January 17, 2009

Doctors Speculate Over Apple CEO Jobs’ Recent Health Issues

Apple Chief Executive Steve Jobs continues to raise concern among investors and employees, as he has yet to announce what is ailing him.

Pancreatic cancer experts can only speculate as to how serious his health problems are or how directly they relate to his bout with cancer.

Jobs stated early last week that he was suffering from an easily treatable "hormonal imbalance" that was robbing his body of the proteins it needs. But on Wednesday, the 53-year-old CEO announced that his health issues were "more complex" than originally thought, and that he would be taking a six-month medical leave from the company.

Without more information, doctors can only guess what his current condition might be, but they said the tumor he was treated for in 2004 could have spread to another organ or resurfaced in the pancreas, requiring surgery or other treatment.

Several experts suggested that Jobs could also be coping with side effects of that surgery that can be treated easily.

The Apple CEO underwent surgery for a rare type of pancreatic cancer called an islet-cell, or neuroendocrine, tumor in 2004. Such tumors can be benign or malignant, but they usually grow slowly and are considered far less deadly than most pancreatic tumors.

Dr. Roderich Schwarz, a cancer surgeon at the University of Texas Southwestern Medical Center in Dallas, said the tumors are easily removed surgically but recur in roughly half of patients.

"Jobs may have a new mass that's substantially altering his physiology and causing him to lose weight," said Dr. Clay Semenkovich, an endocrinologist at Washington University in St. Louis.

The pancreas produces enzymes used in digestion and Islet-cell tumors often create an over-secretion of hormones including insulin into the bloodstream, wreaking havoc on digestion and leading to drastic weight loss"”which could explain Jobs' "hormonal imbalance, Semenkovich said.

However, he added that the limited information made it hard to say for sure, and Jobs has yet to offer any clues.

Rumors of his health problems spread after an Apple event in June 2008, where Jobs appeared gaunt. But doctors said his drastic weight loss could have other, less ominous explanations.

Most experts agree that his surgery in 2004 is likely to have been the so-called Whipple procedure -- an extensive and complicated operation that involves several organs besides the pancreas.

A common side effect of that procedure is rapid weight loss, since a partial pancreas may not be able to effectively aid in the digestion of proteins, carbohydrates and fats.

Schwarz said if an operation removes 30 to 50 percent of the pancreas, you're missing cell mass that produces juices that aid digestion.

"It could lead to weight loss and fatigue," he said, during an American Society of Clinical Oncology conference on gastrointestinal cancers in San Francisco.

Doctors said an insulin deficiency, which would result in diabetes, could also explain his recent health issues. A treatment for these side effects is indeed "simple and straightforward," as Jobs has said.

Patients who lack digestive enzymes can take enzyme capsules to aid digestion, and they are effective fairly quickly, Schwarz said"”which is why Jobs would need six months of medical leave.

Patients whose cancers recur in nearby organs, usually the liver, can be treated using less-invasive procedures than surgery, according to Joseph Kim, a cancer specialist and surgeon at the City of Hope medical center near Los Angeles.

"Cancers can be cut out or burned, and the recovery takes only a few days," he said.

Kim said in Jobs' case, it is likely something more complicated, like surgery"”which would take longer. Surgery on patients with recurrent islet-cell tumors can be "extremely difficult, if not risky," he added.

"Jobs may need new surgery, and six months is a reasonable time for preparation, surgery and recovery, given his weight loss," said Semenkovich.

He said, however, that surgery in somebody who has lost a lot of weight is a risk and recovery could take longer.


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