Steve Jobs' Pancreatic Cancer: A Timeline

Oct. 6, 2011— -- Since he revealed in an email from a hospital bed in 2004 that he had a rare form of pancreatic cancer, Apple CEO Steve Jobs' health became a topic of intense interest. The picture that emerged from subsequent news reports was a patchwork of details that introduced many to the idea that one could live for years with a pancreatic tumor, unlike actor Patrick Swayze, opera legend Luciano Pavarotti and journalist Dith Pran.

"With what was reported to be his type of pancreatic cancer, which was a neuroendocrine tumor, seven years [of survival] is not uncommon," said Dr. Baburao Koneru, chief of the Division of Hepatobiliary Surgery at UMDNJ-The University Hospital in Newark, N.J. "It's quite different from the common form of pancreatic cancer."

"These tend to be slow-growing tumors," said Dr. Steven Libutti, director of the Montefiore Einstein Center for Cancer Care in New York.

While much of Jobs' journey through cancer was swathed in secrecy, other elements of his experience became very public – even if often speculative. Below is a timeline of media reports on Jobs' health:

August 2004: Jobs, 49, told Apple employees in an email that he had been diagnosed with a cancerous tumor in his pancreas and had undergone a successful operation to remove it.

"I have some personal news that I need to share with you, and I wanted you to hear it directly from me," the email read. "I had a very rare form of pancreatic cancer called an islet cell neuroendocrine tumor, which represents about 1 percent of the total cases of pancreatic cancer diagnosed each year, and can be cured by surgical removal if diagnosed in time (mine was). I will not require any chemotherapy or radiation treatments.''

(In truth, statistics indicate that pancreatic neuroendocrine tumors account for 2,000 to 3,000 of an estimated 44,000 cases of pancreatic cancer diagnosed each year.)

It was later revealed that Jobs had been diagnosed in 2003 with the cancer, but he chose not to reveal this to investors at the time.

August 2006: At Apple's annual Worldwide Developers Conference Jobs appeared thin and gaunt. Rumors of his death began to swirl around the Internet and in the media. An Apple spokesperson, however, said "Steve's health is robust."

June 2008: Again appearing gaunt at the annual WWDC, Jobs' health soon became a hot topic. Investors began to worry about the state of Apple, especially because its CEO had such a "hands on" approach. Although initially reps said Jobs was suffering from "a common bug," a New York Times reporter wrote that after speaking with Jobs, "his health issues have amounted to a good deal more than 'a common bug,' [but] they weren't life-threatening and he doesn't have a recurrence of cancer."

At Apple's September 2008 Let's Rock event in San Francisco, Jobs used Mark Twain's oft-cited quote: "Reports of my death are greatly exaggerated." Later he brushed off journalists' questions and soon refused to answer any questions about his health.

January 2009: Explaining his absence at a Macworld event, Jobs issued a statement blaming his noticeable weight loss on a "hormone imbalance."

"My decision to have [Apple marketing chief] Phil Schiller deliver the Macworld keynote set off another flurry of rumors about my health, with some even publishing stories of me on my deathbed. Fortunately, after further testing, my doctors think they have found the cause -- a hormone imbalance that has been 'robbing' me of the proteins my body needs to be healthy."

Jobs further noted in his letter that the remedy for the problem was "relatively simple and straightforward," and that he had already begun treatment to correct the condition.

Koneru said that although he was not involved in Jobs' care and had no specific knowledge as to his medical condition at the time, Jobs may well have experienced such symptoms, as they are not uncommon in patients with his diagnosis.

"Some of these neuroendocrine tumors produce certain chemicals that sometimes cause different types of symptoms depending on the chemicals produced," Koneru said. "In general, for various kinds of neuroendocrine tumors, I think this is quite common."

But two weeks after he issued his letter, Jobs announced in an email that he would be taking a medical leave of absence from Apple.

"Unfortunately, the curiosity over my personal health continues to be a distraction not only for me and my family, but everyone else at Apple as well," Jobs wrote. "In addition, during the past week I have learned that my health-related issues are more complex than I originally thought."

June 2009: A five-month period of relative silence about Jobs' condition during his medical leave was broken by a report in the Wall Street Journal that Jobs had traveled to Tennessee for a liver transplant two months earlier.

The Journal, which said it had no specifics on precisely where or when Jobs had the transplant, noted that the waiting time for donated livers is substantially shorter in Tennessee than it is elsewhere, since fewer people come to the three hospitals in the state that do transplants. Specifically, people in Tennessee wait 48 days, on average, compared with 306 nationally, according to 2006 figures from the United Network for Organ Sharing. Also, the state has no residency requirement for organ recipients.

The operation was confirmed days later by Methodist University Hospital Transplant Institute, the Tennessee center that performed the surgery.

"Mr. Jobs underwent a complete transplant evaluation and was listed for transplantation for an approved indication in accordance with the Transplant Institute policies and United Network for Organ Sharing policies," the hospital said in a press release issued at the time. "He received a liver transplant because he was the patient with the highest MELD score (Model for End-Stage Liver Disease) of his blood type and, therefore, the sickest patient on the waiting list at the time a donor organ became available."

"The choice for him to have undergone a liver transplant … was not an unreasonable choice," said Dr. Michael Pishvaian, assistant professor in the Department of Hematology/Oncology at the Lombardi Comprehensive Cancer Center in Washington, D.C. Pishvaian, who was not involved in Jobs' treatment, said that while a liver transplant in cases similar to Jobs' "is not something that we tend to do in this country," it is a more common approach in Europe that has shown promise.

Less than a week after the news broke about his liver transplant, Jobs was back at work.

And in September, jobs revealed for the first time details about his liver transplant -- including specifics about the donor.

"I now have the liver of a mid-20s person who died in a car crash and was generous enough to donate their organs, and I wouldn't be here without such generosity," he said in a statement.

January 2011: Jobs announced that he would be taking medical leave, generating a new round of speculation about his health.

"At my request, the board of directors has granted me a medical leave of absence so I can focus on my health," Jobs said in a statement to the company. "I will continue as CEO and be involved in major strategic decisions for the company."

Shortly thereafter, a report in Fortune magazine led to speculation that Jobs had flown to Switzerland for a treatment not yet approved in the United States.

Fortune, listed former Apple director Jerry York, who died in 2010, as its source.

August 2011: Jobs announced that he would be stepping down as CEO of Apple.

"I have always said that if there ever came a day when I could no longer meet my duties and expectations as Apple's CEO, I would be the first to let you know," Jobs said in an email to the company. "Unfortunately, that day has come."

Apple declined to comment on the current state of Jobs' health, although his cancer battle was in the forefront of the public consciousness.

On Oct. 5, Steve Jobs died. Doctors said the cause was likely a recurrence of his cancer.

Whether Jobs' legacy of living with cancer will be as remembered along with his visionary achievements in technology and business remains to be seen. But doctors believe that the way Jobs handled his cancer will most certainly leave a lasting impact on others living with a potentially deadly disease.

"I think that anytime any public figure battles cancer it definitely raises awareness," Pishvaian said. "It's not just the 100 patients a year who have this same type of cancer who are going to relate to him."

"The fact that he not only lived for seven years after his diagnosis, but was also amazingly productive and made so many contributions after this diagnosis, it's inspiring," Libutti said.