Medical experts: Rehnquist's condition could be severe

By Kevin Berger
Published October 26, 2004 10:20PM (EDT)

The Supreme Court's brief public announcement on Monday that Chief Justice William Rehnquist has been diagnosed with thyroid cancer, underwent a tracheotomy, and is expected to return to the bench on Nov. 1, likely masks the severity of his condition.

Numerous medical studies only mention tracheotomy -- in which surgeons cut a hole into a patient's windpipe to aid breathing -- as a treatment for a rare form of thyroid cancer called anaplastic carcinoma. According to the University of Virginia Health Center, "anaplastic carcinoma is an extremely serious and aggressive thyroid cancer which often results in the death of the patient  within several months of diagnosis."

Obviously, the news comes at the tense height of the presidential campaign, transforming the chief justice's health into a volatile political issue, one that presents a host of scenarios.

Located at the base of the neck and in front of the trachea, the thyroid gland produces hormones that control metabolism. Less severe forms of thyroid cancer are often arrested through radiation or surgically removing the entire gland. Performing a tracheotomy for thyroid cancer is so uncommon that Kenneth B. Ain, M.D., director of the Thyroid Oncology Program at the University of Kentucky Medical Center, speculates that when it comes to Chief Justice Rehnquist, "either the nature of the surgical procedure done was inaccurately reported or there are many things that have been left unsaid."

In fact, he adds, "It is extraordinarily rare that someone treated for thyroid cancer of any type would receive a tracheotomy at all, and even less common that it would constitute the only surgical procedure performed."

Other thyroid cancer specialists explain that in those rare times when a tracheotomy is performed, it's usually because the cancer has spread and poses an immediate threat to the patient's life. In some cases, the cancer nodules may be squeezing the windpipe, causing the patient to choke. The procedure may also be required after a thyroidectomy (the removal of the gland) and radiation treatments. A former endocrinologist at the University of California at San Francisco says that surgery or radiation can damage the laryngeal nerves that control the vocal cords, potentially causing the vocal cords to shut down and lead to respiratory arrest.

Regardless, the endocrinologist explains, performing a tracheotomy "suggests a very high-grade tumor or that cancer's been extensive and is not a single nodule but is throughout the gland."

Medical details that may shed light on Chief Justice Rehnquist's condition have not been forthcoming. The Naval Medical Center in Bethesda, where the chief justice received treatment, referred War Room to the Supreme Court, whose public information office did not return calls.

Kevin Berger

Kevin Berger is the former features editor at Salon.

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