Fascinating. I must point out that even among physicians, there is a lot of disagreement and uncertainty. Nothing is 100%
Got a tip for us?
Let us know
Become a MacRumors Supporter for $50/year with no ads, ability to filter front page stories, and private forums.
Steve Jobs Regretted Early Decision to Delay Cancer Surgery
- Thread starter MacRumors
- Start date
- Sort by reaction score
Fascinating. I must point out that even among physicians, there is a lot of disagreement and uncertainty. Nothing is 100%
Delay is unlikely to have made a difference
A tumor on an internal organ has probably grown for years. Assume a doubling time of 40 days. For the tumor to have grown from 1 cell to the billions of cells of a 2 cm sized ball it takes years. That time is when they are likely to spread. The reason this cancer is so devastating is that there are no symptoms until it has had so much time to spread. Jobs was stubborn, but not irrational. Its possible (likely?) that he did his research and knew that the chances of survival were not greatly affected by the timing of his surgery. As a prominent oncologist told me: "We tend to cure the cancers that can be cured". It is the TYPE of cancer (and sub-type) not the time of detection & treatment that usually determines success. (Within some limits of course.)
A tumor on an internal organ has probably grown for years. Assume a doubling time of 40 days. For the tumor to have grown from 1 cell to the billions of cells of a 2 cm sized ball it takes years. That time is when they are likely to spread. The reason this cancer is so devastating is that there are no symptoms until it has had so much time to spread. Jobs was stubborn, but not irrational. Its possible (likely?) that he did his research and knew that the chances of survival were not greatly affected by the timing of his surgery. As a prominent oncologist told me: "We tend to cure the cancers that can be cured". It is the TYPE of cancer (and sub-type) not the time of detection & treatment that usually determines success. (Within some limits of course.)
I happen to be an MD who deals with cancer patients, particularly pancreatic patients, all the time. Steve had a neuroendocrine tumor of his pancreas which is made up of malignant cells that produce hormones and chemicals to control various parts of our normal physiology. This is formed from different cells than a more typical adenocarcinoma of the pancreas which is made up of cancerous connective tissue cells. ANY malignant pancreatic tumor is almost invariably fatal, but the neuroendocrine tumors many times are worse depending on their amount of differentiation, or how much they differ from normally functioning cells. These types of tumors can happen throughout the body, and they are bad actors everywhere they form. Small nests of microscopic cells seed the surrounding tissues, and even far away areas (particularly the brain) and are not visible by PET or CT scans, etc until it is too late. Surgery, radiation in particular, and chemo help to control the morbidity (side effects) of the tumor, and extend life...but invariably the pancreatic tumors recur...usually within a couple of years. Steve eventually had a very invasive surgery called a whipple procedure done where they take out all or the majority of the pancreas, the first part of the small bowel, and various other structures in that area of the body depending on the amount of disease. I knew when I heard that he had a liver transplant for "malabsorbtion issues" that he had metastatic lesions to his native liver and they were looking for another time extension by transplanting a non diseased liver in it's place.
In short, earlier surgery may have given Steve a bit more time, but his fate would have almost certainly been the same.
I'm an M.D. too. The survival rate of someone with a neuroendocrine tumor far exceeds that of someone with an adenoCA. The fact that he had a whipple means he waited too long for proper treatment while he was curing himself via "special diet." Maybe he would have had a chance at a cure if he had a complete resection before the thing metastasized all over his abdomen.
I see this junk too often- people, who after reading wikipedia, thinking they can fix their brain tumors with vitamins. It's sad.
I am very curious what "medical profession" you are a part of? Cancer can rarely if ever be considered "curable".... especially with any form of pancreatic cancer! Better survival rate, maybe. But not cured.
and secondly to the first poster Gri... why would you phrase something in those words on a non-medical forum? It irritates me to the bone when people show off their medical knowledge by using terminology ignorantly. If your not an oncologist or even a doc, don't present yourself as one! And if you are, then phases like that can do more harm to educate the public than good.
No-one knows where or when metastasis of the cancer took place. There is research to suggest that going in a cutting right away could have shortened his life by seeding the cancer. So this speculation that he would still be with us if he would of had the surgery earlier has no reasonable foundation. The fact of the matter is that SJ lived a considerable time longer than most with such a diagnosis.
In the end the timing probably would not have made much difference. Pancriatic cancer has a very low survivability rate.
From http://www.pancreatic.org/site/c.htJYJ8MPIwE/b.891917/k.5123/Prognosis_of_Pancreatic_Cancer.htm:
From http://www.pancreatic.org/site/c.htJYJ8MPIwE/b.891917/k.5123/Prognosis_of_Pancreatic_Cancer.htm:
There are plenty of cancers that are curable if caught early. A few off the top of my head that I see on occasion: basal cell, squamous cell, melanoma of the skin, retinoblastoma, ocular melanoma.
All these can recur of course, but not always.
Going against the stats is always unwise.
If you want to use alternative medicine, then use it as a complimentary approach. Modern medicine is far from perfect, but it's the most effective and reliable tool we have. Supplement it with whatever you like, but ignore it to your peril.
