Latest update/October 27, 2004 -- William H. Rehnquist, Chief Justice of the United States Supreme Court since 1986, and the leader of the Supreme Court's conservative majority, has thyroid cancer, according to a spokesperson from the Supreme Court.
According to a statement issued by the Court, the 80-year-old Rehnquist "was admitted to Bethesda Naval Hospital on Friday, Oct. 22 and underwent a tracheotomy in connection with a recent diagnosis of thyroid cancer." The statement indicated that Rehnquist is expected to be on the bench when the court returns to session to hear arguments on Monday, November 1.
Thyroid cancer, usually a highly curable type of cancer, is almost always treated with thyroidectomy -- thyroid surgery -- to remove the cancerous thyroid, followed up by radiactive iodine treatment to ablate any cancerous tissue left behind. Without a thyroid, the patient then goes on lifelong thyroid hormone replacement.
Experts Say Tracheotomy is Unusual for Thyroid Cancer
Tracheotomy -- which involves opening a hole in the windpipe to help breathing -- is performed only when the disease is progressing rapidly and the airway is obstructed, or the thyroid tumor has invaded the trachea -- usually the case in only metastatic or advanced thyroid cancer that cannot be removed surgically. Tracheotomy is typically a palliative treatment performed to ease breathing, and is not a treatment for the thyroid cancer itself.
Dr. Gilbert Daniels, a Harvard Medical School professor and co-director of the Thyroid Clinic at Massachusetts General Hospital, has said that tracheotomy for thyroid cancer is unusual. Daniels told Reuters: "That says something peculiar is going on but it doesn't say what...I'm concerned that he needed a tracheotomy because that generally suggests he had some kind of thyroid cancer that was aggressive, that was growing into his trachea."
Dr. Pramod Sharma, a head and neck surgeon at the University of Utah School of Medicine, also told Reuters, "If done at time of surgery it indicates there may be some invasion from the thyroid gland into the airway." According to Dr. Sharma, this type of spread is more common with anaplastic thyroid cancer.
Dr. Yosef Krespi, chairman of otolaryngology at St. Luke's-Roosevelt Hospital in New York, told the Associated Press that only aggressive or complicated thyroid cancers require a tracheotomy.
Dr. Leonard Wartofsky, a thyroid cancer specialist at Washington Hospital Center, said that the tracheotomy "implies some obstruction and suggests local invasion..." which, would be "not good" for the chief justice's long-term prognosis, according to Wartofsky.
Experts Speculate that Rehnquist May Have Advanced Cancer
While no definitive information is available, some experts are hinting at the possibility that Rehnquist may in fact have an advanced case of thyroid cancer, or the more rare anaplastic thyroid cancer, which is the most serious form of thyroid cancer. Anaplastic thyroid cancer is seen in only 3 percent of all thyroid cancer cases, but is most common in those over 65, and in men. It can spread early and quickly to lymph nodes, and is frequently first diagnosed as a large mass in the neck. Long-term survival rates are far less than for the other types of thyroid cancer. It is a type of advanced, invasive cancer that can often result in the need for a tracheotomy.
Because anaplastic cancer is typically discovered when it is very advanced, it is harder to remove surgically, and thyroidectomy may not be possible. As many as 80 percent of patients with anaplastic thyroid cancer die within a year of diagnosis, even after receiving treatment.
Implications for the Future
So far, the Court has refused to issue any information regarding the type of thyroid cancer afflicting Rehnquist, or any other treatments Rehnquist has received, besides the tracheotomy.
The lack of information -- coupled with the tracheotomy, and its association with anaplastic or advanced thyroid cancer -- make it possible that the seriousness of Chief Justice's condition is being significantly downplayed, while his fitness to return to Court activities in less than a week is being overestimated.
Rehnquist's prognosis also raises two political issues -- first, the greater likelihood of a possible vacancy on the Supreme Court during a period when the opportunity to name a new justice is a hot-button issue in the Presidential election. Second, in the 2000 presidential election, the Supreme Court voted to stop a recount in the disputed race in Florida, making George Bush the winner over Democrat Al Gore. Many political pundits
