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by Mary Shomon

October 25, 2004 -- William H. Rehnquist, Chief Justice of the United States Supreme Court since 1986, and the leader of the Supreme Court's conservative majority, has thyroid cancer, according to a spokesperson from the Supreme Court.

According to spokesman Ed Turner, the 80-year-old Rehnquist "was admitted to Bethesda Naval Hospital on Friday, Oct. 2 and underwent a tracheotomy in connection with a recent diagnosis of thyroid cancer." Turner has stated that Rehnquist is expected to be on the bench when the court is again in session to hear arguments on Monday November 1.

A tracheotomy -- which involves opening a hole in the windpipe to help breathing -- is a not a common procedure for thyroid cancer patients. Thyroid cancer treatment usually involves thyroidectomy -- thyroid surgery -- to remove the cancerous thyroid, followed up by radiactive iodine treatment to ablate any cancerous tissue left behind.

A tracheotomy -- which involves opening a hole in the windpipe to help breathing -- is a not a common procedure for thyroid cancer patients.

Given the unusual procedure of the tracheotomy and its association with advanced or inoperable thyroid cancer, it's possible that the Supreme Court and the Chief Justice himself may be downplaying the seriousness of the cancer, and overestimating Rehnquist's fitness to preside over Court activities. Spokespeople claim Rehnquist will be back on the bench November 1.

Rehnquist's condition also raises two political issues -- first, the issue of a possible vacancy on the Supreme Court during a period when the opportunity to name a new justice is a controversial issue in the Presidential election. Second, in the 2000 presidential election, the Supreme Court voted to stop a recount in the disputed race in Florida, which made George Bush the winner over Democrat Al Gore. Many political pundits already expect the 2004 election to end up in the Supreme Court. The question now is, will Rehnquist be presiding over the Court if and when it hears any 2004 election-related cases?

There are several types of thyroid cancer -- some more serious than others -- and information regarding the type of thyroid cancer afflicting Rehnquist, or any other treatments being provided, has not been released.

Experts Say Tracheotomy is Unusual

Dr. Gilbert Daniels, a Harvard Medical School professor and co-director of the Thyroid Clinic at Massachusetts General Hospital, has said that tracheotomy for thyroid cancer is unusual. Daniels told Reuters: "That says something peculiar is going on but it doesn't say what...I'm concerned that he needed a tracheotomy because that generally suggests he had some kind of thyroid cancer that was aggressive, that was growing into his trachea."

Dr. Pramod Sharma, a head and neck surgeon at the University of Utah School of Medicine, also told Reuters, "If done at time of surgery it indicates there may be some invasion from the thyroid gland into the airway." According to Dr. Sharma, this type of spread is more common with anaplastic thyroid cancer.

Anaplastic thyroid cancer, the rarest and most serious form of thyroid cancer, is seen in only 3 percent of all thyroid cancer cases. It can spread early and quickly to lymph nodes, and is often diagnosed first as a large mass in the neck. It also is the form of thyroid cancer most likely to spread to other organs beyond the thyroid or lymph nodes. This type of thyroid cancer is more common in those over 65, and in men. Long-term survival rates are far less than for the other three types of cancer. It is a type of advanced, invasive cancer that can often result in the need for a tracheotomy. Because it is also very hard to remove surgically, the typical thyroidectomy may not be used as a treatment. As many as 80 percent of patients with anaplastic thyroid cancer die within a year of diagnosis, even after receiving treatment.

About Thyroid Cancer

In 2004, it's estimated that there will be 23,600 new cases of thyroid cancer in the U.S. Of these, 17,640 will be in women, and 5,960 in men. About 1,460 people (840 women, 620 men) are expected to die of thyroid cancer in 2004. According to the Thyroid Cancer Survivor's Association, thyroid cancer is one of the few cancers that becoming more common in the past several years, with a growth rate of 3% per 100,000 people each year. Normally, thyroid cancer is considered an easily cured form of cancer, with surgery and radioactive iodine treatment eliminating the condition in the majority of cases.

The butterfly-shaped thyroid gland, located in the neck, is the master gland of metabolism, and produces hormones that help regulate the body’s use of energy.

There are four types of thyroid cancer: Papillary, Follicular, Medullary, and Anaplastic.

Treatment for Papillary cancer is the most common type of cancer, and mostly involves one side of the thyroid and sometimes spreads into the lymph nodes. The cure rate is very high.

Follicular cancer, the second most common type of thyroid cancer, is somewhat more malignant than papillary. Follicular cancer is more common in older people. Again, the long-term survival rate is high.

Medullary thyroid cancer is the third most common type of thyroid cancer. It spreads to the lymph nodes earlier than papillary or follicular cancers. This type of cancer can run in families, and also has a good cure rate.

For more information, read: An Introduction to Thyroid Cancer