The recurring cancer of President Chávez
21st Feb 2012
One of the most valuable tools that we who try to bring health education to the public have is to take advantage of the illnesses of famous people. In these occasional posts at the blog, we have touched on diverse health problems of famous people (see archive). President Hugo Chávez has just announced his current state of health and this gives us an opportunity to look at what "recurrence of cancer" means".
What is a recurrence?When a patient has cancer and is treated with one of the three modes of treatments that exist; surgery, chemotherapy or radiotherapy, either on their own or in combination, the objective is to destroy the cancerous cells that may be in the body so that they never return. If a previously treated patient shows new growth of a tumour, that is called a recurrence.Recurrences can be in one of two forms; local (in the same location where the first tumour appeared) or at distance (in organs in other parts of the body). In the case of the second type, the recurrence is called a metastasis. Obviously, both types of recurrence are not good news for the patient. In general, the metastasis are more of a problem and more dangerous and the local recurrences are more problematic for the specific area. Even though recurrences are in no way an automatic death sentence, it is known that they greatly reduce the probability of a definitive cure. It's very true that nowadays many types of cancer have become chronic illnesses that can be controlled by diverse treatments over long periods of time.
The case of President ChávezIn a previous post we described what we knew about the operation and diagnostic facts about President Hugo Chávez of Venezuela in June 2011. It's important to note that due to the extremely hermetic circle around President Chávez we have never known exactly what type of cancer he is suffering.
Very recently, the President himself said, "...that he has a 2cm diameter lesion in the same place from where the tumour was extracted nearly one year ago." He said that he travelled last Saturday 18th February to Cuba for rigorous examinations where he was given this result. "I do not have metastasis anywhere", he said.
Firstly, let's do the count. From June 11th 2011, the date on which he had his operation, to this week, is only eight months and the objective of the operation was to totally eliminate the cancer. What's more, the objective to have given him chemotherapy which he received in Cuba and Venezuela was to eliminate any remnant of cancer, both in the location where the tumour started (in medicine it's called the primary location) and also in any other place in the body.Therefore, technically speaking (and as explained previously) the problem that Mr. Hugo Chávez has is not a metastasis, as he himself has affirmed, but a local recurrence. What needs to be done now is to confirm whether that the 2cm tumour that has been found in the check-up is a malignant tumour similar to the one extracted in the first operation.
There are cases in which the extracted tumour looks just like a recurrent cancerous tumour but is in fact a non-cancerous benign tumour (this is very frequent in certain testicular and ovarian cancers).
Progression of the cancerAnother important concept in these cases in which there is an apparent recurrence is to define what's calles the progression of the illness. Here we enter into the concept of time.Imagine that a patient is operated upon for cancer and that in less then three months (a time frame on which experts agree) a local or metastasis recurrence appears. This very early an precocious reappearance of the cancer would indicate that the illness is progressing, that's to say there is a progression of the cancer. Obviously, this is a very delicate situation because it indicates that the cancer was never eradicated and it will advance without control.
To sum up, President Chávez is showing a local recurrence of his cancer at only eight months from his original surgery. He has correctly said that he does not have a metastasis, but has a local recurrence. What's left to know is whether this 2cm tumour is cancerous, which will be known after the operation that he will undertake in Cuba that he announced. We'll keep you informed on this.
It's taken a couple of days for the noise to abate, the bullshit on both sides of this issue to die down and a bit of measured, informed opinion to appear. For example, this post from Dr. Elmer Huerta dated Feb 21st, that we translate below. Huerta runs a blog that's good at converting medical-speak into real world language that allows us mere mortals to get to the bottom of a health situation or issue. Here's his post: