Skip to comments.Rehnquist's diagnosis likely 'bleak'
Posted on 11/02/2004 12:28:39 AM PST by Main Street
Treatments show the chief justice's thyroid cancer is an aggressive form, outside experts say
WASHINGTON - Chief Justice William Rehnquist could not preside over the Supreme Court as planned Monday, and specialists said his treatment indicates a particularly virulent, usually fatal form of thyroid cancer.
Rehnquist said his pledge to return to the court after receiving a cancer-related tracheotomy 10 days ago was "too optimistic" and that he would remain at home while receiving radiation and chemotherapy treatment.
Rehnquist's first public comment since the court announced Oct. 25 that he had been diagnosed with thyroid cancer offered circumstantial evidence that he has the most serious form of the disease, several experts said Monday.
"This adds up to something very bleak," said David Cooper, director of the Thyroid Clinic at the Johns Hopkins University School of Medicine in Baltimore. "That's very, very bad news."
The news about Rehnquist's condition came on the eve of a close election between President Bush and Sen. John Kerry of Massachusetts. If Rehnquist leaves the court for any reason before Jan. 20, Bush could nominate a replacement no matter who wins Tuesday's election.
"The form of treatment he's getting almost certainly indicates he is dealing with the most aggressive form of thyroid cancer, i.e., anaplastic," said Dr. Irwin Klein, chief of endocrinology and metabolism at North Shore University Hospital in Manhasset, N.Y. Another specialist said the disease is "unstoppable" and that treatment is merely an attempt to prolong Rehnquist's life for a few months.
Rehnquist, 80, said in a statement Monday: "While at home, I am working on court matters, including opinions for cases already argued. I am, and will, continue to be in close contact with my colleagues, my law clerks and members of the Supreme Court staff."
In his absence Justice John Paul Stevens presided in the chief justice's absence, announcing thatRehnquist "reserved the right" to vote in the cases he missed based on the briefs and transcripts of the arguments.
Leonard Wartofsky, chairman of the department of medicine at the Washington Hospital Center, was skeptical thatRehnquist will be able to read, write and make decisions normally. "With those therapies, he is going to feel lousy," Wartofsky said. "His ability to eat, drink, speak and breathe are all in that area of the neck."
A diagnosis of anaplastic thyroid cancer, the most serious of four forms of thyroid cancer, would account for Rehnquist's situation, several thyroid cancer experts said Monday. And no other diagnosis would adequately explain his treatment, they said.
Rehnquist's doctors' approach, in sharp contrast to techniques usually used for milder cancers, suggested the physicians were throwing everything they had at the illness, the experts said.
"The growth rate of anaplastic leaves you a short window of time to operate, so you have to kill as many cancer cells (as possible) in a short time," said James Fagin, director of the division of endocrinology at the University of Cincinnati. "That's why you use combination treatment."
Removing the thyroid is not normally done in patients with this form because it spreads so rapidly.
"For anaplastic cancer, almost nothing works," Wartofsky said. "Radiation and chemotherapy are tried sometimes to slow the cancer and buy some time. All thyroid cancers are a little more common in women than men, but men do worse."
Anaplastic cancer'likely' None of the experts interviewed Monday is part of Rehnquist's medical team. None has information beyond the facts that have been made available by the Supreme Court.
But Wartofsky, Cooper and Fagin said no other diagnosis could account for the known facts of Rehnquist's case. Steven Sherman, chair of the department of endocrine neoplasia at the University of Texas M.D. Anderson Cancer Center in Houston, said anaplastic cancer was "likely" but that other explanations could not yet be conclusively ruled out.
Anaplastic thyroid cancer kills patients on average within six months. Looked at another way, 90 percent of patients with anaplastic thyroid cancer die within a year, said Sherman. Wartofsky said in 35 years of treating thyroid cancer, he had seen only two patients survive anaplastic thyroid cancer.
"I have had patients where you can mark on the skin with a pen the edge of the tumor and watch it grow day by day it is that fast," said Sherman.
Wartofsky, Cooper and Fagin said the evidence pointed toward anaplastic thyroid cancer because of the differences between types of thyroid cancer and the differences in treating them.
The Washington Post, Newsday and the New York Times contributed to this report.
The legality of the death penalty depends on this election.
Prayers for the Chief Justice.
|Rehnquist's diagnosis likely 'bleak'
|Posted by GeronL
On News/Activism 11/02/2004 2:51:07 AM EST · 30 replies
Houston Chronicle ^ | Nov 1
My version was excerpted
I didn't make an excuse. Just making a point is all. =o)
Not good news for the Chief Justice...but Daschle lost his suit mostly....
I apologies for posting this. I didn't know you had already posted this article. I ran a search for "Rehnquist", not "Rehnquist's" as I should have, and came up thinking it hadn't been posted. I screwed up. Again, my apology to you.
Stages of thyroid cancer
Once thyroid cancer is found (diagnosed), more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment.
Papillary and follicular thyroid cancer
The following stages are used for papillary and follicular thyroid cancer:
* In patients younger than 45 years, cancer may have spread within the neck or upper chest and/or to nearby lymph nodes but not to other parts of the body.
* In patients aged 45 years and older, the tumor is 2 centimeters (about ¾ inch) or smaller and in the thyroid only.
* In patients younger than 45 years, the cancer has spread to distant parts of the body, such as the lung or bone, and may have spread to nearby lymph nodes.
