Jobs Health Concerns Related to Food Absorption, Not Cancer?

[IJ Reilly]

The five year survival is usually discussed as a prognostic measure of the characteristic of the cancer/success of treatment(s). It's not really a measure of 'cured' per se. You can still have cancer and have a 100% 5 year survival rate if it is non-aggressive or there are good treatments to keep it in check. 5 years is a reasonably long time to assess an outcome but there is always the push to expand studies to address longer-term outcomes to 10 years, 20 years etc where possible. Unfortunately this costs a lot of time and money and gets logistically increasingly difficult.

I'm assuming five years (or whatever number of years) free of the disease. I've heard this described as "cured." With the vast majority of cancers, medical science doesn't know why one person gets it and another does not. In terms of the likelihood of getting the disease, all they really know in most cases about any given person's risk is probabilities. Or so I've been told.

In the case of Steve Jobs, he said after his surgery that he'd been "cured." This worried me at the time, because with cancer, treatment is rarely a cure.

 

[.Andy]

I'm assuming five years (or whatever number of years) free of the disease. I've heard this described as "cured."

5 years free of disease isn't something I'm aware of as a medical measure as you've described it (I certainly don't have a massive knowledge of oncology though). Usually it's dealt with in terms of 5 years disease free survival rates which is what I gave the definition of above. This is dependent on the type of cancer, the treatment given, and the characteristics of the individual getting the treatment. For some cancers making it to 5 years most certainly would be an indicator that you're "cured". However this is certainly not something that could be applied across the board to the majority of cancer types.

With the vast majority of cancers, medical science doesn't know why one person gets it and another does not. In terms of the likelihood of getting the disease, all they really know in most cases about any given person's risk is probabilities. Or so I've been told.

This is most certainly true. For the common cancers we are able to study them quite successfully due to the large number of patients which makes finding statistically significant correlations possible. This is how we fond out that commonly known things such as smoking, diet, asbestos exposure, solvent exposure, excess sun exposure, etc etc all increase your risk of cancer. However these risks are determined for a population. Individual characteristics (genetics, behaviours) confound the risks, making it largely impossible/difficult to determine exactly which individuals will get a specific cancer. However in some conditions it is entirely possible to predict if an individual will get a specific cancer, for example some of common hereditary bowel cancer conditions.

In the case of Steve Jobs, he said after his surgery that he'd been "cured." This worried me at the time, because with cancer, treatment is rarely a cure.

I don't wish to discuss Jobs or the type of cancer he had personally, but the term "cured" as he referred to it could take on any number of definitions.

i.e.
* In the case of a cancer that is at low risk of metastasis, removing it could be said to be a cure.
* A treatment that doesn't abolish the cancer but keeps it in check so that it no longer contributes to your death could be said to be a cure.
* removing a non-essential organ/part of your anatomy that prevents recurrence could be a cure. i.e. prophylactically removing a breast that doesn't contain cancer.
* some aggressive treatments could be said to be a cure, but result in such a poor quality of life or induce other cancers/life threatening side effects. none-the-less they still "cure" the primary cancer.

There is often a gap between the colloquial understanding of cure as opposed to how it is interpreted medically. In the case of Steve Jobs who knows what definition he was using.

 

[Butthead]

I'm a Gastroenterologist (digestive and liver diseases), so to perhaps quell some speculation.....


I suppose he could have recurrent disease, but this is pretty rare, and they have said that his current condition is not related to a recurrence of his cancer.

You have a source for this "rarity", statistics?

Ah statistics. All well and good to look at a large number. Generally speaking, taking statistics of all types of breast cancer, if you get breast cancer (statistics take into account early detection, which does not always happen with other forms of cancer...Paul Newman dies very rather rapidly after losing his battle with lung cancer, even though he was a smoker earlier in his life...Steve Reaves wife dies a mere ~7mo after he dies, yet she never smoked, was living/raised in relatively 'clean' air environment, and still she dies from lung cancer), statistics say you have an 85% chance of surviving the disease. Still leaves thousands of other women who die every year from breast cancer .

