreatic cancer.

In general, patients with pancreatic cancer are diagnosed only after the disease has spread to vital organs, and die within a year or less, says Zev Wainberg, a gastrointestinal oncologist with UCLA's Jonsson Cancer Center.

Neuroendocrine tumors, which arise in hormone-producing cells of the pancreas, typically grow much more slowly, allowing patients to live at least two or there years, says Wainberg, who hasn't treated Jobs.

Unless the disease is completely eradicated, however, the cancer eventually takes a turn for the worse, growing much more quickly, Wainberg says.

While no one can say how Jobs will fare, "I suspect we will not be talking about years" of additional survival, Wainberg says.

With Jobs' work ethic and strong love of his job, doctors say his decision to resign as Apple CEO suggests that he must be feeling very ill.

"Given his will to dominate, you'd have to speculate that he must not be doing well," says James Abbruzzese, a pancreatic cancer expert at Houston's M.D. Anderson Cancer Center. Abbruzzese, one of the USA's leading pancreatic cancer specialists, consulted on Jobs' care early in the course of his treatment, but has not participated in Jobs' treatment in several years.

Jobs has undergone aggressive treatment for the cancer, which he first acknowledged in 2004. Jobs had surgery to treat the original cancer, then underwent a liver transplant in 2009.

That suggests that his original tumor had spread from his pancreas to his liver, in spite of surgery to remove it, says Margaret Tempero, a pancreatic cancer expert at the University of California-San Francisco and former president of the American Society of Clinical Oncology.

Liver transplants for this kind of tumor are "occasionally successful, but it's a real long shot," Tempero says.

Patients who receive organ transplants must take drugs to prevent the body from rejecting the new organ, Tempero says. But because these drugs also suppress the immune system, they can allow the original cancer to re-emerge and attack either the new liver or other organs.

In rare cases, a liver transplant may cure the patient's cancer, if it hasn't spread around the body, Abbruzzese says.

More often, the transplants helps restore normal liver function, giving patients a few more years with a better quality of life, Abbruzzese says.

These neuroendocrine tumors, which develop in the pancreas' hormone-producing cells, tend to grow more slowly than other kinds of pancreatic cancers, making them more curable, experts say.

The fiercely private Jobs has said relatively little about his health problems, although he did acknowledge his bout with cancer during a commencement speech at Stanford University. "No one wants to die," he said. "And yet death is the destination we all share. No one has ever escaped it."

While liver transplants can be life-saving, they aren't always successful. That's because the original tumor can spread to the new liver. Or, treatment for the main cancer can damage the liver. Immediately after surgery, the body also can reject the transplanted liver, experts say.

Some people with neuroendocrine tumors survive for decades, experts say.

Actor Patrick Swayze died of pancreatic cancer in 2009. Opera star Luciano Pavarotti died of the disease in 2007. Supreme Court Justice Ruth Bader Ginsburg also has had pancreatic cancer.

Doctors don't know what causes most cases of pancreatic cancer, although heavy smoking increases the risk by two to three times, experts say. Diets filled with meat and fat also may contribute to the disease. Those at greater risk include men, African-Americans, people older than 50, diabetics and those with a family history of pancreatic cancer. Chronic inflammation of the pancreas and exposure to certain chemicals also can cause the disease.

Scientists are actively studying ways to find the disease earlier, when it might be more curable, by looking at families in which several people have developed the cancer. Researchers also are searching for genes that may be involved. In January, scientists at Johns Hopkins University in Baltimore announced that they had deciphered the genetic code, or genome, of neuroendocrine tumors, which they hope will lead to better treatments.