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Steve Jobs Tumor Was Incidental CT Finding

November 2, 2011
Written by: , Filed in: Abdominal Imaging, Medical Ethics
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The rare pancreatic tumor that led to the death of business titan Steve Jobs was, as it turns out, one of the most significant incidental findings in imaging history. Doctors noticed it on a CT scan while looking for something else.

The New York Times has been exploring Steve Jobs, Walter Isaacson’s new biography of the Apple Inc. CEO who died last month after an eight-year battle with cancer. According to the Times, when the 2003 scan and other tests found a cancerous tumor in his pancreas, Jobs at first refused surgery. Instead, he tried a vegan diet, juices, herbs, acupuncture, and other alternative remedies. As the Times summarizes:

Nine months later, the tumor had grown. Only then did he agree to surgery, during which his doctors found that the cancer had spread to his liver, according to the new biography by Walter Isaacson. Cancer eventually killed him.

Harvard medical researcher Ramzi Amri speculated on October 12, in a long post on the question-and-answer Web site quora.com, that the dalliance with alternative treatments “could have led to an unnecessarily early death.” (Amri had no knowledge of Jobs’ case beyond general media reports.)

The issue is whether the delay in surgery allowed the tumor to metastasize to the liver. Of course there’s no way of knowing whether the cancer had already reached the liver by the time of its accidental discovery in 2003. The tumor was a rare type, a neuroendocrine tumor, much less deadly than the far more common adenocarcinoma. Only 3 percent of tumors in the pancreas are neuroendocrine, the Times reported.

The high-profile nature of Jobs’ case spotlights the question of what to do when a scan unexpectedly detects a tumor too small to be causing symptoms at that point. The Times consulted Steven K. Libutti, MD, director of the Montefiore Einstein Center for Cancer Care in New York and an expert in neuroendocrine tumors. (Again, Dr. Libutti had no involvement in Jobs’ treatment and knew no details other than those publicly available.)

According to the article: “Deciding what to do about these growths, and whether it is ever safe just to watch them, is something that ‘the field is wrestling with now,’ Dr. Libutti said.”

The article doesn’t mention that radiologists are also “wrestling with” the reporting of incidental findings that show up on scans. The current revelations of Jobs’ medical history will certainly stir debate on that topic in public as well as professional circles.

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