Yesterday's MacNN news story, which has not been linked to in this thread yet!?!

http://www.macnn.com/articles/09/01/16/cancer.recurring.in.jobs/

Dr. Roderich Schwarz, an oncological surgeon at the University of Texas Southwestern Medical Center, notes that Jobs was attacked by an unusually rare type of tumor known as an islet cell. These are typically easy to remove in surgery, says Schwarz, but recur in half of patients.

Was this quotation accurate? Another statistic?

Does it trump the other "physician" opinions being stated in this thread?



While it may not be a 'statistic', IMHO; cancer and the causes of each and every type are not well understood (except in a few instances)...as such, take 'statistics' in this regard with a large grain of salt. My mother had a stage 3A or maybe even 3B non-small cell carcinoma of her lung, she went through 4 mo. of chemo & radiation, then the whole lung was removed in surgery along with some nearby lymph nodes. She has had PET/CT scans yearly (sometimes the oncologist's office needs to be reminded of that) since then...and for what? Her initial non-small cell carcinoma (that which is identified by structure, and supposedly by the fact it's less aggressive, multiplies less rapidly) was *invisible* on her chest X-ray 7mo earlier when she had a mild heart attack, yet in just 7mo, that NSCC had grown to a tumor that encompassed more than 1/2 of her lung. 4yrs. later a lump under her tongue was diagnosed as a "mouth cancer". Well sort of, the tumor was removed, and after a week of tests, the specialist medical 'physicist' on staff at the med center, couldn't decide exactly what kind of cancer it supposedly was. Oh well, just zap her throat with high doses of computer guided radiation beams, which mostly killed any ability to taste food, throw in some milder chemo, et viola...cured? 4yrs later, she has been seen by the ENT that did the surgery to remove the tumor in her mouth. For what? An undetermined lump/infection that she was given antibiotics as a treatment for (which did nothing), is still there, right in that spot where she had the mouth 'cancer'.

Sometimes I don't think physicians/medical scientists have all the correct answers, even if they like to think they do.


So Tammy Faye Baker was in 'remission', twice? And still died? Eh, can't rely on wiki for absolute accuracy:

http://en.wikipedia.org/wiki/Tammy_Faye_Messner#Cancer


I know of a woman, who had breast cancer in her 60's, was treated for it, and "cancer free" (yet another fun terminology usage)...until she hit her 80's and got breast cancer again. If you live long enough, you'll likely get some type of terminal disease>>>damned statistics.

 

[.Andy]

You have a source for this "rarity", statistics?

Ah statistics. All well and good to look at a large number. Generally speaking, taking statistics of all types of breast cancer, if you get breast cancer (statistics take into account early detection, which does not always happen with other forms of cancer...Paul Newman dies very rather rapidly after losing his battle with lung cancer, even though he was a smoker earlier in his life...Steve Reaves wife dies a mere ~7mo after he dies, yet she never smoked, was living/raised in relatively 'clean' air environment, and still she dies from lung cancer), statistics say you have an 85% chance of surviving the disease. Still leaves thousands of other women who die every year from breast cancer .

Yesterday's MacNN news story, which has not been linked to in this thread yet!?!

http://www.macnn.com/articles/09/01/16/cancer.recurring.in.jobs/



Was this quotation accurate? Another statistic?

Does it trump the other "physician" opinions being stated in this thread?



While it may not be a 'statistic', IMHO; cancer and the causes of each and every type are not well understood (except in a few instances)...as such, take 'statistics' in this regard with a large grain of salt. My mother had a stage 3A or maybe even 3B non-small cell carcinoma of her lung, she went through 4 mo. of chemo & radiation, then the whole lung was removed in surgery along with some nearby lymph nodes. She has had PET/CT scans yearly (sometimes the oncologist's office needs to be reminded of that) since then...and for what? Her initial non-small cell carcinoma (that which is identified by structure, and supposedly by the fact it's less aggressive, multiplies less rapidly) was *invisible* on her chest X-ray 7mo earlier when she had a mild heart attack, yet in just 7mo, that NSCC had grown to a tumor that encompassed more than 1/2 of her lung. 4yrs. later a lump under her tongue was diagnosed as a "mouth cancer". Well sort of, the tumor was removed, and after a week of tests, the specialist medical 'physicist' on staff at the med center, couldn't decide exactly what kind of cancer it supposedly was. Oh well, just zap her throat with high doses of computer guided radiation beams, which mostly killed any ability to taste food, throw in some milder chemo, et viola...cured? 4yrs later, she has been seen by the ENT that did the surgery to remove the tumor in her mouth. For what? An undetermined lump/infection that she was given antibiotics as a treatment for (which did nothing), is still there, right in that spot where she had the mouth 'cancer'.

