But Wartofsky, Cooper and Fagin said no other diagnosis could account for the known facts of Rehnquist's case. Steven I. Sherman, chair of the department of endocrine neoplasia at the University of Texas M.D. Anderson Cancer Center in Houston, said anaplastic cancer is "likely" but other explanations could not yet be conclusively ruled out.
Anaplastic thyroid cancer kills patients on average within six months. Looked at another way, 90 percent of patients with anaplastic thyroid cancer die within a year, Sherman said. Wartofsky said that in 35 years of treating thyroid cancer he had seen only two patients survive the anaplastic form.
Chief Justice William H. Rehnquist is being treated with chemotherapy and radiation.
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"I have had patients where you can mark on the skin with a pen the edge of the tumor and watch it grow day by day -- it is that fast," Sherman said.
Wartofsky, Cooper and Fagin said the evidence pointed toward anaplastic thyroid cancer because of the clear differences between types of thyroid cancer and the differences in treating them.
Thyroid cancer comes in four forms, Wartofsky said. Papillary cancer accounts for about 80 percent of all thyroid cancers, but it is more common among younger people and is easily curable. Follicular thyroid cancer affects 10 to 12 percent of thyroid cancer patients and strikes patients in their twenties to their sixties. It is also highly curable. For both these cancers, doctors remove the thyroid gland and administer patients with radioactive iodine -- any remaining thyroid cells selectively absorb iodine, making the treatment highly effective.
Medullary thyroid cancer, the third form, has a strong genetic basis, Wartofsky said. Although it can affect patients of all ages, it accounts for only 3 to 4 percent of cases. The survival rate is around 50 percent, Wartofsky said. Surgical removal of the thyroid is often the first line of treatment. While doctors might use radiation for this cancer, the combination of radiation and chemotherapy pointed to anaplastic thyroid cancer, Fagin said.
Anaplastic thyroid cancer primarily strikes the elderly, Wartofsky said, and rapidly affects other tissues. Patients often come into treatment complaining of hoarseness -- as Rehnquist did -- after the cancer attacks nerves that control the vocal cords. It also can affect the windpipe, making it necessary for doctors to open a new airway. The cancer's rapid spread to other tissues renders both surgery and radioactive iodine less effective.
The fact that Rehnquist has had a tracheotomy, without any official confirmation that doctors removed any of his thyroid, is strongly suggestive that he has anaplastic cancer, outside medical experts said.
"To suddenly go to a tracheotomy without a thyroidectomy would most likely be anaplastic cancer," said Cooper, who also directs the division of endocrinology at Sinai Hospital of Baltimore.
Even if doctors had removed Rehnquist's thyroid without announcing it, they would be unlikely to start radiation treatment so soon, Cooper said. Besides, Rehnquist had initially announced he would be back at work yesterday, and Cooper said a thyroidectomy would have ruled out such a quick return.
One other rare cancer that usually affects the lymph nodes could theoretically explain Rehnquist's symptoms, Cooper said. But although it would explain why doctors did not remove Rehnquist's thyroid, Fagin said, "thyroid lymphoma does not fit the bill because radiation therapy would not be part of the picture."
