Steve Jobs’s exit from the top post at Apple Inc., the technology company he co-founded in 1976, follows years of health struggles that began in 2003, when he was diagnosed with a rare form of pancreatic cancer.
His neuroendocrine tumor wasn’t the worst-case scenario, since it’s often less aggressive than other pancreatic malignancies that can kill patients within a year. Jobs said on Aug. 24 he “can no longer meet my duties and expectations” as Apple’s chief executive officer. He will become chairman.
While neuroendocrine tumors can grow slowly and be treated successfully with early removal, those that spread to other organs, such as the liver, can be life-threatening. Although he didn’t specify a reason, Jobs had a liver transplant in 2009, a treatment that can prolong the lives of patients with his type of cancer by an average of about five years. The effects of cancer and a transplant can be difficult to overcome, even with a less demanding job than CEO.
“It’s not at all surprising” that someone with Jobs’s health history would step down, said David Metz, associate chief of gastroenterology at the University of Pennsylvania Perelman School of Medicine in Philadelphia. “Whether transplantation is a cure for neuroendocrine tumors or not remains relatively controversial. In my opinion it’s a low-yield approach.”
No more than 60 percent of patients who had transplants for this purpose survived five years after surgery, according to an analysis Metz published in the World Journal of Gastroenterology in 2005. He has said that his data was of varying quality and that survival odds may be better today.
Metz and other doctors interviewed about Jobs for this story haven’t treated him or seen his medical records. Apple spokesman Steve Dowling declined to comment on Jobs’s health.
Jobs had been on medical leave since Jan. 17, his third since 2004, when he first announced that he had a tumor removed. Since then, interest and speculation about his health have been constant as the chief executive has closely guarded his medical information.
A patient who had a liver transplant after being diagnosed with a neuroendocrine tumor might be suffering from any number of complications, said Simon Lo, director of endoscopy at Cedars-Sinai Medical Center in Los Angeles.
The original cancer may have recurred, leading to typical complications such as fatigue and pain, he said. Neuroendocrine tumors often produce unusually large amounts of hormones, which can disrupt digestion and other processes, he said.
To prevent organ rejection, transplant patients take immune-suppressing drugs that can raise the risk of infections and new cancers, Lo said.
Weight loss can also be caused by the tumor or its treatment, said John Fung, chairman of the Digestive Disease Institute at Cleveland Clinic.
“He looks like he hasn’t recovered the weight he had before his operation,” Fung said. “He may be mentally creative still, but it’s hard to come up with the energy requirement of daily living if you’re that malnourished.”
Many transplant patients, including those who’ve suffered from neuroendocrine tumors, return to work and function well for years, said Abhinav Humar, chief of the Division of Transplantation at the University of Pittsburgh Medical Center. Jobs’s duties may be too demanding for such a patient, he said.
“He doesn’t have the same job you or I or the average person who has had a liver transplant has,” he said in a telephone interview.
Two new drugs won U.S. clearance as neuroendocrine tumor treatments this year: Pfizer Inc.’s Sutent and Novartis AG’s Afinitor. Doctors in Europe are also using new radiation treatments for the disease.
Neuroendocrine tumors are uncommon, with new cases occurring in no more than five people in every 100,000 each year, according to Rodney Hicks, professor of medicine and radiology at the University of Melbourne.
Doctors are still trying to understand these rare tumors, Hicks said.
“There is a great heterogeneity in the behavior of these tumors,” Hicks said in a telephone interview. “And within each of those classes is also a range of aggressiveness from effectively benign tumors right through to very aggressive, malignant tumors.”