A little more than two months ago, Steve Jobs took another leave of absence due to illness. Since the media first revealed that Jobs had pancreatic cancer in 2003, he has been battling the disease for nearly eight years. On the one hand, his tenacity is admirable, but on the other hand, it is also puzzling. It is said that pancreatic cancer has a high death rate and a short survival period, with 90% of patients dying within one year after diagnosis and only a handful of patients surviving beyond five years. “Was it a misdiagnosis, a medical miracle by the doctor who treated Steve Jobs, or was it the “king of cancer” who showed mercy to the IT mogul? The answer may be a play on words. Steve Jobs did have a tumor of the pancreas, but not the pancreatic cancer we often talk about, but islet cell tumor. Because Jobs’ personal health information was rarely disclosed to the outside world, it was only generally described as “pancreatic tumor”, so many people mistook him for the most common type of pancreatic cancer. To understand this point, we have to start with the pancreas. The pancreas is a very interesting gland, it is both an exocrine and endocrine organ, a bit like having two boats in one. In terms of volume, the structure that performs the exocrine function takes up a larger percentage of the pancreas, secreting pancreatic juice containing a variety of digestive enzymes, which flows through the pancreatic ducts into the intestines to help digest food. Since the digestive tract is connected to the outside world, it is called exocrine. If inflammation occurs in this part, it will cause powerful digestive enzymes to enter the abdominal cavity, resulting in pancreatitis; the cells in this part become cancerous, which is what we usually call pancreatic cancer. The endocrine part is smaller in size but not less important because it secretes two hormones responsible for regulating blood sugar, one called glucagon, which is responsible for raising blood sugar, and the other called insulin, which is responsible for lowering blood sugar. As thundering as diabetes is, it’s insulin that’s the problem. The endocrine part is scattered in the pancreas like islets, hence the name islets. Tumors that occur in islet cells are called islet cell tumors. Islet cell tumors can be divided into non-functional islet cell tumors, insulinomas, gastrinomas, pancreatic polypeptide tumors, pancreatic glucagon tumors, pancreatic intestinal peptide tumors, and growth inhibitor tumors, depending on the hormone secreted, with the first three being relatively more common. As the name implies, some of these can secrete hormones and some cannot. For example, insulinoma will cause too much insulin in the body because there are too many cells that secrete insulin. Since the function of insulin is to lower blood sugar, this kind of patient is exactly the opposite of diabetes, and hypoglycemia often occurs, and even coma occurs, and the symptoms disappear immediately after oral or intravenous glucose is given, but it will recur. Another example is gastrinoma, which releases large amounts of gastrin. Since gastrin promotes the secretion of gastric acid, which in turn causes gastric and duodenal ulcers, patients with gastrinoma are characterized by stubborn peptic ulcers. Other types of islet cell tumors also secrete different hormones depending on the cell type and produce different clinical manifestations. There are also benign and malignant islet cell tumors, which naturally have different effects on outcome. In general, both islet cell tumors and pancreatic cancer can be called “pancreatic tumors”, but the clinical manifestations, treatments, and outcomes of these two diseases are very different, and even islet cell tumors and pancreatic cancer can be divided into many subcategories, each of which is different. The purpose of classifying tumors is to guide treatment and evaluate the therapeutic effect, and different types of tumors should not be confused, otherwise it is impossible to compare them. If a less malignant tumor is “accidentally” classified as “pancreatic cancer”, the treatment effect will be overestimated, which will be detrimental to the real pancreatic cancer patients who come to the clinic. Since not much has been revealed about Jobs’ condition, for example, we have not heard that he had a hypoglycemic coma or that he had a gastric or duodenal ulcer, it is impossible to know exactly which type of islet cell tumor he had. But in any case, using the general understanding of pancreatic cancer to apply to the condition of an islet cell tumor patient certainly does not make sense. Of course, for this IT hero, not having the most malignant tumor is always a blessing among misfortunes, and those of us who care about the Apple saga hope that he will recover soon and continue to lead Apple in launching more good products.