Outlook for Chávez Darkens, Doctors Say

Cancer Specialists Say Disease’s Recurrence Means Venezuelan Leader Is Increasingly at Risk, He Likely Has Sarcoma


Venezuelan President Hugo Chávez’s cancer is most likely terminal given the disease’s recurrences, and while the president may bounce back for periods, his health is increasingly at risk, say several leading cancer specialists not involved in the treatment.

Mr. Chávez is recovering from surgery in Cuba this week after the president said malignant cells reappeared for a third time in his abdomen. Venezuela’s government hasn’t disclosed what type of cancer he has or what the surgery was for. But it has described the more than six-hour operation as “complex and delicate” and said Mr. Chávez might not be back in Caracas in time for his Jan. 10 inauguration for a new term after 14 years in power.

Doctors say Venezuelan President Hugo Chavez is almost certainly suffering from sarcoma, a rare cancer that is usually more aggressive than other types of the disease. Jose de Cordoba has details on The News Hub. Photo: Reuters.

On Thursday, Venezuela’s government said doctors upgraded Mr. Chávez’s condition to “favorable” from “stable.” Earlier, it said the operation had “complications” and “needed corrective treatment due to bleeding.”

Doctors say cancer is a game of odds, and that Mr. Chávez may yet stage a full recovery. “The one thing we do know is that we are not great at predicting,” said J. Randolph Hecht, director of gastrointestinal oncology at the University of California at Los Angeles. “Only in Hollywood do people know how long they have.”

Despite the secrecy surrounding the politician’s condition, however, intelligence analysts in the hemisphere and doctors who specialize in cancer say they can piece together a rough prognosis based on publicly available information—even though they have no direct knowledge of the case.

His latest operation suggest the president’s odds of survival are worsening, doctors say. The fact that his cancer has returned twice after undergoing four surgeries and treatment like radiation therapy and chemotherapy that Mr. Chávez has said he had indicates the cancer is aggressive and unlikely to be cured, the doctors say.

“There is no question that a recurrence now is an ominous sign. Any additional procedures are palliative in the sense they are to prevent symptoms from getting worse, rather than curative at this stage,” said Michael Pishvaian, an oncologist at Georgetown University’s Lombardi Cancer Center.

Mr. Chávez faces a potentially dangerous recovery from his latest surgery, said Thierry Jahan, an oncologist at the University of California, San Francisco. Excessive use of anti-inflammatory steroids during his treatments during Mr. Chávez’s illness could cause muscles to waste away, and, after an operation, increase the chances of infections leading to sepsis, a potentially deadly infection, blood clots, gastrointestinal bleeding and an increased risk of rising sugar levels leading to diabetes, Dr. Jahan said.

Mr. Chávez was first diagnosed with cancer in June 2011, after doctors operated on him to treat a pelvic abscess and discovered a “baseball-size tumor,” Mr. Chávez said. After a separate surgery to remove the tumor, followed by chemotherapy and radiation therapy, the cancerous cells reappeared and were removed again in February. He then underwent more anticancer treatment, and again said he said was cured.

Doctors say cancer in the abdomen is almost always one of four types: prostate, colon, bladder or sarcoma, which is a rare form of cancer that arises not from an organ, but from connective tissue like muscles, ligaments, fat or bones. Mr. Chávez’s former family doctor, Salvador Navarrete, has said publicly that Chávez family members told him the tumor was sarcoma.

ReutersA Chávez supporter holds a picture of the president Thursday during a campaign rally for the ruling party’s gubernatorial candidate in Miranda state.

Since cancers like colon and prostate usually only require one surgery, doctor say, repeated surgeries and treatment suggests the cancer is sarcoma, which reappears following initial surgery unless a broad enough section of tissue around the diseased area is removed, doctors say.

“When sarcomas occur in the belly area it’s pretty dramatic. It’s pretty difficult to get back in there and get everything, because the abdominal cavity is such a permissive environment for tumor cells,” said Dr. Jahan, who specializes in sarcoma surgery.

The description of Mr. Chávez’s cancer “is certainly highly consistent” with a sarcoma, said George Demetri, medical director of the center for sarcoma and bone oncology at the Dana-Farber Cancer Institute, Boston.

“They tend to follow this kind of path: a lump is taken out, the patient is fine,” he said. Patients may receive either radiation or chemotherapy. But “almost inevitably, they come back in or near where they started,” he added. Patients get a second surgery and the sarcomas come back again. “These patients can go through multiple surgeries.”

But multiple surgeries take a high toll on the body, creating added layers of scar tissues that can become “cement-like,” Dr. Demetri said. Both scar tissue and the tumors can cause obstructions to blood vessels or the bowel, for example, which could require immediate surgery, Mr. Demetri said. They can also put pressure on any of a variety of nerves to the bladder, pelvis, bowel and lower legs, resulting in extraordinary pain, he said.

Patients who suffer from sarcoma tumors that are aggressive and incurable usually live between one to three years. If Mr. Chávez suffered from advanced sarcoma when he was diagnosed, he would be in the middle of that range right now.

One cancer specialist says he gives Mr. Chávez a 50% chance of survival in the next six months, with decreasing odds of survival thereafter.Mr. Chávez, who looked more robust in the run-up to his victory in October’s presidential election, is now likely to endure more anticancer treatments, the doctors say. While he may have several months of renewed energy, he is likely to become increasingly symptomatic and tired.

“Physically, as he goes through therapies, he’ll want to fight this, but as he does this it will take a toll on him. His stamina will steadily decline as he goes on in the treatment,” said Dr. Pishvaian. “Mentally, he’s going to be distracted by his sickness, by his mortality. Most people are afraid to die and it’s going to take away from the ability to focus on the task at hand.”

There are only about 9,000 new sarcoma cases a year in the U.S. compared with about 200,000 cases of lung cancer, according to Dr. Pishvaian, who treats about 50 to 100 sarcoma cases a year.

Because it is rare, patients treated at one of a handful of sarcoma specialty centers had better outcomes than those treated elsewhere, according to a study by the University of Miami School of Medicine that reviewed 4,205 cases over a 20-year period.

Mr. Chávez has been treated at Havana’s cancer center, which isn’t considered among the elite anticancer or sarcoma centers, a handful of which are located in the U.S. and Europe, doctors said. Mr. Chávez turned down an offer by Brazil’s president to be treated in a world-renowned cancer hospital in São Paulo.

Many analysts say Mr. Chávez chose Cuba to keep details of his illness secret, but that may be hurting his chances for survival.

Dr. Demetri said the secrecy with which Mr. Chávez and Venezuelan authorities have surrounded his case may have deprived him of access to potential approaches that could have improved his care.

—David Luhnow contributed to this article.


Author: `