Cancer's Return Shouldn't Limit Elizabeth Edwards, Doctors Say

With expert care, she could maintain good quality of life

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HealthDay Reporter

THURSDAY, March 22, 2007 (HealthDay News) -- John and Elizabeth Edwards' decision to carry on his bid to be the Democratic nominee for the White House is the right one, given what's known about her recurrent cancer and advances in treatment today, two expert oncologists say.

The couple announced Thursday that Elizabeth Edwards' breast cancer had returned, this time spreading -- but perhaps remaining localized to -- a rib on her right side. Her doctor, Dr. Lisa Carey, described the tumor as Stage IV metastatic disease.

However, although metastatic cancer is ultimately fatal, proper monitoring and treatment could give the 57-year-old Mrs. Edwards years, perhaps even decades, of life, leading oncologists say.

"That's why we say that this is not a curable disease but more like a chronic illness," said Dr. Toby Greene, a breast cancer surgeon at Hackensack University Medical Center in Hackensack, N.J. "You can never forget that you have it, but it doesn't mean that you cannot live a long, hearty, prosperous life. She may see him through his entire presidency, should he win."

The prognosis once someone is Stage IV varies depending on the type of cancer, Greene said. According to the U.S. National Library of Medicine, recurrence rates for breast cancer still range between 5 percent and 25 percent.

But Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said, in a prepared statement, "The outlook for a woman who walks into the doctor's office with metastatic disease is significantly worse than for a woman, like Mrs. Edwards, who presents initially with disease confined to the breast and adjacent lymph nodes. The survival statistic for patients who present with Stage IV disease has no meaning in Mrs. Edwards' case, and should not be interpreted as a suggestion of her survival chances."

"Yes, it is scary, and it raises the flag that this really needs attention, and we really need to deal with it," Greene said. "But it doesn't really mean that just because it's stage 4 that her life is over."

Elizabeth Edwards struck a similar upbeat note during Thursday's press conference as she stood beside her husband, a former U.S. senator for North Carolina who is considered a top contender for the Democratic nomination. Early reports had suggested he might bow out of the race should his wife's cancer return, but the couple appears determined to move forward with the campaign.

"I don't look sickly, I don't feel sickly," Mrs. Edwards told reporters. "I am as ready as any person can be for that."

Elizabeth Edwards, a lawyer and mother of four (one son, Wade, died in a 1996 car crash) was first diagnosed with invasive ductal carcinoma, the most common form of breast cancer, in the final days of her husband's 2004 vice-presidential campaign. After surgery and months of chemotherapy, her doctors could find no further signs of recurrence. She wrote of her life, and her struggle against breast cancer, in her 2006 memoir Saving Grace.

Speaking with reporters, John Edwards said his wife noticed a pain in her left side on Monday -- later diagnosed as a broken rib. Further bone study and a biopsy on Wednesday uncovered the malignant tumor in a rib on the opposite side.

CT scans have not shown evidence of further spread, although Carey, Elizabeth Edwards' doctor, did tell reporters that spread to a lung was a possibility, and more tests will be needed to rule that out.

According to Greene, simply removing the affected rib is not an option. "We have to treat patients like Mrs. Edwards with metastatic disease as if they have the potential of having the cancer be everywhere," the surgeon explained. "We have to treat them systemically, not just locally. Removing the rib would not really then take care of the whole body. And we know that we can treat the rib without her undergoing surgical intervention."

A lot will depend on just what kind of breast cancer Mrs. Edwards originally had, something that wasn't divulged at the press conference. Cancers that are "estrogen-receptor positive" -- meaning they can grow under the influence of circulating estrogen -- may be reined in for months or years by hormonal therapy, which has relatively few side effects.

"If she has the option of hormone therapy and responds to it, she may return to her same quality of life and function and do very well," said Dr. Julia Smith, director of the Lynne Cohen Breast Cancer Preventative Care Program at the New York University Cancer Institute and Bellevue Hospital, in New York City. "There is a subset of patients with bone-only disease -- as it appears that she has -- who respond to hormones and do very well for a very long time, possibly well longer than 10 years."

"So, I think that's the hope," Smith said. "If she has hormone receptor negative disease, then you do not have that option anymore. Then you have to put the patient on (stronger) chemotherapy."

Depending on the treatment she receives, Elizabeth Edwards could face a "rocky" year ahead, Greene said, although the side effects from the types of systemic chemotherapy and radiation she might receive are not as onerous as those used in the past. She might require a few weeks of radiation first to treat the bone tumor and hopefully eliminate other stray cells, Greene said. And if her cancer is hormone-receptor positive, she could be placed on hormonal treatments for years to come.

"This doesn't necessarily mean that her quality of life is going to be altered," the breast cancer specialist said. "Some patients do say that radiation therapy makes them a bit tired, but it doesn't cause nausea, vomiting, hair loss."

But Smith reiterated that there is ultimately no cure for metastatic disease.

"You cannot eradicate this disease and never have to deal with it again," she said. "Mrs. Edwards will be dealing with this disease the rest of her life, and it is likely to limit her life. She will be on therapy, if not the rest of her life, then intermittently on-and-off therapy."

"It's more of a chronic disease," agreed Greene, who said she supported the Edwards' decision to carry on with the political campaign.

"Presuming that she's strong, he's strong, and they have talked it over and agreed upon it, there is no reason for them to stop in their tracks and sit and 'wait for the end,' " she said.

More information

There's more on breast cancer at the American Cancer Society.

SOURCES: March 22, 2007, press conference, with John and Elizabeth Edwards, and Dr. Lisa Carey, associate professor of medicine, University of North Carolina School of Medicine's Division of Hematology/Oncology, Chapel Hill; Toby Greene, M.D., breast cancer surgeon, Hackensack University Medical Center, Hackensack, N.J.; Julia Smith, M.D., Ph.D., director, Lynne Cohen Breast Cancer Preventative Care Program at the New York University Cancer Institute and Bellevue Hospital, New York City; Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society

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