Editor's note: This story originally appeared in 2008. We are reposting a version of it in light of the death of Apple Computer co-founder Steve Jobs from complications from pancreatic cancer. Patients tend to die shortly after diagnosis, but Jobs was unusual in that he survived seven years after he got the bad news (he had a less aggressive form of the cancer). Overall, the odds of a patient living five years is just 5.8 percent, according to statistics from the Centers for Disease Control and Prevention (pdf).

Editor's note (10/17/11): The following clarification comes from Allyson Ocean of the New York–Presbyterian Hospital/Weill Cornell Medical Center: Steve Jobs was diagnosed with pancreatic neuroendocrine cancer, a malignancy of the endocrine cells of the pancreas, which usually has a more indolent, slow-growing course than adenocarcinoma of the pancreas, which is a malignancy of the exocrine cells of the pancreas. Patients with adenocarcinoma have a worse prognosis and usually more rapid deterioration.  Also, the two cancers are treated in different ways.

The pancreas secretes hormones and enzymes to digest our fats. One of those hormones is insulin, which prompts the body to use sugar in the blood rather than fat as energy. Its levels are low in diabetic patients, who suffer from abnormally high blood sugar.

 Only one fifth of Americans diagnosed with pancreatic cancer survive for a full year, according to the American Cancer Society, and it is the fourth leading cause of cancer death in the country.

How does the disease develop without noticeable symptoms and then kill so quickly?

To find out, we called Allyson Ocean, an oncologist at New York–Presbyterian Hospital/Weill Cornell Medical Center, who specializes in gastrointestinal cancers including pancreatic cancer. An edited transcript follows.

Only about 10 to 15 percent of pancreatic cancers are diagnosed when they could be considered for surgery. And the prognosis is poor even in patients who do have surgery, because it comes back about 85 percent of the time. At best, 25 to 30 percent of patients are alive five years after surgery.

When doctors do pancreatic cancer surgery, they take out 95 percent of the pancreas, including the tumor, and then they leave a small remnant of the pancreas in there that serves [the insulin-producing] functions.

If a person can live without a fully functional pancreas, then what, ultimately, kills most pancreatic cancer patients?

When most patients die of pancreatic cancer, they die of liver failure from their liver being taken over by tumor.

What precludes doctors from performing surgery on late-stage patients?

We don't do surgery if the tumor has already spread outside the pancreas, because there's no survival benefit in removing the tumor. We also sometimes can't do surgery [when the tumor] involves the great blood vessels, the superior mesenteric vein and superior mesenteric artery. Those are the main vessels that come off of the aorta, the main artery in our body. If the tumor is wrapped around those blood vessels, then we can't take it out.

Because of the nature of the tumor cells. They escape the treatments, they hide out, and then they come back. And they grow again and they affect the liver and then they kill people.

The biggest known risk factors are smoking and family history—it can be a hereditary disease. Then there are some other more obscure risk factors, such as defects in the anatomy of the pancreas, but that's very rare.

Depending on where the cancer is diagnosed in the pancreas, it can affect how soon it's diagnosed. For instance, if the cancer is in the head of the pancreas, which is close to the common bile duct, and it grows and it causes obstruction of the common bile duct, a patient can get jaundiced. And then they could [show symptoms] sooner than someone whose pancreatic cancer is in another part of the pancreas, like the tail. They would not present with jaundice, so we would not have a clue that there was necessarily anything wrong with them.

Unexplained weight loss, abdominal pain, nausea, vomiting. Back pain is another one, because the pancreas is very posterior in the body. Back pain is also the most common complaint that patients go to an emergency room for, and most of the time it's just muscle pain—it's not pancreatic cancer.

Chemotherapy and radiation therapy. Sometimes we do both together. We are also using biologic agents now, meaning antibody therapy. There's a drug called Tarceva, which is an antibody [or immune protein] against the growth factor that the tumor cell makes, and so it blocks that growth signal. It's given in combination with [a chemotherapy called] Gemcitabine. In a large randomized clinical trial, [the combination of the two drugs] was shown to improve upon Gemcitabine alone.