* In patients aged 45 years and older, the tumor is larger than 2 centimeters but not larger than 4 centimeters (between ¾ and 1½ inches) in the thyroid only.
The cancer is found in patients aged 45 years or older. The tumor either:
* is larger than 4 centimeters; or
* may be any size and has spread just outside the thyroid and/or to lymph nodes in the neck.
The cancer is found in patients aged 45 years or older. The tumor may be any size and has spread within the neck and/or to lymph nodes in the neck or upper chest.
The cancer is found in patients aged 45 years or older. The tumor may be any size and has spread to neck tissues near the backbone or around blood vessels in the neck or upper chest. Cancer may have spread to lymph nodes.
The cancer has spread to other parts of the body, such as the lung or bone, and may have spread to nearby lymph nodes.
Anaplastic thyroid cancer
Anaplastic thyroid cancer is considered to be stage IV thyroid cancer. It grows quickly and has usually spread within the neck when it is found. Anaplastic thyroid cancer develops most often in older people.
What's the Prognosis ??
Most thyroid cancers are very curable. In fact, the most common types of thyroid cancer (papillary and follicular) are the most curable. In younger patients, both papillary and follicular cancers can be expected to have better than 95% cure rate if treated appropriately. Both papillary and follicular cancers are typically treated with complete removal of the lobe of the thyroid which harbors the cancer, PLUS, removal of most or all of the other side.
Medullary cancer of the thyroid is significantly less common, but has a worse prognosis. Medullary cancers tend to spread to large numbers of lymph nodes very early on, and therefore requires a much more aggressive operation than does the more localized cancers such as papillary and follicular. This cancer requires complete thyroid removal PLUS a dissection to remove the lymph nodes of the front and sides of the neck.
The least common type of thyroid cancer is anaplastic which has a very poor prognosis...it tends to be found after it has spread and is not cured in most cases. Often an operation cannot remove all the tumor.
What About Chemotherapy ??
Thyroid cancer is unique among cancers, in fact, thyroid cells are unique among all cells of the human body. They are the only cells which have the ability to absorb Iodine. Iodine is required for thyroid cells to produce thyroid hormone, so they absorb it out of the bloodstream and concentrate it inside the cell. Most thyroid cancer cells retain this ability to absorb and concentrate iodine. This provides a perfect "chemotherapy" strategy. Radioactive Iodine is given to the patient and the remaining thyroid cells (and any thyroid cancer cells retaining this ability) will absorb and concentrate it. Since all other cells of our bodies cannot absorb the toxic iodine, they are unharmed. The thyroid cancer cells, however, will concentrate the poison within themselves and the radioactivity destroys the cell from within. No sickness. No hair loss. No nausea. No diarrhea. No pain. More about this on the pages for each specific thyroid cancer type.
Not all patients with thyroid cancer need radioactive iodine treatments after their surgery. This is important to know. Others, however, should have it if a cure is to be expected. Just who needs it and who doesn't is a bit more detailed than can be outlined here. Patients with medullary cancer of they thyroid usually do not need iodine therapy...because medullary cancers almost never absorb the radioactive iodine. Some small papillary cancers treated with a total thyroidectomy may not need iodine therapy as well, but for a different reason. These cancers are often cured with simple (complete) surgical therapy alone. Important!!! This varies from patient to patient and from cancer to cancer. Don't look for easy answers here. This decision will be made between the surgeon, the patient, and the referring endocrinologist or internist. Remember, radioactive iodine therapy is extremely safe. If you need it, take it.
The most serious form of the disease, known as anaplastic thyroid cancer, accounts for no more than 3 percent of all cases, but it is by far the deadliest. Most commonly seen in patients over 65, it invades the thyroid so quickly and thoroughly that there is no way to remove it surgically, Burman said.
"Mortality is very high. The lifespan is six to 12 months," Burman said.
The hole in the throat created by a tracheotomy is permanent. But once a patient can breathe normally again, the opening is closed by a small plastic plug so that the patient can speak.
Rehnquist has been treated for skin cancer in the past, and he is far from the first member of the court to receive a cancer diagnosis. Sandra Day O'Connor, 74, survived breast cancer; John Paul Stevens, 84, has been treated for prostate cancer, and Ruth Bader Ginsburg, 71, had colon cancer.
Rehnquist has had other health conditions, including recurrent back problems and a hospitalization in 1982 for what were described as withdrawal symptoms related to a reduction in the medication he had been taking for back pain. In 2002, a torn tendon in his leg kept him out of oral arguments for two weeks. But despite his advancing age, he has shown no apparent loss of interest in his job or of his ability to do it.
During the first two weeks of oral arguments in the term that began Oct. 4, Rehnquist sounded hoarse -- a symptom that can result from the pressure of a growing thyroid tumor against the nerve in the throat that controls the voice box, doctors said.
"When someone comes with hoarseness and a thyroid nodule, you think cancer affecting that nerve," said Kenneth Burman, chief of the endocrine section at Washington Hospital Center and professor of internal medicine at Georgetown University.
If this election ends up in the courts again this will be very bad.
So not only will there be an open seat on the court, but the Chief Justice seat. Any ideas who the new Chief Justice will be?
If you ask me it should be my paisan, Nino Scalia! ;-)
In the event that he should pass away, how long would the appointment process for a new Supreme Court justice take?
This makes the President's re-election even MORE important!!
He will be dead by Inauguration, and replacing him will be the #1 issue of the next president's first 100 days.
Dear God, may George Bush win!
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