Does Anybody Really Understand The Extent Of McCain's Cancer?

[Anonymous]

You know, when someone healthy is elected to the Presidency, you don't worry too too much about who is one heartbeat away from the Presidency.

People blithely say that McCain has survived cancer, or that he had skin cancer removed. As though it's something small and pesky.

The truth is, McCain has malignant melanoma. Once you have it, you always have it. Melanoma is extremely hard to treat. I think he's had at least 2, if not 3 recurrences, which is evidence of matastisis. They staged him at 2A -- which is actually not very good -- but I have a feeling someone is fudging about this. They cut much more off of his face than they normally would for a Stage 2 melanoma.

Once melanoma mestastizes, it can kill you in a matter of months. There currently is no treatment that is proven to be effective at treating melanoma. Patients subject themselves to brutal treatments in the hopes of a big benefit but, more often than not, all they do is subject themselves to brutal treatments and die quickly anyway.

www.mpip.org

If the 72-year-old McCain with melanoma should die in the next 4 years -- which is actually LIKELY (check out the staging charts and the chances of survival), what are we going to be left with?

A lot of snark. And hopefully a cabinet that will prop her up. Still, we will look incredibly weak to our enemies if such a situation were to occur. The world would be laughing at us and we most certainly will be attacked.

[Anonymous]

Anonymous wrote:You know, when someone healthy is elected to the Presidency, you don't worry too too much about who is one heartbeat away from the Presidency.

People blithely say that McCain has survived cancer, or that he had skin cancer removed. As though it's something small and pesky.

The truth is, McCain has malignant melanoma. Once you have it, you always have it. Melanoma is extremely hard to treat. I think he's had at least 2, if not 3 recurrences, which is evidence of matastisis. They staged him at 2A -- which is actually not very good -- but I have a feeling someone is fudging about this. They cut much more off of his face than they normally would for a Stage 2 melanoma.

Once melanoma mestastizes, it can kill you in a matter of months. There currently is no treatment that is proven to be effective at treating melanoma. Patients subject themselves to brutal treatments in the hopes of a big benefit but, more often than not, all they do is subject themselves to brutal treatments and die quickly anyway.

www.mpip.org

If the 72-year-old McCain with melanoma should die in the next 4 years -- which is actually LIKELY (check out the staging charts and the chances of survival), what are we going to be left with?

A lot of snark. And hopefully a cabinet that will prop her up. Still, we will look incredibly weak to our enemies if such a situation were to occur. The world would be laughing at us and we most certainly will be attacked.

As someone who was cured of melanoma more than a decade ago, married to a man who was cured of melanoma more than a decade ago, I don't think these statements are accurate. Certainly it is inaccurate to say that "once you have it, you always have it." Stage 0 or I melanoma is almost always completely cured. A stage IIa melanoma is localized and is frequently completely curable. McCain's surgery was very extensive in order to ensure that the tumor had not spread to the lymph nodes or parotid gland. Often more extensive surgery is performed in order to err on the side of caution. Both my husband and I can speak to this firsthand. With a stage II melanoma one must always be extremely vigilant, but McCain has been cancer free for 8 years. There were no metastases found during his surgery. Thus, the OP's statements about metastatic melanoma don't apply to McCain.

It is also inaccurate to say that McCain has had "recurrences" of melanoma. Dr. Lawrence Altman, the NYT's medicine reporter, recounts the history of McCain's melanomas here:

Mr. McCain has had four melanomas.

In 1993, he waited more than six months before seeking care after a Navy doctor recommended that he consult a dermatologist for a lesion on his left shoulder that turned out to be his first melanoma. It was excised and has not recurred.

Pathology tests showed that the two other melanomas — detected on his upper left arm in 2000 and on his nose in 2002 — were of the least dangerous kind, in situ. In that type the malignant cells are confined to the outer layer of skin.

The most serious melanoma was spotted on his temple in 2000 by the attending physician at the United States Capitol after it had escaped the eye of Mr. McCain’s personal physician at Mayo Clinic Scottsdale. (The Capitol physician also spotted another melanoma that was in situ.)

Melanoma in situ has, by definition, not spread beyond the most superficial layer of skin. These melanomas are separate incidences, not recurrences.
Finally, it is inaccurate to say that "McCain is likely to die in the next 4 years" based on the staging charts. Dr. Altman again:

The melanoma removed in 2000 was Stage IIa on a standard classification that makes Stage IV the most serious. For Stage IIa melanoma, the survival rate 10 years after diagnosis is about 65 percent. But the outlook is much better for patients like Mr. McCain, who have already survived more than seven years.

