Steve Jobs' Illness Offers Complex Mystery

Whatever else Apple CEO Steve Jobs is accomplishing by his cryptic health statements, he's stimulating a lot of public education about such obscure maladies as pancreatic insufficiency and glucagonomas.

In his latest statement released Wednesday, Jobs, 53, says his condition is "more complex" than he thought it was last week. At that time, he had said his chronic weight loss was due to a "hormonal imbalance" that was robbing his body of proteins but was readily treatable. Now he says he needs to take six months off for therapy and recuperation.

Last week many medical experts thought the likeliest explanation was a recurrence of the rare islet cell, or neuroendocrine, cancer that Jobs suffered in 2004. Such tumors are slow-growing, unlike more typical pancreatic cancers. They also can produce abnormal amounts of hormones, such as glucagon, that are necessary to absorb proteins and other nutrients. They are usually treatable.

Now unnamed sources who claim knowledge of Jobs' health situation are quoted as saying he is not suffering from a recurrence of cancer.

Possible Complications

Endocrinologist Clay Semenkovich of Washington University thought cancer recurrence was most likely. Though he has no direct knowledge of Jobs' case, when asked about other possibilities, he listed several:

Pancreas insufficiency, Semenkovich says, is the most common noncancerous explanation for weight loss years after pancreas surgery. The pancreas makes enzymes needed to digest food. Patients who've had part of their pancreas removed often get enzyme pills to compensate, but these supplements don't always do the job.

Diabetes is another type of pancreas insufficiency, which can result from surgical removal of the islet cells that make insulin and other hormones. It might not show up initially, Semenkovich says, but "chronic exposure to the stresses of daily living" can reduce the number of remaining islet cells. Insulin is necessary for the body to absorb proteins as well as glucose (blood sugar) and fats. But diabetes is usually treatable with insulin injections.

A new gastrointestinal cancer, he says, also is possible. People like Jobs who get islet cell or neuroendocrine tumors are sometimes predisposed to a spectrum of cancers. The condition is called multiple endocrine neoplasia type 1, or MET-1. These cancers can include so-called carcinoid tumors that arise from cells lining the stomach and intestinal tract. They crank out intestinal hormones, and they can be treated with anti-hormones.

These do not exhaust the possibilities. Only Jobs, his doctors and those Jobs has taken into his confidence know his diagnosis — if, in fact, his doctors have one.

Health Challenges Of Weight Loss

Whatever it is, weight loss itself can be a complicated thing, with its own side effects. Protein deficiency can cause bleeding, for instance, because the proteins necessary for blood to clot normally are depleted. Weight loss can depress the immune system, leading to infections. Wasting also leads to weakness and fatigue.

At some point, when a patient can't regain weight doctors often resort to artificial feeding, called hyperalimentation. Vital pre-digested nutrients are pumped directly into veins through a catheter, bypassing the patient's intestinal tract.

Whatever Jobs is suffering from is his own business, of course. But there's no question it affects his company and its stockholders. So, as he probably knows by now, speculation will continue until he offers definitive information about his diagnosis.

Meanwhile, those following the story are learning a lot about what can go wrong with the gastrointestinal system.

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