Oncology

REHNQUIST SURGERY

Chief justice William Rehnquist’s diagnosis of thyroid cancer is a concerning one.
His age, and the fact he needed to have a breathing pipe put in has experts worried about his overall prognosis.

Rehnquist is among the estimated 23,600 Americans who are diagnosed with thyroid cancer each year. Most people do well.
But given what we’ve been told, his is unlikely to be one of the cases that ends favorably.
Rehnquist needed a tracheotomy to allow him to breathe.
A tracheotomy is a surgical procedure done usually under general anesthesia in the operating room. It’s an incision in the windpipe, or trachea, that creates a permanent opening called a tracheostomy. Through that opening a breathing tube is placed, and it’s through that tube that William Rehnquist will be able to breathe.
A tracheotomy is performed in only 2 to 10 percent of thyroid cancer surgeries.
It’s done when an invasive tumor has affected the larynx or voice box, trachea or the nerves leading to the larynx.
It may also be performed when the surgery is complicated by injury to the vocal cords.
Dr. Robert Johnson, Chairman of the Department of Surgery at St. Louis University, says, “It is unusual to have thyroid cancer invade the windpipe. The invasion of the trachea can cause the windpipe to be narrowed and that would be the reason for someone to require a tracheostomy to have an opening to breathe below where the thyroid cancer has invaded the windpipe.”
The thyroid gland produces hormones that help regulate the body's use of energy. There are several types of thyroid cancer but given the need for a tracheostomy, it is likely to be one that spreads…in this case, it is very hard to remove surgically, 80 percent of patients with the likely type in this scenario, anaplastic thyroid cancer, die within a year of diagnosis, even with treatment.
For now, the question remains: will Rehnquist be able to speak normally?
“Obviously the very fact that you get a tracheostomy, suggest that the area above the tracheostomy is narrowed. So, you have to be able to get enough air through whatever invasion has occurred to get enough air to get through the glottis to be able to vocalize,” states Dr. Johnson.
Thyroid cancer is most often diagnosed between the ages of 25 and 65. Two to four times more women than men are diagnosed with thyroid cancer.
Thyroid cancer often appears as a small lump or swelling on the front of the neck. But, these small lumps, called nodules, are fairly common and are usually benign.
Other symptoms of thyroid cancer can include hoarseness, difficulty swallowing, an enlarged neck node or a persistent cough.
Surgery to remove a malignant thyroid nodule is the most common treatment to manage thyroid cancer. In some cases, the entire thyroid gland may need to be removed. Some patients may need radioiodine therapy, in which the patient swallows a radioactive iodine solution.
Depending on the treatment, the patient may need to take thyroid hormone pills to replace the hormones that the thyroid gland no longer produces.

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