For patients with a melanoma like Mr. McCain’s who remained free of the disease for the first five years after diagnosis, the probability of recurrence during the next five years was 14 percent and death 9 percent, a study published in 1992 found.

In other words, McCain has been cancer free for 8 years. The likelihood of his dying of melanoma in the next 4 years is much lower than the OP suggests -- you can extrapolate and see that it's well under 9 percent, since he's already 8 years out on a 10-year prediction. I would hardly say that means he is "likely" to die in the next 4 years.

Dr. Altman published his story in March 2008, before McCain released his full medical records. The records have since been released. Here's a link to his story if you're interested:

http://www.nytimes.com/2008/03/09/us/politics/09mccain.html?pagewanted=1&_r=2&adxnnl=1&ref=politics&adxnnlx=1220641275-y1XF8PPIrkBZdeYpLjfGYA

It's reasonable to inquire about McCain's health, given his age and his history of melanoma. But let's stick to the facts, please.

[Anonymous]

I believe McCain's last bout with melanoma occured sometime this year.

Stage Ia melanoma has a 95% survival rate.

It goes rapidly downhill from there.

What you posit about the doctors doing so much cutting in order to make sure that the disease had not lymph nodes does not make medical sense -- and I am not the first one to say this. The standard of care is to excise the melanoma by wide margin excision and a sentinel node biopsy. Not to just cut and cut and cut. The fact that the care he received in relation to his most recent reoccurrence deviated from what is standard of care for a 2a melanoma makes me, and others, suspicious as to what exactly his stage is. He has thus far refused to release his medical information. However, the amount of cutting he had most recently suggests that he may have had a surgical resection. This would be only necessary if he was actually at Stage 3. There is only a 50% survival rate for Stage 3 melanoma.

I am glad that you have not had a recurrence of your melanoma in ten years. Time is certainly on your side, and I wish you and your husband nothing but good health. However, I have read plenty about people with stage 1 melanoma being NED for a number of years, and then all of a sudden they're at stage 4. It is not uncommon. You do not have progress from stage 1, to 2, to 3 .. . etc. McCain could very easily go from a stage 2 to a stage 4 in a very short time

I will look at the information you have cited to, but www.mpip.org remains the best source of information. It is sponsored by Sloan-Kettering. And you will find lots and lots of stories there of real people progressing very quickly. It ain't pretty.

[Anonymous]

PP here. Thanks for your follow-up post. All of McCain's medical records are now available. Everything prior to 2000 was already available; in May he released all of his records from 2000 forward. His doctors and the team that did his surgery in 2000 had a press conference to discuss the melanoma and surgery, as well as McCain's general health. I believe they confirmed at that time that he has been cancer free since 2000. You can probably find the info with a search.

[Anonymous]

As we age, the risk of metastasis increases.

[Anonymous]

Anonymous wrote:Patients subject themselves to brutal treatments in the hopes of a big benefit but, more often than not, all they do is subject themselves to brutal treatments and die quickly anyway.

As someone who just lost a parent to terminal cancer, I find the way you write about the disease completely callous and offensive. I know that John McCain is your enemy, but he is also a human being.

[Anonymous]

As someone whose husband has had cancer twice, I don't think PP was callous or offensive. Just straightforward.

Re: McCain: Even though each of the melanomas was a separate occurence not a recurrence, they add up to at least 6 incidents. That in itself suggests danger to me. I would think that someone with that medical history would have a much higher than normal risk of ultimately having malignant melanoma. Anyone know of any stats?

[Anonymous]

18:47 here. Just wanted to add my sincere condolences for the loss of your parent. You have my prayers.

[Anonymous]

OP here.

I knew before I started this thread that cancer is a very sensitive subject that strikes close to the heart.

I do not wish bad health for John McCain.

To the PP that asked about stats: I believe he has had 4 melanomas, not 6. I also believe that each one was considered a new primary rather than a reccurence of a prior melanoma. It's much better to have a new primary than a recurrence.

But the PP who said it gets worse as you get older is correct.

Also, with all due respect, a patient's own doctor will almost always paint a better picture for their celebrity/important/public figure patients than may actually be the case. Patrick Swayze's doctor told the press that he is responding very well to his treatments. Well, Patrick Swayze seems like a nice man and I do not mean this to sound snarky but, and assuming Patrick Swayze was otherwise qualified for the Presidency, I wouldn't want him as our President based on his doctor's reassurances, unless I felt very comfortable with the person who is going to be a heartbeat away from the Presidency.

