Is Steve Jobs really dead

When Steve Jobs publicly stated that he had cancer in 2004, he gave few facts. He only informed his employees as far as his ability to work was concerned - after all, this was also of great importance to the company for which they worked. He held back from providing further information - he regarded his health primarily as a private matter.

And although many people now want to know what Jobs suffered and what he ultimately died of, they have to be content with the sparse facts that the Apple founder has revealed.

The first time the public learned about Jobs' health problems it was through an email to his employees. In it he informed them: "This weekend I underwent a successful removal of a tumor from my pancreas." It was a rare form of pancreatic cancer with good prospects for a cure: a neuroendocrine islet cell tumor.

The cancer affected cells in the pancreas, the so-called islet cells. Neuroendocrine refers to the fact that it affects tissue that makes hormones. The hormones insulin and glucagon are produced in the pancreas, a tongue-shaped organ behind the stomach. The far more common form of pancreatic cancer - adenocarcinoma - affects the exocrine cells that produce digestive enzymes.

While patients with this form have a short life expectancy even after surgery and despite chemotherapy or radiation therapy - according to the American National Cancer Institute, around 80 percent die within a year of being diagnosed with the rapidly growing form of cancer - the chances of a cure for the endocrine forms are greater.

The entrepreneur was among those around one to five percent of patients with this pancreatic cancer, which spreads more slowly and can even be cured with an operation if diagnosed early. Neither radiation nor chemotherapy were apparently necessary. In July 2004, however, the pancreas had to be removed - in whole or in part.

He was already working again in September. And in 2005 he publicly declared in front of students at Stanford University that he was cured. In this speech he described for the first time how he had experienced the diagnosis and how he had dealt with it. "Your time is limited, so don't use it to live other people's lives," he advised the audience.

However, he lost more and more weight in the following years, so that concern about his health increased again in the Apple community. Whether his condition was related to the operation remained unclear, although the suspicion was obvious. After all, the pancreas is responsible for making insulin. And a lack of insulin can lead to weight loss.

It wasn't until the beginning of 2009 that Jobs himself gave information about his state of health. He had canceled the traditional lecture at the Macworld fair and was now responding to speculation about the reasons. "Fortunately, after a series of other tests, my doctors think they've found the cause - a disrupted hormonal balance that is robbing me of the proteins my body needs to stay healthy." What that actually meant remained in the dark.

The 2004 operation naturally had an impact on his hormonal balance. The fact that the proteins were being stolen from him was, however, very imprecise. The digestive enzymes actually produced by the pancreas - certain proteins - break down other proteins from food in the small intestine. If the pancreas is completely or partially missing, these enzymes can be deficient and the nutrients are not properly broken down. One consequence could be weight loss. However, Jobs spoke of a disturbed hormone balance. So it remains unclear whether he was talking about problems with insulin after all.

Shortly afterwards, Jobs informed his employees that his health was more complex than he had originally assumed. Then he announced a six-month break. During this time, in April 2009, Jobs got a new liver. The reason for the transplant has not been published. It is known, however, that the cancer from which Jobs suffered can spread to the liver. Removal of the affected organ can slow the progression of the disease again or cure it, if the spread is actually limited to the liver.

However, drugs must be used after a transplant to prevent the immune system from rejecting the foreign organ. A weakened immune system, however, may benefit the cancer. If other organs are affected, the outlook is poor.

Job's prognosis was "excellent," according to the Methodist University Hospital Transplant Institute in Memphis, Tennessee, where he had been operated on. According to experts, it is not uncommon for patients to survive six or more years after being diagnosed with "neuroendocrine islet cell tumor". Some are even considered completely cured after operations.

Whatever Steve Jobs has now died of - the achievements of modern medicine have given him seven more successful years.

At Stanford, Jobs described death as "possibly the best invention of life". Because "it clears out the old to make way for the new".

© sueddeutsche.de/woja/gba