Outlook: Some Patients Live Years but Each Case is Different, Doctors Say

Mar 23, 09:40 AM

Current Headlines: By Laura Giovanelli, Winston-Salem Journal, N.C.

Mar. 23--When John Edwards announced yesterday that his wife's breast cancer is out of remission and is incurable, he compared her treatment to diabetes.

Some local doctors specializing in cancer treatment say that's optimistic, but they also stressed that Elizabeth Edwards' diagnosis is not necessarily a death sentence.

Edwards' cancer is at Stage 4, or metastatic breast cancer. That's when cancer cells migrate out of a woman's breasts and surrounding lymph nodes. Cancer cells move through the bloodstream and can take hold anywhere in the body, but in breast cancer they are particularly likely to appear in bone, said Dr. Nick Chrysson, an oncologist with Forsyth Regional Cancer Center who specializes in breast cancer.

Edwards' doctor, Lisa Carey, told reporters in Chapel Hill yesterday that tests have found cancer cells in a rib on her right side, and possibly in a lung.

Metastatic-cancer treatments include chemotherapy, hormones and radiation. Surgery isn't an option, Carey said yesterday.

If there is any good news, it's that cancer is less aggressive in bone and can be treated with different medications. A class of drugs called bisphosphonates can also be used to specifically protect the bone.

"We consider breast cancer confined to the bones to generally have a better prognosis than in other parts of the body," Chrysson said.

It's more of a concern when cancer cells show up in organs, such as the lungs, liver and brain.

Doctors cautioned, though, that cancer in general is unpredictable, and they were reluctant to comment on Edwards' case because they don't know the specifics of past treatments and recent tests.

"Every case is different," Chrysson said, "and there is a very wide spectrum of response in patients.

"Not everyone lives with it like they may live with diabetes," he said. "It's hard to make an actual prediction that if I do a (certain) treatment that I can assure a patient that everything will be OK."

The median survival time for women with a diagnosis of metastatic breast cancer is two to five years, said Dr. Julia Lawrence, an oncologist at Wake Forest University Baptist Medical Center. "Yet all of us within our practices have women who live with metastatic breast cancer 15 and 20 years."

More than 170,000 women each year receive diagnoses of breast cancer, and more than 40,000 die of the disease, according to the National Institutes of Health. The number of women who have died because of breast cancer has been declining since the early 1990s, Lawrence said, partly because of chemotherapy and detection. Only about a third of women with breast cancer see it progress to the metastatic stage.

"It's a pretty rare occurrence," she said, but one that Edwards will have to live with. "It's a big change for her, for the rest of her life to think about dealing with breast cancer."

--Laura Giovanelli can be reached at 727-7302 or at lgiovanelli@wsjournal.com.

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