Sometimes I don't think physicians/medical scientists have all the correct answers, even if they like to think they do.


So Tammy Faye Baker was in 'remission', twice? And still died? Eh, can't rely on wiki for absolute accuracy:

http://en.wikipedia.org/wiki/Tammy_Faye_Messner#Cancer


I know of a woman, who had breast cancer in her 60's, was treated for it, and "cancer free" (yet another fun terminology usage)...until she hit her 80's and got breast cancer again. If you live long enough, you'll likely get some type of terminal disease>>>damned statistics.

Well that's cleared things up.

 

[IJ Reilly]

There is often a gap between the colloquial understanding of cure as opposed to how it is interpreted medically. In the case of Steve Jobs who knows what definition he was using.

The RDF definition? Not to single him out, I've known others who have declared themselves "cured" of cancer after the first treatment. Either they haven't been told of, or have placed far in the back of their minds, the likelihood that the disease may have been beaten back, but not beaten.

Well that's cleared things up.

Yes, insofar as we should understand that in the end it's all a crapshoot.

 

[doug in albq]

This is what I said in my blog 3 weeks ago before any of this new information about Steve's health came to light:

"Lets talk about the Mac-chief for a moment. There seems to be much talk in the Mac-kingdom about their ruler's physical health. While the publicly-presented picture is that Steve Jobs battled and defeated cancer in 2004, take it from me, someone who has done much research into health-related issues, it is never that simple with cancer. First off, the established American medical community will consider cancer in remission if the patient shows even the smallest amount of improvement. Even if that improvement is temporary or based on a flawed examination. This may upset some, but let us talk about the type of cancer specific to Steve Jobs–pancreatic cancer. For most people a diagnosis of pancreatic cancer is a death sentence. The established medical community has stated that Steve has a rare, but treatable type of pancreatic cancer. Well, to the established medical community, as opposed to the alternative medical community, the only way they treat pancreatic cancer is with a procedure called pancreaticoduodenectomy, or the “Whipple Procedure,” and/or chemotherapy & radiation. "The most common technique of a pancreaticoduodenectomy consists of the en bloc removal of the distal segment (antrum) of the stomach; the first and second portions of the duodenum; the head of the pancreas; the common bile duct; and the gallbladder."(Wiki). I hate to know this, but when one has all those vital organs removed from their body, cancer or no cancer, one has just drastically shortened their lifespan. Personally, I would have never allowed those doctors and their scalpels anywhere near me. But, had I received the Whipple Procedure in 2004 like Steve did, I would have retired from any sort of stressful work immediately."

http://dougitdesign.com/blog_1_07_09.html

I am not trying to sound like a predictor of the future, I simply know how it usually goes with cancer and the established medical community, always the same BS and never a cure!

 

[.Andy]

This sure has brought out those with complete misconceptions of all things medicine.

it is never that simple with cancer. First off, the established American medical community will consider cancer in remission if the patient shows even the smallest amount of improvement.

Here's the definition for the American Cancer Society;

Remission is a period of time when the cancer is responding to treatment or is under control. In a complete remission, all the signs and symptoms of the disease disappear. It is also possible for a patient to have a partial remission in which the cancer shrinks but does not completely disappear. Remissions can last anywhere from several weeks to many years. Complete remissions may continue for years and be considered cures. If the disease returns, another remission often can occur with further treatment. A cancer that has recurred may respond to a different type of therapy, including a different drug combination.

In practice what constitutes remission isn't taken lightly. The majority of clinicians go to great lengths to avoid giving a patient false hope.

Even if that improvement is.....based on a flawed examination.

