The Cheerful Oncologist

In accordance with the shoddy standards of medical communication upheld in this country, here is a clarification on White House Press Secretary Tony Snow’s condition. Yesterday it was implied that he had a liver metastasis removed. I assumed this required a hepatic lobe resection, which as fellow ScienceBlogger Orac has remarked, is a major operation. It turns out that the offending lesion was on the surface of the liver, not within.

The recurrence of cancer found in White House spokesman Tony Snow was attached to his liver, not in the organ, his deputy said Wednesday. On Tuesday, Dana Perino announced that Snow’s cancer had returned and spread to his liver. But she said Wednesday that it was not inside the liver, an important distinction in medical terms.

Why is this distinction important? Orac says it best in his post:

In fact, I’m going to go out on a limb a little here and speculate that the “growth” that was found was probably carcinomatosis, which is the growth of tumor along the peritoneal lining that covers our abdominal organs and that a nodule was found on the surface of his liver. Carcinomatosis can range from a single nodule on the peritoneum only a few millimeters in diameter, to many small nodules (known as “peritoneal studding”), to golfball- or softball-sized tumors all over the abdomen, and it is usually unresectable and incurable, except in rare cases because the presence of one nodule usually indicates that there is disease elsewhere.

If I may put this in my own words, metastatic colon cancer on the external surface of the liver may mean that the tumor is likely to be just one of many nodules growing on the outside of the abdominal organs and lining of the abdomen, not unlike mold growing on bread. This complication is different from resecting part of the liver in order to remove one or two (preferably one, but this is a matter of fate) tumor nodules growing within the liver. Such an operation has been shown to cure metastatic colon cancer in 30 to 40% of patients. Unless Mr. Snow’s liver lesion represents a true hepatic metastasis that just happened to arise on the surface of the liver, his operation may not do much to prolong his survival.

Chemotherapy plus targeted therapy, however, does have a chance to prolong the lives of patients with metastatic colorectal cancer, whether they ever have surgical removal of distant lesions or not. This image from a recent medical review shows how the average survival of patients has nearly tripled with the development and release of bevacizumab, capecitabine, and oxaliplatin – just to name a few of the advances coming from Big Pharma, bless their capitalist souls.

i-9a44ea888750d4182403ac2cf165eb60-colon cancer survival.gif

The right-hand side of this graph shows the average survival of patients who receive no anti-cancer therapy to be 4-6 months, while the left-hand side shows how this has improved to 20-21 months, and hopefully more (see the far left bar).

This is an example of why medical oncologists give treatments designed to kill, disable and humiliate cancer cells – not because we are satisfied with making tumors a little smaller, and certainly not because we insist upon making the ill feel even worse, but because we, just like the patients sitting before us, want more time out of this life on Earth. Our interests are aligned – it is now up to both of us to make something good happen.


  1. #1 Echo Doc
    March 29, 2007

    Good post. Agree with “shoddy standards” of reporting comment wholeheartedly.

    I’m dealing with the avalanche of calls about the study showing coronary stents “are not necessary.”

    Wish medical reporting were better + more specific. But that wouldn’t be sensational enough.

    Echo Doc

  2. #2 RoseG
    March 29, 2007

    I have come to believe that medical reporting in general newspapers is geared towards selling newspapers and not towards being overly accurate about the situation.

    I also despise the constant reporting of things that do and don’t cause cancer.

  3. #3 youtube
    February 25, 2008

    Wish medical reporting were better + more specific. But that wouldn’t be sensational enough.

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