i read a couple replies:
Here's one from a faculty in the division of onc at pitts.
AB, oncologist
Look, Dr. Amri
Your answer may be nice, but it is wrong.
Let's just say for the sake of argument that I am a Professor of Medicine and Associate Chief of Medical Oncology at a major medical center, so I do know what I am talking about.
From my understanding of the literature as well as my personal experience with this kind of tumor as well as my understanding of Mr. Jobs condition from reading between the lines of what has been reported, this is what likely happened:
Mr. Jobs was diagnosed with a neuroendocrine tumor of the pancreas which, like a great majority of these tumors, likely had micrometastatic spread at diagnosis. I agree that he likely had a resection of the tumor, whether through a Whipple procedure or another less radical procedure. Whether he had some liver involvement at diagnosis is unclear, but my bet is that he had some minimal liver abnormalities on CT of unclear significance, and they went ahead with the surgery given his age and his desires.
As you likely know as a surgical fellow (not as a Harvard Cancer Expert as Gawker claims you are this AM -- that's right, this has hit the mainstream media), neuroendocrine tumors of the pancreas do not respond all that well to cytotoxic chemotherapy. There are a few older papers in the literature on intrahepatic chemotherapy with anthracyclines, as well as papers on 5-FU and streptozocin systemic therapy. Most of the papers give median survivals for this disease of 6-8 years.
I suspect that Mr. Jobs liver metastases showed up within a few years of diagnosis, and he did get systemic and likely intrahepatic chemotherapy. Some pictures released of Mr. Jobs sometime in the late 2000s show him with no hair.
As you also likely know, the major complications of these tumors have to do with the hormones they secrete. That is why Mr. Jobs had his weight loss.
You also know that he had a liver transplant in 2009 at a hospital in Memphis, likely because the tumor burden in his liver was such, and the systemic symptoms such (i.e. the weight loss), that a heroic effort was a reasonable option. It gave all of us two more years of Mr. Jobs.
The reason for his cancer progression and likely death was progressive tumor in either the abdomen (carcinomatous peritonitis with attendant bowel obstruction--the most likely scenario) or recolonization of his liver with metastases (less likely).
He outlived the median survival of his disease by a few years.
Whether he used alternative therapies or not had absolutely no effect on his survival or outcome--that was dictated from day one by his tumor and its biology, and our lack of effective therapies for this condition.
Sorry for this rant, but it is disingenuous for a surgical fellow with minimal if any real world clinical experience to be making statements like the one you did, not matter how helpful they may or may not be in getting people to not ignore the signs and symptoms of cancer.
As you have seen yourself, these comments get picked up by the mainstream media. With all good intentions by everyone, they inflame a situation with information which is likely incorrect, and potentially may cause harm to Mr. Jobs family if they were to read them.
Let this be a good lesson for you as you finish your surgical training.