10 Comments

1. 1. jaythakar 08:27 AM 10/6/11

   Pancreatic cancer is one of the most dangerous cancers. As per Steve Jobs:
   
   The beauty cries for centuries, because
   Only once in this time an AVITAR is bourn!
   

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2. 2. exdisq13 08:58 AM 10/6/11

   I think what Steve Jobs had was a different condition. What your article describes is a pancreatic cancer of the exocrine ducts, while what Steve Jobs had was a malignant islet cell tumor, i.e. a cancer of the neuroendocrine glands in the pancreas. It is considered to be slower growing and the treatment approaches are also different.

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3. 3. pyam in reply to exdisq13 01:04 PM 10/6/11

   Thanks, exdisq13, that's a great point. We'll try to clarify things on an updated story about pancreatic cancers shortly.

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4. 4. ironjustice 02:05 PM 10/6/11

   "What Is Iron Overload Disorder? What Is Hemochromatosis? What Causes Iron Overload Disorder?"
   "Commonly, if it is allowed to progress, the pancreas becomes damaged"

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5. 5. jgrosay 04:09 PM 10/13/11

   Both pancreas and ovarian cancer are called "the silent killer", because many times when symptoms of disease do begin to be noticed, disease has grown a lot and spread to non-curable stages. However, a trend exists more recently to consider this diseases not so silent, as many times a previous history of vague abdominal complaints, often described by patients as "bloating" or "poor digestion" can be elicited. Just going to the doctor when you have any abdominal nuisance lasting more than 15 days may help, a non invasive and cheap image procedure as ultrasound abdominal imaging or other tests considered adequate by the physician may discover some of this very dangerous cancers or other treatable conditions while they are in a stage more favourable to the patient.

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6. 6. sunnystrobe 07:44 AM 10/14/11

   What has not been mentioned yet at all is the role that lifestyle plays in the development of pancreatic cancers;
   being cancers of the digestive tract, and running second to colon cancer in mortality rates, the Standard American Diet ( high fat/low fiber/high sugar& alcohol) seems to be a highly likely culprit; not to mention the delayed self-immolation by smoking. So, do we know HOW the Apple man lived his days, diet-wise? The logo rather reminds me of an apple left uneaten than fully consumed!
   An apple a day keeps the doctor away,they say.It's an old wife's tale, confirmed by latest research findings.
   After all, an ounce of prevention is better than a pound of cure-all the more so since there IS still NO cure of cancer offered by conventional medicine.
   

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7. 7. jgrosay 10:53 AM 10/14/11

   Yeah !: more than 50% of all cancer cases are cured, most of them just by surgery. Most hematological malignancies can be cured with chemotherapy and other therapies, and for the cancers not included in the curable list ( see www.cancer.net ) there is very good palliation, and therapies that do prolong life span for many. In the end, just birth is an incurable disease, everybody that is born, finally dies. ( Just for the prophet Elias we don't know his fate )

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8. 8. Quinn the Eskimo 04:36 PM 10/14/11

   I will miss his flair for making me want something badly, that I've never seen before.
   
   Gates couldn't do that. Don't even ask Ballmers or Ellison to do that.

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9. 9. Jake R in reply to pyam 08:28 PM 10/17/11

   Local Silicon Valley news reports said that Jobs' cancer was easily curable but that he had opted for diet as treatment. If true, this suggests that he succumbed not to cancer, but to quackery in the place of legitimate medical care.

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10. 10. Obbop 05:17 PM 10/14/12

    I do not applaud the emotion-laden irrationality that places so much emphasis upon the "pink ribbon" type of unrestrained cellular growth while other cancer-types seem to be relegated to virtual anonymity in a mass media so concerned with attracting the maximum number of "eyes" possible in order to maximize the rates charged to advertisers.
    
    Toss in the sad reality that an apparent majority of USA dwellers are reached via emotional appeal vice rationality or logic.

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