72 is hardly young and Stage 2a melanoma is actually a pretty big deal. He is at high risk for metastisis, and the idea of this Sarah Palin being in charge really scares me. I am scared for my children. All we've seen of her is that she's attractive and mean-spririted. Who is she to ridicule Obama's service as a community organizer? What does that say to the rest of us that are trying to serve our communities? I think it says F you.

People can make fun of Obama's "thin resume" all the like. But the fact remains that he does come off as someone who will be taken seriously on the international stage and so does Biden.

Palin doesn't. One degree earned from the University of Idaho (which is not a good school), without any distinction is simply not the stuff of an intellect (I know I'm such an elitist). So she led her high school team in basketball and loves to shoot moose. Do you think the rest of the world is going to take her seriously? Do you think our enemies would even hesitate to attack us if she was in charge????

And shouldn't the President of the United States be smarter than the average Joe? Why is it not a good idea to have a President with a huge appetitite for knowledge (Bill Clinton)? What is wrong with having an Ivy League education? I was much happier having a President who I knew was a genius that I was with Bush carrying around his copy of "I Am Charlotte Simmons" by Tom Wolfe. Really. It's a joke. That's why Cheney had to do everything for him. He did not have the intellectual horsepower or the fortitude to do the job.

You can keep hammering away at the fact that Obama does not have a lot of executive experience. The fact remains that he has two Ivy League degrees, wrote two million-dollar books himself that needed very little editing, was invited to teach at one of the best law schools in the United States, managed to come into Chicago politics as an outsider and succeed, and managed his own campaign for the past 18 months. Which started out looking like a long shot. But he succeeded. His VP pick makes up with experience what is lacking in his academic pedigree. No one dismisses Joe Biden.

And neither one of these two men are old and battling cancer.

When you become a mother, you really want to keep your children safe. Even more than yourself. I trust McCain to keep us safe, but I trust Obama just as much. I just don't trust that John McCain is going to stay alive. And what if he wins another term (incumbent always has the advantage). He'll be 80 if he lives to serve out that second term.

And I just can't imagine if he is gone, and all we have is this poorly educated, pretty, and snarky woman to protect us. In these times.

It seems like quite a gamble to me.

[Anonymous]

VERY WELL STATED OP!!!
I agree with every thing you said.

I think about a totally hypothetical situation where WWIII were to start, and all of the Executive staff were either dead or kidnapped, scary. Even the speaker of the house and so on. Who would be a good person to put in charge until an election were held? I would think of a senior Senator (Kennedy before he got sick) or a governor of a big state (such as Tom Ridge), or an ex-president (Bush or Clinton) or a former high level cabinet member (such as Kissinger, in his younger years). This is all hypothetical of course, but it is about how I feel about leadership. I DO NOT think about Palin as that person. Not now, not even as a "temp" Pres.

I was going to vote McCain. I have voted republican the last two times. Not because I like Bush (I think he is dumb), but because I am in health care and HRC's ideas scared me. Edwards loved to sue doctors, and Kerry seemed like he would sell us down river. But now, NOOO way. Obama gets my vote. I can't think about my wallet, this is about responsibly.

[Anonymous]

Anonymous wrote:
One degree earned from the University of Idaho (which is not a good school), without any distinction is simply not the stuff of an intellect (I know I'm such an elitist). So she led her high school team in basketball and loves to shoot moose. Do you think the rest of the world is going to take her seriously? Do you think our enemies would even hesitate to attack us if she was in charge????

Harry Truman did not have a college degree. People also had very low expectations for him and his popularity ratings were very low. Scholars now admit that he was one of our best presidents. McCain has been around long enough to pick good advisors and cabinet members. If something happened to him, there would be an entire framework already in place to advise Palin. Also, Palin is a confident speaker and can communicate the administration's position on issues. One of my biggest complaints about Bush is that he is a lousy speaker. You can't expect to lead a country if you can't communicate effectively with its people.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You know, when someone healthy is elected to the Presidency, you don't worry too too much about who is one heartbeat away from the Presidency.

People blithely say that McCain has survived cancer, or that he had skin cancer removed. As though it's something small and pesky.

The truth is, McCain has malignant melanoma. Once you have it, you always have it. Melanoma is extremely hard to treat. I think he's had at least 2, if not 3 recurrences, which is evidence of matastisis. They staged him at 2A -- which is actually not very good -- but I have a feeling someone is fudging about this. They cut much more off of his face than they normally would for a Stage 2 melanoma.

