WASHINGTON – Chief Justice William Rehnquist said Monday that he was taking radiation and chemotherapy treatments for his thyroid cancer and would not be returning to the Supreme Court as soon as he had planned, indicating he may have one of the more aggressive forms of the disease and raising questions about his future on the court.

Rehnquist said in a written statement that his doctors had told him his initial plan to return to the court Monday was “too optimistic.” He said he would work on court matters at his home and stay in close contact with the other justices, law clerks and the court’s staff.

During Monday’s session, Rehnquist’s black leather chair in the center of the court’s bench was empty.

Justice John Paul Stevens, the most senior associate justice, presided over the court during arguments in tax and personal injury cases. Stevens said Rehnquist could rely on the briefs and transcripts of the arguments to help him decide those and future cases.

Rehnquist’s announcement Monday came on the final day of a remarkably hard-fought and close presidential campaign. It served as yet another reminder that, with four justices 70 or older, there is a significant likelihood of one or more vacancies in the next four years. That would give the next president the opportunity to shape a court that is closely divided on controversial issues.

That said, vacancies are impossible to predict. Four years ago, court watchers were certain President Bush would make at least one appointment – and possibly two or three – to the court. Instead, all the justices have stayed put during his presidency so far.

Rehnquist, 80, disclosed Oct. 25 that he was suffering from thyroid cancer and had undergone a tracheotomy two days earlier. Rehnquist has not revealed the type of thyroid cancer he is suffering from. Some types of thyroid cancer are easily treatable, but others can be aggressive and deadly, particularly in older patients.

Dr. Edwin Kaplan, head of endocrine surgery at the University of Chicago Hospitals, said radiation and chemotherapy are generally used to treat the most aggressive types of thyroid cancer. Most thyroid cancers are easily treated with surgery and radioactive iodine, but the more aggressive forms do not generally respond to those treatments.

“We know that he has a serious situation,” Kaplan said. “It’s usually a very aggressive tumor or one that cannot be removed surgically that is treated this way.”

Kaplan said Rehnquist’s course of treatment suggests either that he is suffering from an aggressive tumor that could respond to radiation and chemotherapy, or that the tumor already has spread into his trachea or possibly elsewhere, making usually curative surgery impossible.

Kaplan said radiation and chemotherapy might be given to a patient suffering from one of two types of thyroid cancers, papillary cancer or anaplastic cancer. Papillary cancer, the most common type of thyroid cancer, is easily cured in younger patients, but becomes much more aggressive with each added decade of life.

Anaplastic cancer is the most aggressive of the thyroid cancers and generally requires radiation and chemotherapy for treatment. But even with those treatments, only 15 to 20 percent of those with anaplastic thyroid cancer live more than a year after their diagnosis, Kaplan said.

Radiation and chemotherapy treatments also take a physical toll on patients. With radiation therapy to the neck area, a patient could expect swelling that might make swallowing difficult to the point that, in some cases, a feeding tube might be necessary, Kaplan said.

A patient also would feel quite weak and be in pain during treatment. Radiation therapy usually lasts about a month, and chemotherapy is often longer, depending on the regimen that is used, Kaplan said.

“It’s unlikely that he would be back in a month. It probably would be several months before he would resume full work, assuming everything went very well,” Kaplan said.

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If nothing else, Rehnquist’s absence from the bench will deprive the court for a time of one of its more pointed questioners, as well as a calm, commanding presence during oral arguments.

But Kaplan said Rehnquist’s doctors might be giving a shorter course of treatments, in the event they are trying to shrink a tumor so it could be removed surgically.

“It’s possible they are treating it this way first,” Kaplan said. “If it hasn’t spread around the body, and if it can be controlled locally, sometimes tumor removal is possible in the future.”

Rehnquist was nominated by President Richard Nixon and has served on the Supreme Court since 1972. An anchor of the court’s conservative wing, he was elevated to chief justice in 1986.

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He has taken the conservative position in cases on gay rights, affirmative action, abortion and other social issues, often finding himself in the minority. Rehnquist has played a crucial role in moving the court to give states more power in a series of federalism cases.

Rehnquist presided over President Bill Clinton’s impeachment trial in 1999, making him only the second chief justice to supervise such a proceeding. He also was in the majority in the court’s 5-4 decision in Bush v. Gore, which decided the 2000 election.

Although the next president could name as many as three Supreme Court justices, Bush and Democratic candidate John Kerry have spoken relatively little about the issue in the campaign, though partisans on both sides have been keenly aware of the stakes. But Rehnquist’s illness may spur belated attention to the issue.



(c) 2004, Chicago Tribune.

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AP-NY-11-01-04 1949EST



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