* Surgery, radiation could take 10 months
* Fatigue could bog down re-election bid
* Cancer could return, spread
By Julie Steenhuysen
CHICAGO, Feb 25 As Hugo Chavez heads to
Cuba to have surgery on a second lesion in his pelvis, medical
experts say the Venezuelan president still has a chance to be
cured, but he may have to battle fatigue as he campaigns for
re-election in October.
After declaring himself cancer-free last October, Chavez now
says he has a 2 centimeter (0.79 inch) lesion in the same pelvic
area where doctors in Cuba removed a baseball-sized tumor during
his original treatment last year.
Doctors say the fact that Chavez' cancer has returned is
worrisome, but the second surgery will give him one more chance
at a cure.
"If it is localized and they can get it out and they get
good, clean surgical margins, there is a 20 to 25 percent chance
that he could be cured," said Dr. Richard Schilsky, a specialist
in gastrointestinal cancers at University of Chicago Medicine
who is not treating Chavez.
It is still not clear what kind of cancer the Venezuelan
leader has, but comments made by Chavez and his handlers suggest
he may have rectal or bladder cancer, or possibly soft tissue
sarcoma. Schilsky said colon or rectal cancers sometimes come
back in the pelvis or abdomen.
"It's hard to know without knowing what the primary tumor
was. Local occurrence of colon cancer is less common than rectal
cancer," Schilsky said.
Dr. Charles Fuchs, director of the gastrointestinal oncology
program at the Dana-Farber Cancer Institute in Boston, said
rectal cancer is more prone to local recurrence than colon
cancer because the pelvis is such a crowded area that it is
difficult for surgeons to get clean margins.
"Nothing has been said as to the origin of the cancer. All
we know is that this was a tumor in the pelvis. After that he
had a number of cycles of chemotherapy, presumably around 6
cycles. We don't even know what drugs he was given in the way of
chemotherapy," said Sunil Daryanani, an oncologist at the
Hospital de Clínicas Caracas.
He said because Chavez' tumor was diagnosed with an
infection, the fact that he has had a local recurrence is not a
surprise, but the time between treatment and progression of the
cancer has been pretty short.
TREATMENT COULD CONTINUE UNTIL MAY
"This could imply that the original chemotherapy wasn't
effective enough, but this is just speculation," Daryanani said.
"Once they've opened him up (on Monday/Tuesday), they'll
have an idea if this is a localized occurrence or something more
advanced," he said.
With a local recurrence of cancer, doctors will likely
remove the tumor and then use radiation to "sterilize" the area
and potentially kill off any remaining local cells, said Dr.
Michael Pishvaian, a gastrointestinal cancer specialist at
Georgetown University's Lombardi Comprehensive Cancer Center.
Radiation typically starts about a month after surgery and
involves daily treatment, Monday-Friday, for five to six weeks.
The whole treatment process could last through mid-May.
Side effects tend to be mild and localized, and fatigue is
usually the biggest problem, doctors said.
"Some can go back to work on the same day; some are severely
laid up and need to rest the whole time," Pishvaian said.
He said he thinks Chavez will be able to carry on the
activities of being president, but "in terms of the rigors of a
campaign trail, that would be pretty hard for anyone undergoing
"I think it definitely could have an impact in the middle of
Schilsky said three months from now, Chavez should be
feeling pretty good. What is less clear is whether the cancer
will spread to other parts of his body, like the liver or lungs.
"The highest risk of finding a metastasis would be some time
in the next two years. That would be an important milestone,"
As for Chavez seeking treatments in Cuba, Pishvaian said he
hears the medical education in Cuba is surprisingly good, and
the treatment Chavez needs is widely available. "There is no
fancy chemotherapy that he would need at this point."