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Chief Justice Rehnquist Dies of Thyroid Cancer


Updated September 04, 2005

Did Rehnquist Have Anaplastic Thyroid Cancer?

From the initial announcement of the Chief Justice's thyroid cancer, experts speculated that Rehnquist might have anaplastic thyroid cancer, even though the specific type of thyroid cancer has not been confirmed. Anaplastic thyroid cancer, usually the most advanced, invasive and serious of all thyroid cancers, 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.

One reason that anaplastic was suspected is that the first treatment reported was tracheotomy -- which involves opening a hole in the windpipe to help breathing. Tracheotomy 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 typical 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, said at the time 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.

Subsequently, it was also reported that Rehnquist would undergo chemotherapy and radiation. Chemotherapy is not used for thyroid cancer, except in rare cases for anaplastic cancer that has spread.

Dr. Ann M. Gillenwater of the University of Texas M.D. Anderson Cancer Center in Houston told the Associated Press that said that "the combination of chemotherapy and radiation is the normal treatment for anaplastic thyroid cancer."

Dr. Herman Kattlove, an oncologist and medical editor for the American Cancer Society, told Bloomberg that "the announcement suggests that Rehnquist is suffering from anaplastic thyroid cancer. According to Kattlove, "It's rarely, if ever, curable, and most patients die within a few months.''

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.

Chief Justice Rehnquist's death comes a little more than 10 months after his diagnosis.

About Thyroid Cancer

In 2004, it's estimated that there were 23,600 new cases of thyroid cancer in the U.S. Of these, 17,640 were in women, and 5,960 in men. About 1,460 people (840 women, 620 men) died of thyroid cancer in 2004.

According to the Thyroid Cancer Survivor's Association, thyroid cancer is one of the few cancers that becoming more common in the past several years, with a growth rate of 3% per 100,000 people each year. Normally, thyroid cancer is considered an easily cured form of cancer, with surgery and radioactive iodine treatment eliminating the condition in the majority of cases.

The butterfly-shaped thyroid gland, located in the neck, is the master gland of metabolism, and produces hormones that help regulate the body's use of energy.


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