Worries rise about recovery

Steve Jobs, the chief executive of Apple who stepped aside on Wednesday to focus on his health, has looked increasingly gaunt in recent months, writes David Gelles . He has cited a "hormone imbalance" as the culprit. But observers have feared the return of the pancreatic cancer for which Mr Jobs was operated on in 2004.

The pancreas, an organ in the upper abdomen that is connected to the small intestine, produces insulin to keep sugar levels stable and digestive enzymes that help break down food.

In 2004 Mr Jobs had part of his pancreas removed in an operation at Stanford University Medical Center. The treatment, known as Whipple procedure, also involves removing a small portion of the small intestine.

Dr Jeffrey Mechanick, a professor of endocrinology at Mount Sinai Hospital in New York, said a common side effect of the treatment was weight loss. "One of the effects of doing Whipple procedure is you get pancreatic insufficiency," he said. "You can get abnormal digestion of fat. And because there are certain vitamins that require fat to be absorbed, you get vitamin deficiency."

Mr Jobs's weight loss does not mean the cancer has returned, said Dr Mechanick. "As a result of pancreatic surgery, a patient can have a very difficult time regaining weight, even if the cancer has been cured," he said.

Yet it is unclear why Mr Jobs would be suffering the after-effects so long after the procedure. "The enzyme deficiencies are not hard to treat," said Dr Run Yu, medical director of the Carcinoid and Neuroendocrine Tumor Center at Cedars-Sinai Medical Center in Los Angeles. "Normally people with those conditions can proceed with a normal work schedule. So there may be something more serious that is preventing him from continuing as CEO."

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