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      Steve Jobs managed to live more than seven years with a rare
form of pancreatic cancer that grows more slowly than the common
kind. But his need for a liver transplant two years ago was a bad
sign that his troubles with the disease probably were not over.


      The Apple founder long kept information on his illness behind a
firewall, and no new details emerged immediately after his death.


      However, medical experts unconnected with his care say Jobs most
likely needed the transplant because his cancer came back or
spread. They said his death could have been from cancer, the new
liver not working, or complications from immune-suppressing
medicines to prevent organ rejection.


      A liver transplant can cure Jobs' type of cancer, but "if it
were to come back, it's usually in one to two years," said Dr.
Michael Pishvaian, a gastrointestinal cancer specialist at
Georgetown University's Lombardi Comprehensive Cancer Center.


      Jobs declared he was cured after surgery in 2004 for an islet
cell neuroendocrine tumor, a much more treatable form of pancreatic
cancer than the more common form of the disease that killed actor
Patrick Swayze two years ago.


      But the Apple chief never revealed whether the cancer had spread
to his lymph nodes or liver, or how extensive his surgery was. Many
doctors speculated he had a Whipple procedure, in which part of the
pancreas, part of the small intestine and in some cases part of the
stomach are removed and the digestive system is reconstructed.


      "It's a big operation" and patients can have digestive
difficulties long afterward, said Dr. Steven Libutti, director of
the Montefiore-Einstein Center for Cancer Care in the Bronx.


      Several years later, Jobs was dramatically thinner and gaunt. In
January 2009, he attributed those problems to a hormone imbalance
and said there was a simple treatment for it. A few weeks later, he
went on a medical leave and then had a liver transplant that was
kept secret for two months.


      Even then, Jobs would not say why the transplant was needed,
though doctors said spread of his cancer to the liver was the
likely explanation.


      Usually transplants aren't done for people with cancer, but
"there is some support for the idea that a liver transplant can be
curative" for a neuroendocrine tumor as long as the cancer has not
spread beyond the liver, Pishvaian said.


      Average survival for people with neuroendocrine tumors that have
spread is seven to eight years, and some patients have survived 20
to 30 years, said Dr. Martin Heslin, cancer surgery chief at
Vanderbilt University.


      In January, he announced his third and final leave of absence,
and resigned in August.

Gallery

Steve Jobs managed to live more than seven years with a rare form of pancreatic cancer, but his need for a liver transplant two years ago was a bad
sign that his troubles with the disease probably were not over.

Doctors say cancer likely killed Steve Jobs

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