Elizabeth Edwards and Her Cancer: A Controllable Disease

By Katherine Hobson.
US News & World Report

Although the breast cancer diagnosed and treated more than two years ago in Elizabeth Edwards has spread and can no longer be eradicated completely, its progression can often be managed, much as is done with other chronic diseases.

The cancer that has afflicted the wife of Democratic presidential candidate John Edwards is now lodged in a right rib bone.

"I always remind my patients that diabetes is not curable and hypertension is not curable," says Aman Buzdar, deputy chairman of the department of breast medical oncology at the M. D. Anderson Cancer Center in Houston, who isn't familiar with the specifics of Edwards's case. "But we can keep those diseases under control for a long period of time."

Edwards said at a press conference in North Carolina that she sought medical treatment for pain on her left side. That turned out to be a cracked rib she suffered while moving furniture in her new house, but the same X-ray that revealed the break also showed a suspicious spot on the opposite side of her ribcage. A bone study and other follow-up tests confirmed that there was cancer in a rib bone.

That's clearly disappointing but not surprising. When breast cancer does escape the confines of the breast and spreads to other organs, the bone is the most common site for it to take root. Because the cancer has spread to another organ, it is automatically classified as late stage, or stage IV.

Survival will hinge on many factors, including the number of areas affected by cancer and how big the tumors are, doctors say. Edwards's tumor is small, and a CT scan showed very little presence of the disease in soft tissues beyond the bone.

Treatment options for breast cancer that has spread to bone break down into two categories, says Harold Burstein, medical oncologist at Dana-Farber Cancer Institute in Boston and an assistant professor of medicine at Harvard Medical School. A group of drugs called bisphosphonates are used to strengthen and heal the bone. The drugs, Zometa and Aredia, are similar to drugs taken to combat osteoporosis but are more powerful and are given intravenously rather than orally.

"Doctors may also start specific treatment against the tumor," says Burstein. That may include drugs that block estrogen, if the tumor is fueled by that hormone, or chemotherapy. (Looking to the future, a monoclonal antibody called denosumab is currently in clinical trials for use against both bone metastasis and osteoporosis.)

True, the treatments now available can only delay the progression of the cancer and alleviate symptoms; the tumor may become resistant to one treatment over time, forcing a switch to something else. But Buzdar says this can extend the life of even a late-stage cancer patient for years.

"There is hope," he says. "A recurrence of cancer does not mean there's no hope, and people can live a very productive, comfortable life."

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I would just like to add my own two cents right here. I pray for Elizabeth and her family as she continues in her struggles and hopes. I pray she is well taken of by her husband, her doctors and our Lord. Hang in there, Mrs. Edwards. We are praying for your health and you...all politics aside.

Elizabeth Edwards' metastasized breast cancer should be treatable

Experts say she could have a good quality of life for many more years with medication. (LA Times)

By Thomas H. Maugh II, Times Staff Writer.

The recurrence of Elizabeth Edwards' breast cancer years after treatment is a serious setback, but probably one she can live with for five to 10 years, perhaps even longer, experts said Thursday.

Still, she will have to take medications for the cancer for the rest of her life.

Such recurrences are not unusual. About a third of breast cancer patients have a disease that has metastasized, or spread from the original location, typically to bones.

If the disease has spread, "we do not feel that it is curable, but it is treatable," said Dr. Linnea Chap, a breast cancer specialist at Premier Oncology in Santa Monica, which is affiliated with St. John's Health Center.

"We have very good treatments that can allow patients to live with breast cancer for many years with a good quality of life."

Cancer metastases are so difficult to cure because surgery is no longer an option once the disease has spread beyond its original confined location, said Dr. Marisa Weiss, president of breastcancer.org and a cancer specialist at Lankenau Hospital in the Philadelphia area. Drugs also become less effective because the metastasized cells "get into hiding spots that the drugs can't get into as easily."

Experts cautioned that it was difficult to predict treatment and outcome for Edwards because the details of her tumor had not been made public.

The treatment is individualized, depending on the characteristics of a patient's cancer. The approach can be as minimal as a pill to block estrogen, which contributes to the growth of many breast cancers. "That is taken daily and is very well tolerated," Chap said.

If the cancer has spread more widely, her physician will probably be more aggressive, using drugs such as Xeloda — an oral drug that blocks an enzyme needed by tumors — or one of the taxane drugs, such as paclitaxel or docetaxel. Those drugs must be given intravenously, and have stronger side effects.

Either might be given in combination with Avastin, which blocks the growth of blood vessels supplying nutrients to the tumors.

The patient also is typically given monthly doses of one of the bisphosphonate drugs, such as Actonel or Fosamax. These drugs do not attack the tumor directly, but strengthen the bone, making it more resistant to fractures. They have also been shown to reduce bone pain in the metastases.

If the cancer has spread to organs other than the bones, as Edwards' physician has hinted, then the initial therapy would be more aggressive, using the strongest of those drugs.

"If it is just in the bones, then the outlook is more favorable than for cancer that has gone to the liver," Weiss said.

Send comments and questions to Thomas Maugh.

I would just like to add my own two cents right here. I pray for Elizabeth and her family as she continues in her struggles and hopes. I pray she is well taken of by her husband, her doctors and our Lord. Hang in there, Mrs. Edwards. We are praying for your health and you...all politics aside.