What on earth are you basing this on ? Are you honestly suggesting that oncologists do not examine their patients properly and hand out false hope of response to treatment on no evidence? That's a pretty serious charge which you can't possible back up.

I hate to know this, but when one has all those vital organs removed from their body, cancer or no cancer, one has just drastically shortened their lifespan.

In a Whipple procedure there are no vital organs removed. If there was you would die and the procedure would be useless. Vital organ = essential for life. I guess you were right that having vital organs removed "drastically" shortens your lifespan. Even a broken clock....

Well, to the established medical community, as opposed to the alternative medical community

Care to highlight what treatments the alternative medical community has for pancreatic cancer you are referring to here?

Personally, I would have never allowed those doctors and their scalpels anywhere near me.

And you would have died in a short timespan of your pancreatic cancer. Not many young people with a long life ahead of them would take that option.

I simply know how it usually goes with cancer and the established medical community

You've demonstrated that your opinion on both matters is far from informed.

always the same BS and never a cure!

Modern medicine has "cures" for many different cancers. There are literally thousands and thousands of doctors and researchers who have devoted their lives to finding cure for different cancers. As such treatments are constantly changing and improving. To claim it's always the same BS is incredibly misinformed. Within the last year alone there were 2528 research articles published in relation to "pancreatic cancer" alone. Bear in mind that the majority of these would contain at least 1-5 years of research.

take it from me, someone who has done much research into health-related issues

I'd suggest doing more research. Also might be worth running future articles past someone with medical knowledge to double-check what you've written.

 

[jnyepu]

You have a source for this "rarity", statistics?

Ah statistics. All well and good to look at a large number. Generally speaking, taking statistics of all types of breast cancer, if you get breast cancer (statistics take into account early detection, which does not always happen with other forms of cancer...Paul Newman dies very rather rapidly after losing his battle with lung cancer, even though he was a smoker earlier in his life...Steve Reaves wife dies a mere ~7mo after he dies, yet she never smoked, was living/raised in relatively 'clean' air environment, and still she dies from lung cancer), statistics say you have an 85% chance of surviving the disease. Still leaves thousands of other women who die every year from breast cancer .

Yesterday's MacNN news story, which has not been linked to in this thread yet!?!

http://www.macnn.com/articles/09/01/16/cancer.recurring.in.jobs/



Was this quotation accurate? Another statistic?

Does it trump the other "physician" opinions being stated in this thread?



While it may not be a 'statistic', IMHO; cancer and the causes of each and every type are not well understood (except in a few instances)...as such, take 'statistics' in this regard with a large grain of salt. My mother had a stage 3A or maybe even 3B non-small cell carcinoma of her lung, she went through 4 mo. of chemo & radiation, then the whole lung was removed in surgery along with some nearby lymph nodes. She has had PET/CT scans yearly (sometimes the oncologist's office needs to be reminded of that) since then...and for what? Her initial non-small cell carcinoma (that which is identified by structure, and supposedly by the fact it's less aggressive, multiplies less rapidly) was *invisible* on her chest X-ray 7mo earlier when she had a mild heart attack, yet in just 7mo, that NSCC had grown to a tumor that encompassed more than 1/2 of her lung. 4yrs. later a lump under her tongue was diagnosed as a "mouth cancer". Well sort of, the tumor was removed, and after a week of tests, the specialist medical 'physicist' on staff at the med center, couldn't decide exactly what kind of cancer it supposedly was. Oh well, just zap her throat with high doses of computer guided radiation beams, which mostly killed any ability to taste food, throw in some milder chemo, et viola...cured? 4yrs later, she has been seen by the ENT that did the surgery to remove the tumor in her mouth. For what? An undetermined lump/infection that she was given antibiotics as a treatment for (which did nothing), is still there, right in that spot where she had the mouth 'cancer'.

Sometimes I don't think physicians/medical scientists have all the correct answers, even if they like to think they do.


So Tammy Faye Baker was in 'remission', twice? And still died? Eh, can't rely on wiki for absolute accuracy:

http://en.wikipedia.org/wiki/Tammy_Faye_Messner#Cancer


I know of a woman, who had breast cancer in her 60's, was treated for it, and "cancer free" (yet another fun terminology usage)...until she hit her 80's and got breast cancer again. If you live long enough, you'll likely get some type of terminal disease>>>damned statistics.

Islet cell tumors are neuroendocrine tumors. The recurrence rate is a little less than 50%, but as I said before, it is a rare tumor to begin with, so it's hard to generate "set in stone" numbers.

It sounds like you and your family have been through a lot. Just remember, experiences and #s from one type of cancer don't apply to another.

In addition, please remember, when physicians quote a survivial, response or cure rate, there are obviously people who deviate from that number. Patients always ask "how long" or "what percentage". We give a best estimate based on studies to date, but that's all these #s end up being, our best estimate.

I can't speak for other physicians, but I NEVER tell any patient that I have the correct answers. All I can tell them is what I know based on my experience and training. I don't promise things that can't be promised.

 

[jnyepu]

I'm assuming five years (or whatever number of years) free of the disease. I've heard this described as "cured." With the vast majority of cancers, medical science doesn't know why one person gets it and another does not. In terms of the likelihood of getting the disease, all they really know in most cases about any given person's risk is probabilities. Or so I've been told.

In the case of Steve Jobs, he said after his surgery that he'd been "cured." This worried me at the time, because with cancer, treatment is rarely a cure.

From my understanding, no evidence of disease at 5 years = unlikely to recur (again, limiting our discussion to individuals who have had definitive therapy with curative intent and have responded as such).

 

[someone28624]

No. But what problem makes a doctor tells you, "Well this problem will last exactly 5 months" besides a very common disease like cancer? With cancer doctors can predict how long treatment will take.

That's just my opinion. And it doesn't really matter much - when it comes down to it, he's sick.

Dude, not sure what your qualifications are, but as an oncology RN, you're NUTS if you think cancer treatment is exact in any way, shape, or form. We often tell people they can expect to be in the hospital a month. Some of them are still there 6 months later.

 

[.Andy]

From my understanding, no evidence of disease at 5 years = unlikely to recur (again, limiting our discussion to individuals who have had definitive therapy with curative intent and have responded as such).

Again as I've posted above this isn't necessarily true and a somewhat dangerous misconception to have out there. The prognosis following a 5 year disease-free survival will depend on the individual, the treatment, and most importantly the type of cancer that individual has. As such one should base their prognosis, screening, and treatments on their own circumstances in consultation with their oncologist/doctor.

To reiterate. There is no set time across all different cancers when they're all unlikely to recur. If you've had cancer for the best outcomes you must maintain follow up vigilance and treatment as long as required in consultation with your medical professional(s). This applies even if the original treatment was provided with curative intent.

 

[Xfujinon]

Summary: I hope Jobs gets better, I think his problem is personal but yet he owes some information to shareholders, and I believe Apple will be fine without him.


As a medical student, it is somewhat appalling to see the ignorance in this thread regarding modern medicine. It seems like the more jaded a person gets, the more loud and cranky they become about "the mainstream" and thus dedicate their lives to proselytizing the "alternatives" or some such thing. What you do to yourself is fine, and I don't care what you believe. But, when you begin to spread your psychosis onto others, it can be very dangerous. The crap about vaccines and autism, for instance, makes my blood boil. Or, for that matter, the increasing tendency for people to accept blindly what their chiropractor says but balk at their medical doctor's advice. Depressing, at the least, and terrifying at the most.

Sometimes, the simplest answer is the best one. Why is mainstream medicine "mainstream" in the first place? Could it be that some of its principles and practices actually work? Most of the FUD from the anti-medicine people is a result of misinformation, ignorance, or just plain old fashioned stupidity. I feel sorry for the impressionable people they "convert", and the lives that are lost or ruined due to artificial enlightenment sold by these quacks. My aunt is dying from breast cancer because she refused to see a conventional doctor for ten years. Her cancer was easily operable, treatable, resectable, and in all measures, totally curable. Now she is confined to bed, with an NG tube, weak and wasted from systemic metastases that need not have formed. In the last month, she has finally admitted she was a fool for using hot baths, magnetic bracelets, and special herbal teas. She'll pay the price for this stubbornness with her life. I respect her right to choose her own path, and to make her own decisions, but the fact that she regrets her past actions so strongly motivates me to better inform people so they don't end up the same way.

