Chief Justice William H. Rehnquist did not appear as planned at Supreme Court oral arguments yesterday, announcing that his pledge to do so after receiving a cancer-related tracheotomy 10 days ago was "too optimistic," and that he would remain at home while receiving radiation and chemotherapy treatment.
Rehnquist's first public comment since the court announced Oct. 25 that he had been diagnosed with thyroid cancer offered circumstantial evidence that he has the most serious form of the disease, several experts said yesterday.
Chief Justice William H. Rehnquist is being treated with chemotherapy and radiation.
"This adds up to something very bleak," said David Cooper, director of the Thyroid Clinic at the Johns Hopkins University School of Medicine. "That's very, very bad news."
The news about Rehnquist's condition came on the eve of a close election between President Bush and Sen. John F. Kerry (D-Mass.). If Rehnquist were to leave the court for any reason before Jan. 20, Bush could nominate a replacement no matter who wins today's election.
Meanwhile, the court faces a full caseload, and Rehnquist's absence from oral arguments was the first public confirmation that his illness had affected the functioning of the court.
Justice John Paul Stevens presided in the chief justice's absence, announcing that Rehnquist "reserved the right" to vote in the cases he missed based on the briefs and transcripts of the arguments.
Rehnquist, 80, said in his statement that he is working on court business at home, including some opinions in cases that have already been argued.
But Leonard Wartofsky, chairman of the department of medicine at the Washington Hospital Center, was skeptical that Rehnquist will be able to read, write and make decisions normally. "With those therapies, he is going to feel lousy," Wartofsky said. "His ability to eat, drink, speak and breathe are all in that area of the neck."
Supreme Court spokeswoman Kathy Arberg declined to comment.
A diagnosis of anaplastic thyroid cancer, the most serious of four forms of the disease, would account for Rehnquist's situation, several experts on thyroid cancer said yesterday. And no other diagnosis would adequately explain his doctors' treatment decisions, the experts said.
Rehnquist's doctors' approach, in sharp contrast to techniques usually used for milder cancers, suggested the physicians were throwing everything they had at the illness, the experts said.
"The growth rate of anaplastic leaves you a short window of time to operate, so you have to kill as many cancer cells [as possible] in a short time," said James Fagin, director of the division of endocrinology at the University of Cincinnati. "That's why you use combination treatment." Removing the thyroid -- a common treatment for patients with the other forms of thyroid cancer -- is not normally done in patients with this form because it spreads so rapidly.
"For anaplastic cancer, almost nothing works," Wartofsky said. "Radiation and chemotherapy are tried sometimes to slow the cancer and buy some time. . . . All thyroid cancers are a little more common in women than men, but men do worse."
None of the experts interviewed yesterday is part of Rehnquist's medical team. None has information beyond the facts that have been made available by the Supreme Court.