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Correction to This Article
An Oct. 26 article on cancer-related surgery performed on Chief Justice William H. Rehnquist incorrectly said that the opening in the throat made by a tracheotomy is permanent. The opening may be either temporary or permanent.

Rehnquist Has Surgery For Cancer In Thyroid

By Charles Lane
Washington Post Staff Writer
Tuesday, October 26, 2004; Page A01

The chief justice of the United States, William H. Rehnquist, underwent cancer-related surgery at Bethesda Naval Hospital on Saturday but plans to return to the bench for oral arguments when the Supreme Court reconvenes Nov. 1, the court announced yesterday.

In a brief statement, the court said doctors performed a tracheotomy on Rehnquist, who turned 80 on Oct. 1, "in connection with a recent diagnosis of thyroid cancer."

Chief Justice William H. Rehnquist received a tracheotomy as a part of Saturday's surgery. (Jason Reed -- Reuters)

The news that the chief justice has a potentially life-threatening condition suddenly threw into doubt the stability of a court whose membership last changed in 1994. And as the presidential candidates entered the last week of a campaign that has so far been dominated by the economy and national security, the report gave fresh prominence to the future of the Supreme Court.

There are various types of thyroid cancer. Some are much more easily treated than others, but all are more difficult to treat in older patients, medical experts said. Court spokeswoman Kathy Arberg declined to comment on the precise nature of Rehnquist's illness or on why a tracheotomy was necessary. She said he would be released from the hospital this week.

The thyroid is a gland near the base of the throat that helps to regulate body temperature and metabolism, as well as to maintain normal functioning of the heart and brain. Tumors in the thyroid can sometimes invade the windpipe, or trachea. Generally, doctors use a tracheotomy -- making a small hole in the neck to permit air to enter the windpipe directly from the outside -- in cases in which, for any reason, a patient has no other way to get air.

Rehnquist was appointed to the court by President Richard M. Nixon in 1972 and elevated to chief justice by President Ronald Reagan in 1986. Rehnquist leads a five-member majority of Republican-appointed justices who regularly steer the law in a conservative direction.

A court without Rehnquist at its helm would look different depending on who wins the presidency, if the candidates' professed views on the judiciary are any guide. If President Bush were reelected, the net change might be minimal, because he would probably nominate someone as conservative as Rehnquist. But if Sen. John F. Kerry (D-Mass.) were to win, he could have the opportunity to reverse the 5 to 4 advantage conservatives enjoy over liberals.

Rehnquist has been treated for skin cancer in the past, and he is far from the first member of the court to receive a cancer diagnosis. Sandra Day O'Connor, 74, survived breast cancer; John Paul Stevens, 84, has been treated for prostate cancer, and Ruth Bader Ginsburg, 71, had colon cancer.

Rehnquist has had other health conditions, including recurrent back problems and a hospitalization in 1982 for what were described as withdrawal symptoms related to a reduction in the medication he had been taking for back pain. In 2002, a torn tendon in his leg kept him out of oral arguments for two weeks. But despite his advancing age, he has shown no apparent loss of interest in his job or of his ability to do it.

During the first two weeks of oral arguments in the term that began Oct. 4, Rehnquist sounded hoarse -- a symptom that can result from the pressure of a growing thyroid tumor against the nerve in the throat that controls the voice box, doctors said.

"When someone comes with hoarseness and a thyroid nodule, you think cancer affecting that nerve," said Kenneth Burman, chief of the endocrine section at Washington Hospital Center and professor of internal medicine at Georgetown University.

It is unclear how or when Rehnquist received his diagnosis. Typically, doctors detect thyroid cancers first by feeling for unusual lumps in the neck, and then through follow-up tests that can range from blood work to the surgical removal of suspected tumors, according to the National Cancer Institute's Web site.

The cause of thyroid cancer is not fully understood, although it has been linked to radiation exposure. It is the fastest-growing cancer diagnosis in the United States.

Of the varieties of thyroid cancer, the two most common -- and mildest -- are known as papillary and follicular thyroid cancer. They account for about 80 percent of the 11,000 new thyroid cancer cases reported each year, and their cure rate is greater than 90 percent. Doctors use a combination of surgery, radioactive iodine therapy and hormone treatments to eradicate the disease and restore patients to health, but success is harder to achieve in older patients.

"The older you are with those cancers, the worse you do," Burman said.

The milder forms of the disease are far more common among women than men, with women accounting for about three out of four cases, according to the institute.

The most serious form of the disease, known as anaplastic thyroid cancer, accounts for no more than 3 percent of all cases, but it is by far the deadliest. Most commonly seen in patients over 65, it invades the thyroid so quickly and thoroughly that there is no way to remove it surgically, Burman said.

"Mortality is very high. The lifespan is six to 12 months," Burman said.

The hole in the throat created by a tracheotomy is permanent. But once a patient can breathe normally again, the opening is closed by a small plastic plug so that the patient can speak.

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