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Tuesday, March 27, 2007

Boston doctors comment on another cancer recurrence

By Elizabeth Cooney, Globe Correspondent

Presidential spokesman Tony Snow's colon cancer has returned and spread to his liver, news that comes less than a week after Elizabeth Edwards, wife of presidential candidate John Edwards, revealed her breast cancer has come back in her bones.

Two Boston oncologists, speaking only in general terms, said medicine has more to offer patients with metastatic cancer -- cancer that spreads -- today than before, but that may not be enough.

"In the past 10 years we've really gotten better at this. There are more effective drugs that allow patients to live longer and better with colon cancer than 10 years ago," said Dr. Charles Fuchs, a medical oncologist who specializes in treating gastrointestinal cancer at the Dana-Farber Cancer Institute. "I would emphasize that what we have is not adequate. It's not where we want to be, but we're able to allow patients to live longer."

Snow had surgery in 2005 to remove his entire colon, followed by six months of chemotherapy. A growth that was first spotted in his lower right pelvic area last year was removed yesterday and found to be cancerous. Cancer was also in his liver.

Patients whose cancer has spread from the colon to their lymph nodes have a 35 percent to 40 percent chance of it recurring, despite the surgery and chemotherapy, Fuchs said. That recurrence typically happens within three years and the liver is the most common organ to which colon cancer migrates.

Some patients who have cancer that is confined to one portion of their liver might have chemotherapy to shrink it so it can be removed by a surgeon.

"Regrettably that tends to be only a subset of patients," he said.

For patients with metastatic, or stage IV, colon cancer, the average survival is about two years. That compares to 10 months' survival average from 10 years ago, Fuchs said.

"Clearly that is not sufficient, but we are making some measure of progress with some of the newer drugs we are now testing," he said.

For metastatic breast cancer, newer treatments make it difficult to predict survival rates, said Dr. Ann H. Partridge, a medical oncologist at Dana-Farber who focuses on breast cancer. Average survival rates are five years, but that's based on old data that don't reflect current therapies that allow improvements in both quality and quantity of life.

"Some women live a very long time -- decades -- with metastatic breast cancer and some women die within the first few months," she said. "Those two extremes are extraordinarily rare. Most women are somewhere in between."

Elizabeth Edwards said Sunday she had a "hot spot" of metastatic cancer in her hip bone as well as one rib. Breast cancer commonly spreads to more than one place in a woman's bones, Partridge said. For a woman with her type of cancer, surviving 10 years would be "possible but not probable," she said.

"But never say never," she said. "I say to women, 'I can give you an average but you are a single individual, and for you it's all or nothing. Your cancer either gets better or worse or stays the same. Our goal is to control it to stay the same or get better.' "


Posted by Elizabeth Cooney at 03:29 PM
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