Oh, and here is my differential, in case any of the MDs/DOs out there care.

1. Malabsorption syndrome secondary to complications of the Whipple.
2. Metastasis into abdomen, specifically into the small intestine.
3. Hepatobiliary insufficiency, unable to speculate on cause.

 

[carlgo]

Summary: I hope Jobs gets better, I think his problem is personal but yet he owes some information to shareholders, and I believe Apple will be fine without him.


As a medical student, it is somewhat appalling to see the ignorance in this thread regarding modern medicine. It seems like the more jaded a person gets, the more loud and cranky they become about "the mainstream" and thus dedicate their lives to proselytizing the "alternatives" or some such thing. What you do to yourself is fine, and I don't care what you believe. But, when you begin to spread your psychosis onto others, it can be very dangerous. The crap about vaccines and autism, for instance, makes my blood boil. Or, for that matter, the increasing tendency for people to accept blindly what their chiropractor says but balk at their medical doctor's advice. Depressing, at the least, and terrifying at the most.

Sometimes, the simplest answer is the best one. Why is mainstream medicine "mainstream" in the first place? Could it be that some of its principles and practices actually work? Most of the FUD from the anti-medicine people is a result of misinformation, ignorance, or just plain old fashioned stupidity. I feel sorry for the impressionable people they "convert", and the lives that are lost or ruined due to artificial enlightenment sold by these quacks. My aunt is dying from breast cancer because she refused to see a conventional doctor for ten years. Her cancer was easily operable, treatable, resectable, and in all measures, totally curable. Now she is confined to bed, with an NG tube, weak and wasted from systemic metastases that need not have formed. In the last month, she has finally admitted she was a fool for using hot baths, magnetic bracelets, and special herbal teas. She'll pay the price for this stubbornness with her life. I respect her right to choose her own path, and to make her own decisions, but the fact that she regrets her past actions so strongly motivates me to better inform people so they don't end up the same way.

Oh, and here is my differential, in case any of the MDs/DOs out there care.

1. Malabsorption syndrome secondary to complications of the Whipple.
2. Metastasis into abdomen, specifically into the small intestine.
3. Hepatobiliary insufficiency, unable to speculate on cause.

I happened onto one of those forums. What a bunch of morons. They withhold vaccines from their kids and put them at risk. I actually posted and told them they would be murdered in their sleep when their kid found out that his polio could have been prevented but for his parents' involvement in cults.

All this pancreas stuff is pretty heavy. I'm going to tape magnets to it.

Hey, Steve, I had a dose of the Big C. I wrote a detailed letter to everyone explaining everything from the severity, to the treatment and the likely outcome. I did the wills, everything.

It is the adult thing to do, and the right thing to do for everyone who cares about you or who depends on you at your job. In my case it was a few people, in yours it is millions. Man-up and do what is right. You will feel soooo relieved when you do this.

 

[xbjllb]

Steve Reeve's wife dies a mere ~7mo after he dies, yet she never smoked, was living/raised in relatively 'clean' air environment, and still she dies from lung cancer)

And you can say with absolute certainly that she DIDN'T grow up in a house with parents who smoked, or where wood-burning fireplaces were burned constantly during the Winter, or candles were lit 24/7? How about her adult homelife?

There are far more sources of indoor carcinogenic smoke than just tobacco smoking, although tobacco smoke is by far the worst because it is inhaled deliberately every few seconds.

As far as breast cancer, it was virtually unheard of in the years prior to the 1920's before women smoked, and has been skyrocketing since in a curve that exactly matches the number of women who smoke.

Ditto lung cancer, although some women early in the 20th century who never smoked caught the disease from cooking over wood stoves most of their lives and breathing in that smoke.

One source of cancer-causing smoke that is often overlooked today are self-cleaning ovens, which will kill a pet bird dead in five minutes.

You also couldn't pay me enough to ever burn a candle, incense, or anything in my home.