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Rehnquist's treatment indicates grave illness

Chief justice's cancer of the thyroid seen as aggressive by analysts

WASHINGTON -- Chief Justice William H. Rehnquist revealed yesterday that he is undergoing chemotherapy and radiation treatment for thyroid cancer, signs he has a grave form of the disease and probably will not return to the bench soon.

The election eve disclosure by the 80-year-old justice underscores the near certainty that the next president will make at least one appointment to the Supreme Court, and probably more.

Rehnquist had planned to join his colleagues when they returned to hear arguments yesterday after a two-week break. Instead, he issued a statement from home about the treatment he's receiving. It said he plans to work from home and made no mention of leaving the court.

The chief justice did not disclose what type of thyroid cancer he has, how far it has progressed, or the prognosis.

Rehnquist was released from a Maryland hospital last Friday. The court has released no details about his weeklong stay at Bethesda Naval Medical Center, except to say that he had a tracheotomy.

Several types of cancer can affect the thyroid, a gland in the neck that produces hormones to help the body regulate its energy use. The most common forms of the cancer grow slowly and are readily treated, usually with surgery to remove the gland, or radioactive iodine.

But the combination of chemotherapy and radiation is the normal treatment for the much more aggressive anaplastic thyroid cancer, specialists said. Anaplastic thyroid cancer grows very quickly, usually resulting in a large growth in the neck, and often spreads throughout the body.

''Now we have much more compelling evidence that he has an aggressive cancer of some kind in this area," said Dr. Marshall Posner, director of the head and neck oncology program at Dana-Farber Cancer Institute. ''The most likely diagnosis is anaplastic thyroid carcinoma, which would be devastating and tragic," or a cancer that has metastasized from another part of his body such as his lymph nodes.

Although both forms of cancer are rare and potentially deadly, the difference between the two is critical. Anaplastic thyroid cancer, the rarest of the thyroid cancers, is one of the most dangerous cancers known, with a typical life expectancy of just three to nine months. A cancer that metastisized from the lymph nodes, by contrast, has a 40 to 50 percent cure rate.

However, Posner said that even older patients can sometimes recover from anaplastic thyroid cancer. Unpublished data at Dana-Farber shows that an 81-year-old anaplastic thyroid cancer patient was well more than two years after his diagnosis as a result of surgical removal of the tumor followed by radiation and aggressive chemotherapy to destroy remaining cancerous cells.

If Rehnquist suffers from that type of cancer and is successfully treated, Posner predicted that he could not return to the bench for six to eight weeks ''if at all."

However, if Rehnquist suffers from a lymphoma that has spread to his thyroid, Rehnquist could be physically recovered within a week after treatment, Posner said.

Dr. Herman Kattlove of the American Cancer Society said he began to suspect anaplastic cancer when the court announced that Rehnquist had a tracheotomy, saying, ''That's an unusual event." A tracheotomy involves cutting open the throat and inserting a tube to make it easier for the patient to breathe.

''Our guess was that he had this uncommon, yet fairly lethal form of thyroid cancer . . . which is typically treated not with surgery but with chemotherapy and radiation," he said, adding, ''Unfortunately, it rarely responds very well and this is just a holding action for most patients."

Dr. Joseph Geradts of Roswell Park Cancer Institute in Buffalo, N.Y., also said the treatment given Rehnquist raises the suspicion that he has the anaplastic form of cancer. But not knowing the type of cancer or whether the thyroid has been removed makes it hard to speculate, he said.

In the statement, Rehnquist, 80, said he was receiving outpatient radiation and chemotherapy.

''According to my doctors, my plan to return to the office today was too optimistic," he said. ''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."

Scott Allen of the Globe staff contributed to this report.

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