Rehnquist has thyroid cancer; will keep schedule

WASHINGTON -- Chief Justice William H. Rehnquist has been diagnosed with thyroid cancer and was hospitalized over the weekend, a surprise development in the final week of the election campaign that highlights a president's power to fill Supreme Court vacancies.

The Supreme Court released a brief statement yesterday disclosing that Rehnquist, 80, was admitted Friday to Bethesda Naval Hospital in suburban Maryland. On Saturday, the court said, he underwent a tracheotomy, the insertion of a tube into the windpipe to improve a patient's breathing.

The court announced the diagnosis for Rehnquist, who has been one of the most conservative jurists on the Supreme Court for the past 32 years. It noted that he ''is expected to be back on the bench when the court reconvenes" next Monday, the day before the election.

Cancer specialists said the seriousness of Rehnquist's condition depends on the type of thyroid cancer he has. The details that have been made public about his condition are conflicting, they said. The most common form is easily treatable, and the patient can return to normal activity within days. But a tracheotomy is usually performed only on patients with a much rarer and more deadly form, anaplastic thyroid cancer, according to Dr. Marshall Posner, director of the head and neck oncology program at the Dana-Farber Cancer Institute in Boston. ''This is a very unusual circumstance," he said.

The news of Rehnquist's hospitalization rippled through the nation's capital, where legal activists have been transfixed by the prospect that the next president could potentially fill as many as four vacancies on the Supreme Court, which would transform its delicate balance into a solid ideological majority that would control American law for decades on contentious issues such as abortion, the role of religion in public life, and civil rights.

Judicial scholars and specialists across the political spectrum took pains to express their hope that Rehnquist experiences a full and speedy recovery. At the same time, however, the possible implications of his condition became an immediate subject of intense speculation about how it might affect any post-vote election litigation, who might be appointed to fill his seat should he need to retire, and what kind of confirmation battle would ensue in the Senate.

Most immediately, the news reminded voters set to decide the dead-heat presidential race between President Bush and Senator John F. Kerry that the power to appoint justices to the court could be the most far-reaching consequence of the election.

''I don't know how serious it is, but it underscores the importance of the judicial nomination process in our country's life," said C. Boyden Gray, a former senior White House counsel in the first Bush administration who chairs the Committee for Justice, a conservative judicial nomination group. ''It points out that whoever becomes president will have a potentially huge impact on the makeup of the court for the next generation."

That analysis was echoed across the ideological divide by Nan Aron, president of the liberal Alliance for Justice.

''Picking a Supreme Court justice is one of the most important things a president gets to do, and judges affect everything," Aron said. ''Judges have an enormous impact on our lives. If this development helps educate people about the role of judges, that's a very positive development."

Bush has in the past said his model for the ideal Supreme Court nominee are Justices Antonin Scalia and Clarence Thomas, two conservative jurists opposed to any right -- such as abortion rights -- that is not found in the text of the Constitution. Kerry has said he would not appoint a justice who would overturn abortion rights.

''There's no way that John Kerry would appoint someone who would, across the range of issues, be nearly as close to Scalia and Thomas as Rehnquist," said Professor Laurence Tribe, a constitutional scholar at Harvard Law School.

Rehnquist, the senior member of a sharply-divided but aging court that has not had a new member since 1994 -- the longest period without one in more than 180 years -- was appointed an associate justice by Richard M. Nixon in 1972, and elevated to chief justice by Ronald Reagan in 1986.

In addition to Rehnquist, the seats seen as most likely to turn over belong to Justice John Paul Stevens, a liberal who is the court's oldest jurist at 84; Justice Ruth Bader Ginsburg, a 71-year-old liberal who underwent chemotherapy and radiation treatment for colon cancer in 1999; and Justice Sandra Day O'Connor, 74, who successfully underwent surgery for breast cancer in 1988.

The severity of the treatment Rehnquist will have to undergo, and how that may affect his ability to continue to serve on the court, remains unclear.

''Once they explain why he had a tracheotomy, everything will be a lot clearer," said Dr. Gilbert Daniels, chief of the thyroid unit at Massachusetts General Hospital.

Each year, some 23,600 people -- most of them women -- develop cancer of the thyroid, a gland located below the Adam's apple that produces hormones to regulate the body's use of energy.

The cancer is most likely to be detected by a doctor during a neck exam, but sometimes the patient may see or feel the lump himself, according to Dr. Anthony Hollenberg, chief of the thyroid unit at Beth Israel Deaconess Medical Center.

Though doctors are unsure of the causes of thyroid cancer, both radiation exposure and family history appear to increase the risk, while smoking has not been strongly associated with the disease. Rehnquist is a smoker.

Treatment often involves removal of the thyroid gland, likely requiring the patient to take hormones to compensate. In addition, patients can take radioactive iodine pills, a relatively low-side effect treatment that destroys thyroid cancer cells. Patients may still require external radiation and other chemotherapy, especially if the cancer has spread beyond the thyroid.

By far the most common form of the disease, papillary thyroid cancer, is slow-growing, seldom spreads to other organs, and is readily treatable. Mortality studies show that 80 percent to 90 percent of patients are still alive a decade after treatment.

''Even people at the chief justice's age, can do phenomenally well" after treatment, Hollenberg said.

Posner said it is unlikely that Rehnquist has papillary thyroid cancer because the tumor seldom grows big enough to narrow the patient's airway, requiring a tracheotomy. ''I'd be surprised if 1 in 1,000 patients [with papillary thyroid cancer] get a tracheotomy."

Patients with anaplastic thyroid cancer, by contrast, commonly need a tracheotomy because the cancer spreads so fast.

''They choke to death from the disease, and you have to put a 'trach' in when you find them," Posner said. Even with aggressive radiation and chemotherapy, he said patient life expectancy is typically just three to nine months.

While the hole in the throat created by a tracheotomy is permanent, after a patient's breathing returns to normal, the opening is sealed with a plug.

The other forms are follicular/Hurthle cell thyroid cancer and medullary thyroid cancer.

Daniels said the court statement predicting a swift return to work for Rehnquist is inconsistent with a man suffering such a lethal cancer.

''If somebody had that, I'm not sure they'd be going back to work in a week," he said.

Charlie Savage reported from Washington, Scott Allen from Boston.