Steve Jobs went to Switzerland in search of cancer treatment

                                       

In early 2009, the tech and investing worlds were trying to untangle a puzzle about Apple. The company was putting out incredible devices, but it was unclear why the legendary leader wasn't there. AsFortune 

reported [See: "The Trouble with Steve Jobs"], Jobs had surgery for pancreatic cancer in 2004, taking a leave of absence to recover. He had returned, only to disappear a few years later, a second medical absence for roughly six months in 2009. How sick was he? And what did he have? It wasn't until June 20th, two months after the fact, that the Wall Street Journaluncovered the fact that Jobs had undergone a secret liver transplant at Methodist University Hospital in Memphis, Tennessee. However, during that absence, Fortune can report, Jobs also took an unpublicized flight to Switzerland to undergo an unusual radiological treatment at the University of Basel for neuroendocrine cancer, according to Jerry York, the Apple (AAPL) director who died in March 2010.

Yesterday, Apple announced the third known absence by Jobs for medical reasons over the last 7 years. York told me about the treatment, which was not available in the U.S., in the context of our discussions about Jobs, his health and Apple's future. Under our agreement at the time, York wanted the facts of Jobs's treatment in Switzerland to remain out of the news. He didn't say whether the board knew of it. (With York's death, the off-the-record agreement is no longer in place.)

A neuroendocrine cancer expert at the University of Iowa Hospitals and Clinics said Monday that recent studies show that "survival rates are improving" due to better treatment. At the time Jobs's cancer was originally diagnosed in 2004, according to Dr. Thor Halfdanarson, the five-year survival rate for metastatic disease was thought to be less than 20%. Today "the prognosis is getting better," with the five-year survival rate at 55% to 57%, he said, according to one recent study.

The circumstances surrounding this leave by Jobs are unknown, but the kind of cancer he was treated for in 2004 is known to recur. If his leave is due to a recurrence, "we don't know where, in his new liver or elsewhere,'' that recurrence could be, said Dr. Halfdanarson. Speculation about Jobs's prognosis would thus also be premature, according to Dr. Halfdanarson.

Apple spokeswoman Katie Cotton in an email response to questions declined to elaborate on the company's announcement. However, the announcement by Apple seems to indicate that Jobs is taking his health extremely seriously. As Peter Elkind reported in his 2008 "Trouble with Steve" Fortune story, Jobs was initially opposed to his 2004 surgery, choosing instead to treat his tumor through a special diet. Whatever course of action Jobs is taking now, his leave of absence suggests it's not one that can be balanced with the duties of leading the world's largest tech company and second largest U.S. company overall.

While York told me he didn't know exactly why Jobs and his doctors had sought medical care in Switzerland, it is the home for the world-renowned University Hospital of Basel, which has developed a special form of hormone-delivered radiotherapy to treat neuroendocrine cancer. The treatment isn't available in the U.S. (In April 2009, Jobs underwent his liver transplant at the Methodist University Hospital in Memphis, Tennessee. Given the demands of transplant recovery and the timing of his return to Apple, it's likely he visited Basel before his transplant.)

York, who grew up in Tennessee, told me he was "very familiar" with the Memphis hospital and the care offered there. The Wall Street Journal reported in April 2010, after York's death, that he was displeased with Jobs's lack of transparency about his illness and had nearly resigned from the board over the matter.

According to Jobs and Apple, the diagnosis of the chief executive officer's illness took place in 2004 as a result of a lesion in his pancreas. Doctors removed the tumor. Sometimes neuroendocrine cancer, which generally is a slow-growing tumor, is confused with more virulent forms of pancreatic cancer. The disease can spread to endocrine tissue in the liver, lungs and other organs and most commonly is treated with surgery to remove, burn, freeze or starve the tumors.

Dr. Halfdanarson said that chemotherapy, which once was regarded as ineffective against neuroendocrine cancer, is showing some promise. Sutent, Asinitor, Xeloda used with Temodar are medicines that have been able to slow growth or shrink tumors in some patients, he said. However, Halfdanarson added that shrinking tumors and slowing their growth doesn't necessarily add to life expectancy.

"There has been an explosion of research," he said. "That's probably because there are more patients since many formerly went undiagnosed."