by Anonymous Coward writes:
on Monday January 05, 2009 @01:22PM (#26331745)
I am a junior doctor and an old time contributor to Slashdot. I want to comment on this press release but I'm not interested in any trouble my guesswork may cause me.
Steve Jobs had pancreaticoduodenectomy (Whipple's Procedure) for pancreatic neuroendocrine cancer a while ago. His press release is very cryptic and makes little sense because he's using the layman's definition of terms he's using instead of precise medical terms. I'll do my best to decipher it.
First of all, Jobs is losing weight. Is this malnutrition or cancer-related cachexia? The former simply has to do with the body not receiving enough nurishment. The latter is an inflammatory condition related to abnormalities in inflammatory cytokines. Both cause similar outward effects but the underlying processes are very different. If we are to believe the press release then Jobs doesn't have a resurgence of his cancer. A Bloomberg article [bloomberg.com] today commented that "Neuroendocrine islet cell tumors can cause overproduction of either one, or other powerful hormones such as somatostatin or gastrin, which are involved in digestion." While this is true, we are assuming Jobs had his tumor completely reseted so this isn't very likely. Therefore he probably has some form of malnutrition (more on this later).
"Nutrition Management of the Cancer Patient" By Abby S. Bloch states on page 89:
"Surgical resection as a treatment modality for pancreatic cancer creates several nutrition challenges: malabsorption caused by inadequate or absent exocrine pancreatic secretions or obstruction of the common bile duct (or both), diabetes mellitus resulting from resection of endocrine pancreatic cells, and protein-calorie malnutrition, which develops secondary to malabsorption."
If we are to believe the press release, then chances are it could be any of these issues. The only issues that fall under a "nutritional problem [that] is relatively simple and straightforward" are or absent exocrine pancreatic secretions, diabetes mellitus, and protein-calorie malnutrition secondary to malabsorption.
There are several [redorbit.com] articles [karger.com] which discuss these issues both in chronic pancreatitis and in patients status-post pancreatic resection and intestinal bypass. The one curious omission in the press release is the onset of symptoms. Mr. Jobs sounds like he was surprised by his weight loss and his doctors were confused. In Pancreatic Exocrine Insufficiency patients often have statorrhea which is a white-colored and foul smelling fat rich stool. Did he not notice this or was this detail to vulgar for Apple's shareholders and fanbase? It's wholly possible that he didn't have statorrhea which could have caused his doctors to run more tests to check for the worst-case scenarios such as his cancer reappearing. I think its fairly safe to take Mr. Jobs at his word. If his symptoms don't change by Spring then we can revisit this topic.
Anyway, "Pancreatic Cancer" By Douglas Brian Evans, Peter W. T. Pisters, James L. Abbruzzese is a wonderful resource that spends a great deal of time discussing Whipple's Procedure and I would suggest reading Part III from pages 123 to 232. Another great research paper is: "Management of complications following pancreaticoduodenectomy" by CJ Yeo.
Lastly I'd like to say this is all guesswork without having Mr. Jobs' and his test results in front of me so I welcome other doctors, experts, and researchers to comment on this press release. We can all benefit by collaboration. Remember, chaos is the score upon which reality is written but collaboration can swiftly bring some order.
One thing to consider: If someone has survived a treatable form of pancreatic cancer, then it is quite possible that three years later they suffer from a completely unrelated illness. And if a dozen doctors all say "the guy had pancreatic cancer, and now how he has weight loss, so how does pancreatic cancer cause weight loss" they might completely miss the fact that one doesn't have anything to do with the other. So when you asked
Is this malnutrition or cancer-related cachexia
then maybe it is neither?
Asynchronous inputs are at the root of our race problems.
-- D. Winker and F. Prosser
Guesswork at its best... (Score:2, Interesting)
I am a junior doctor and an old time contributor to Slashdot. I want to comment on this press release but I'm not interested in any trouble my guesswork may cause me.
Steve Jobs had pancreaticoduodenectomy (Whipple's Procedure) for pancreatic neuroendocrine cancer a while ago. His press release is very cryptic and makes little sense because he's using the layman's definition of terms he's using instead of precise medical terms. I'll do my best to decipher it.
First of all, Jobs is losing weight. Is this malnutrition or cancer-related cachexia? The former simply has to do with the body not receiving enough nurishment. The latter is an inflammatory condition related to abnormalities in inflammatory cytokines. Both cause similar outward effects but the underlying processes are very different. If we are to believe the press release then Jobs doesn't have a resurgence of his cancer. A Bloomberg article [bloomberg.com] today commented that "Neuroendocrine islet cell tumors can cause overproduction of either one, or other powerful hormones such as somatostatin or gastrin, which are involved in digestion." While this is true, we are assuming Jobs had his tumor completely reseted so this isn't very likely. Therefore he probably has some form of malnutrition (more on this later).
"Nutrition Management of the Cancer Patient" By Abby S. Bloch states on page 89:
"Surgical resection as a treatment modality for pancreatic cancer creates several nutrition challenges: malabsorption caused by inadequate or absent exocrine pancreatic secretions or obstruction of the common bile duct (or both), diabetes mellitus resulting from resection of endocrine pancreatic cells, and protein-calorie malnutrition, which develops secondary to malabsorption."
If we are to believe the press release, then chances are it could be any of these issues. The only issues that fall under a "nutritional problem [that] is relatively simple and straightforward" are or absent exocrine pancreatic secretions, diabetes mellitus, and protein-calorie malnutrition secondary to malabsorption.
There are several [redorbit.com] articles [karger.com] which discuss these issues both in chronic pancreatitis and in patients status-post pancreatic resection and intestinal bypass. The one curious omission in the press release is the onset of symptoms. Mr. Jobs sounds like he was surprised by his weight loss and his doctors were confused. In Pancreatic Exocrine Insufficiency patients often have statorrhea which is a white-colored and foul smelling fat rich stool. Did he not notice this or was this detail to vulgar for Apple's shareholders and fanbase? It's wholly possible that he didn't have statorrhea which could have caused his doctors to run more tests to check for the worst-case scenarios such as his cancer reappearing. I think its fairly safe to take Mr. Jobs at his word. If his symptoms don't change by Spring then we can revisit this topic.
Anyway, "Pancreatic Cancer" By Douglas Brian Evans, Peter W. T. Pisters, James L. Abbruzzese is a wonderful resource that spends a great deal of time discussing Whipple's Procedure and I would suggest reading Part III from pages 123 to 232. Another great research paper is: "Management of complications following pancreaticoduodenectomy" by CJ Yeo.
Lastly I'd like to say this is all guesswork without having Mr. Jobs' and his test results in front of me so I welcome other doctors, experts, and researchers to comment on this press release. We can all benefit by collaboration. Remember, chaos is the score upon which reality is written but collaboration can swiftly bring some order.
Re: (Score:3, Insightful)
Is this malnutrition or cancer-related cachexia
then maybe it is neither?