That poignant statistic may be accurate, but it isn't particularly relevant here. Various forms of pancreatic cancer range from practicably incurable to quite treatable, and Steve had the latter. Looking at "all pancreatic cancer combined" isn't particularly useful unless your purpose is to build awareness.
Nine months is a long time; given the relative success of Steve's treatments once they were started, I don't think it reasonable to downplay the possible consequences of his decision. It could have made the difference.
Very sad, though not entirely surprising. Many people take solace in alternative treatments: they're appealing on so many levels. But they just don't work, not against cancer, not against anything.
Thanks for the insight, doc... but in the long term the outcome is always the same, no matter how healthy you are.
If the neuroendocrine tumor is well differentiated, I agree with you 100%, but when they are more primitive, in my experience, they are usually worse. From what I've gathered, if the tumor spread throughout his porta hepatis that much over 9 months, I doubt it was a well differentiated islet cell tumor. Anyway, it's all hear-say at this point.
I am not going to get into an argument on this forum over this but the bases of statement is wrong. Yes, you may have a 100% survival rate but that does not equal cured. You can never be fully sure that you eliminate all cancerous cells and thus cure the disease! Yes, with BCC and SCC you can be pretty much 99% sure that you removed the majority of the cancerous tissue that would lead to further disease. But still this does not equal cured. Secondly, note that in my post I said "rarely." If you are in the medical field you know that SCC and BCC are not often grouped within the epidemiological aspects of cancer unless they have severely metastasize. So, yes by the general public's standards these are considered cured... Not by the oncology/medical standards.
I would have liked to hear more on Steve's thoughts of the medical industry. At least medical / insurance industry has it's problems and reminds me of Windows 95. It needs a Steve Jobs type person to fix it, I suppose.
Isaacson replies, "I think that he kind of felt that if you ignore something, if you don't want something to exist, you can have magical thinking...we talked about this a lot," he tells Kroft. "He wanted to talk about it, how he regretted it....I think he felt he should have been operated on sooner."
I'm looking forward to read the book, although it's hard to tell which are the exact words straight from Steve Jobs, and which are the author's interpretation of what the man thinks.
It's hard not to think about the road not taken. However much we all wish that Steve Jobs had done the surgery earlier and perhaps would've had a better chance of survival, we can't know about what would've happened in this scenario. What if he had complications and that actually would have endangered or ended his life earlier? We just don't know.
I'm looking forward to read the book, although it's hard to tell which are the exact words straight from Steve Jobs, and which are the author's interpretation of what the man thinks.
It's hard not to think about the road not taken. However much we all wish that Steve Jobs had done the surgery earlier and perhaps would've had a better chance of survival, we can't know about what would've happened in this scenario. What if he had complications and that actually would have endangered or ended his life earlier? We just don't know.
Apparently he is not the only one. Some cancer patients, I guess in denial, refuse treatment first or at least delay it, hoping it would just go away. Some even go with 'organic diets' and stuff like that, and refuse chemo.
I hope neither you or I or anyone here would have to make a decision around surgery, but you would be surprised how reasonable, successful, smart people behave in such circumstances.
It's impossible to separate Steve's rejection of cancer treatment from his brilliance as an innovator and CEO.
A more risk averse guy, with less of a sense of drive and infallibility would have got the operation sooner. But a more risk averse guy wouldn't have taken on the job of Apple CEO for a second time and rebuilt the company.
If a parallel universe was inhabited by 'sensible Steve' who got the cancer op immediately, I'm pretty sure that none of us would have heard of him. What sort of sensible person would continue to work long hours, if they had a great family sitting at home and a billion already in the bank? I wouldn't!
So this 'stupidity' is just the flip side of the coin of Steve's brilliant personality. Yes, he died sooner than he should have - but he also accomplished more during that time than most of us ever will.
A more risk averse guy, with less of a sense of drive and infallibility would have got the operation sooner. But a more risk averse guy wouldn't have taken on the job of Apple CEO for a second time and rebuilt the company.
If a parallel universe was inhabited by 'sensible Steve' who got the cancer op immediately, I'm pretty sure that none of us would have heard of him. What sort of sensible person would continue to work long hours, if they had a great family sitting at home and a billion already in the bank? I wouldn't!
So this 'stupidity' is just the flip side of the coin of Steve's brilliant personality. Yes, he died sooner than he should have - but he also accomplished more during that time than most of us ever will.
So you thought an individual that neglected his family was perfect?
(Authorized a book so that his kids can know him because he was not there. Source: his words)
Boy are you stupid.
You can say what you want now, but don't assume you know what you'd do in this situation if you haven't actually found yourself in it. There is so much going through the mind of someone with such an unexpected piece of news - I do not think Steve was stupid, merely overwhelmed and confused.
Life is a crap shoot, Showing his flaws in his health decisions. Steve Jobs could have easily been a Bus driver you would have never heard of but instead, the stars alined for a split second and he fell in the black hole where all of his best attributes worked for his career. Most never fall in that black hole that allows them such success.
Even those that think different!
Even those that think different!