Cancer has reached most serious phase

CHAPEL HILL -- Elizabeth Edwards' breast cancer is "completely treatable," John Edwards said Thursday, but it also is advanced and incurable.

Elizabeth Edwards' cancer has reached stage four, the disease's most serious phase, the couple said. As Edwards, 57, again prepares to wage a public battle against cancer, the strategy has shifted to controlling her disease and keeping her as healthy as possible.

Elizabeth Edwards' oncologist, Dr. Lisa Carey of UNC Hospitals, said the ductal carcinoma originally diagnosed in the fall of 2004 has spread to a right rib, surrounding bones and, possibly, to her lungs.

Survival rates for people with stage four breast cancer, which means the disease has spread to other organs and tissue, are poor. About 16 percent of patients are alive after five years, according to the American Cancer Society.

Still, Carey characterized the amount of cancer in Edwards' system as "small," and Carey said she has had patients with a similar diagnosis live many years.

The recurrence was discovered in an X-ray taken after Edwards sought treatment this week for a left rib, which she injured, apparently while moving a heavy piece of furniture in the family's new home in Chapel Hill, and then "popped" when her husband, the former North Carolina senator, hugged her.

Had it not been for the injury, Edwards said, it might have been months before the recurrence was discovered. She said she has no symptoms and is otherwise in excellent health -- factors she is confident will keep her feeling well even as she undergoes another round of treatment.

"I don't look sickly and I don't feel sickly," Edwards said at a news conference Thursday in a sunny courtyard at the Carolina Inn, where the Edwardses celebrated their wedding reception 30 years ago. "I expect to do next week all the same things I did last week. I don't expect my life to be significantly different."

'We can't eradicate it'

Carey offered a guarded assessment of Edwards' prognosis.

"We can suppress it, we can even shrink it, but we can't eradicate it from her body," said Carey of the cancer. She indicated Edwards would likely begin treatment within a week or two. "The fact that she is a healthy person, that she doesn't have a lot of cancer and that she doesn't have symptoms all work in her favor."

Oncologists often warn patients to ignore the statistics about life expectancy, because so much depends on the characteristics of their cancers and their response to treatment.

"There are situations where it may be rapidly progressive, and there are situations where you see [slow-moving] disease and patients may live for several years," said Dr. Elizabeth E. Campbell, a medical oncologist with Cancer Centers of North Carolina in Raleigh, one of the state's largest private cancer practices.

"It is sobering for anybody to have a recurrence at any point," said Campbell, who is not involved with Edwards' care. "But there still are potentially lots and lots of alternatives for treatment."

Additional tests will determine what therapy Elizabeth Edwards will face. She said she thinks it will be less toxic than the chemotherapy she underwent before having a lumpectomy and radiation. She joked that her children were disappointed she would not likely lose her hair again -- a common result of cancer treatment.

Oncologists who plan treatment for patients with advanced breast cancer said that, depending on the biological characteristics of Edwards' cancer, she could be treated with one of several drugs, such as Tamoxifen or newer treatments such as Arimidex or Femara, which inhibit hormones that stimulate tumor growth. She might receive intravenous chemotherapy or follow a regimen of pills. Radiation to beat back the cancer in Edwards' bones is also a possibility.

Edwards expressed confidence that she would be able to continue campaigning with her husband. Other survivors, who have looked at Elizabeth Edwards as an inspiration since her diagnosis in 2004, said they hoped Edwards would be able to manage the punishing schedule of campaigning while undergoing treatment.

Marlene Dixon, 71, a breast cancer patient who lives in Cary, said she thinks Edwards will be fine on the campaign trail. Dixon continued to work full time as a real estate agent after her diagnosis in 1999 and still maintains a part-time business despite a recurrence that was diagnosed last spring. Dixon, who like Edwards has stage four metastatic disease, also in the bones and lungs, has been on an oral treatment therapy since then.

"Here I am a year later and I haven't felt sick once," Dixon said. "No one even knows I'm sick."

Dixon also spoke highly of Edwards' oncologist, Carey, who is also Dixon's doctor:

"She couldn't be in better hands."

Kristine Kulowiec, 49, a breast cancer patient who lives in Wake Forest, was more skeptical about Edwards' plans to soldier on. Kulowiec, who was initially diagnosed in March 2003, said she was weak and sick during chemotherapy she had to treat a recurrence discovered in March 2005. She had stage four disease that has spread to her liver. She said she went online to read about Edwards' recurrence as soon as she heard the news.

"It depends on her treatment, but if her chemo is anything like mine, I can't imagine her being able" to campaign. Kulowiec said. "No matter what, it will be a challenge."