Once melanoma mestastizes, it can kill you in a matter of months. There currently is no treatment that is proven to be effective at treating melanoma. Patients subject themselves to brutal treatments in the hopes of a big benefit but, more often than not, all they do is subject themselves to brutal treatments and die quickly anyway.

www.mpip.org

If the 72-year-old McCain with melanoma should die in the next 4 years -- which is actually LIKELY (check out the staging charts and the chances of survival), what are we going to be left with?

A lot of snark. And hopefully a cabinet that will prop her up. Still, we will look incredibly weak to our enemies if such a situation were to occur. The world would be laughing at us and we most certainly will be attacked.

As someone who was cured of melanoma more than a decade ago, married to a man who was cured of melanoma more than a decade ago, I don't think these statements are accurate. Certainly it is inaccurate to say that "once you have it, you always have it." Stage 0 or I melanoma is almost always completely cured. A stage IIa melanoma is localized and is frequently completely curable. McCain's surgery was very extensive in order to ensure that the tumor had not spread to the lymph nodes or parotid gland. Often more extensive surgery is performed in order to err on the side of caution. Both my husband and I can speak to this firsthand. With a stage II melanoma one must always be extremely vigilant, but McCain has been cancer free for 8 years. There were no metastases found during his surgery. Thus, the OP's statements about metastatic melanoma don't apply to McCain.

It is also inaccurate to say that McCain has had "recurrences" of melanoma. Dr. Lawrence Altman, the NYT's medicine reporter, recounts the history of McCain's melanomas here:

Mr. McCain has had four melanomas.

In 1993, he waited more than six months before seeking care after a Navy doctor recommended that he consult a dermatologist for a lesion on his left shoulder that turned out to be his first melanoma. It was excised and has not recurred.

Pathology tests showed that the two other melanomas — detected on his upper left arm in 2000 and on his nose in 2002 — were of the least dangerous kind, in situ. In that type the malignant cells are confined to the outer layer of skin.

The most serious melanoma was spotted on his temple in 2000 by the attending physician at the United States Capitol after it had escaped the eye of Mr. McCain’s personal physician at Mayo Clinic Scottsdale. (The Capitol physician also spotted another melanoma that was in situ.)

Melanoma in situ has, by definition, not spread beyond the most superficial layer of skin. These melanomas are separate incidences, not recurrences.
Finally, it is inaccurate to say that "McCain is likely to die in the next 4 years" based on the staging charts. Dr. Altman again:

The melanoma removed in 2000 was Stage IIa on a standard classification that makes Stage IV the most serious. For Stage IIa melanoma, the survival rate 10 years after diagnosis is about 65 percent. But the outlook is much better for patients like Mr. McCain, who have already survived more than seven years.

For patients with a melanoma like Mr. McCain’s who remained free of the disease for the first five years after diagnosis, the probability of recurrence during the next five years was 14 percent and death 9 percent, a study published in 1992 found.

In other words, McCain has been cancer free for 8 years. The likelihood of his dying of melanoma in the next 4 years is much lower than the OP suggests -- you can extrapolate and see that it's well under 9 percent, since he's already 8 years out on a 10-year prediction. I would hardly say that means he is "likely" to die in the next 4 years.

Dr. Altman published his story in March 2008, before McCain released his full medical records. The records have since been released. Here's a link to his story if you're interested:

http://www.nytimes.com/2008/03/09/us/politics/09mccain.html?pagewanted=1&_r=2&adxnnl=1&ref=politics&adxnnlx=1220641275-y1XF8PPIrkBZdeYpLjfGYA

It's reasonable to inquire about McCain's health, given his age and his history of melanoma. But let's stick to the facts, please.

BRAVO. I've had malignant melanoma too, and I'm only in my thirties. I have one of the best docs in the country (nowhere near DC) and he and I plan on me living a very long time, just like my parents who are in their sixties (mom) and seventies (dad) and who have both had several malignant melanomas removed as well (including stage 2s).

Brilliant reply - and life-affirming to me. Thanks!

[Anonymous]

Melanoma or not, he is old and is likely to die soon.

[Anonymous]

Anonymous wrote:
BRAVO. I've had malignant melanoma too, and I'm only in my thirties. I have one of the best docs in the country (nowhere near DC) and he and I plan on me living a very long time, just like my parents who are in their sixties (mom) and seventies (dad) and who have both had several malignant melanomas removed as well (including stage 2s).

Brilliant reply - and life-affirming to me. Thanks!

I'm the poster you quoted. You're welcome. I'm glad you felt my reply was not only reasonable, but meaningful to you. I wish you many more decades of happy life and good health!

[Anonymous]

Old or not, cancer or not, any president may die. The age and the cancer may be reminders of this, but I see no reason to need the reminders. Death happens!