Although the walnut-sized tumor removed from Cardinal Joseph Bernardin’s pancreas proved to be malignant and he still is facing an uphill battle against cancer, his physicians said Wednesday that they were optimistic about his chances.
They prescribed full bouts of chemotherapy and radiation and stood by their earlier 20-25 percent chance of survival to 5 years, but said that Bernardin would be able to resume “full activities” at the archdiocese.
“It’s been totally removed,” said Dr. Richard I. Fisher, director of the Loyola University Cancer Center in Maywood, speaking about Bernardin’s pancreatic cancer. “Therefore we expect that the cardinal will recover from the surgery as well as he has been doing, continue to recover, and go back to resuming his normal activities.”
But whether Bernardin will be able to keep up his demanding schedule remains unclear. The seriousness of the surgery-and of the treatment-will change his dietary habits and perhaps limit his endurance.
Fisher said that Bernardin accepted the biopsy reports from his doctors “very matter-of-factly.” He received the news of his further treatment “enthusiastically,” Fisher said, and was “buoyed by the prospect that the treatment could prevent recurrence.”
All things considered, the 67-year-old prelate has been lucky so far.
Only about 10 percent of patients suspected of having pancreatic cancer are able to be opsidious, however, that the cardinal has agreed to undergo further therapy.
Dr. Gerard Aranha, chief of surgical oncology at Loyola, said that one nearby lymph node out of 14 biopsied during Bernardin’s extensive exploratory operation Monday had been found to be malignant.
Although only one node was involved, that opened the door to the possibility that microscopic cancer cells had spread elsewhere in the cardinal’s body.
Such metastases, of course, make cancer a killer.
More Top Picks Best Dip Bars For Home Gyms
A surgeon’s knife can expunge solid tumors, but only radiation can help prevent recurrence at the tumor site, and only chemotherapy can work systemically to seek out and destroy renegade cancerous cells.
Aranha stressed that the margins, or adjoining tissues, of the pancreas, bile duct, stomach and small intestine that remained in Bernardin after his surgery all were cancer-free.
“So we have a situation where a malignancy of the pancreas has been removed completely with benign tissue remaining,” Aranha said.
Postsurgical radiation and the powerful drug 5-FU may improve survival. About 40 percent of patients treated with such combined therapy are alive in two years, representing a twofold increase over those who don’t have it.
Beginning in about a month, Bernardin will undergo “routine” chemotherapy with 5-FU (5-fluorouracil), one of many chemicals that are often effective in prolonging life.
He will receive daily radiation treatments for four to six weeks, with weekends off. At the same time, he will undergo chemotherapy injections every two weeks, and perhaps have chemo for an entire week with an IV.
Survival statistics are confusing in cases such as Bernardin’s because not enough patients have beaten pancreatic cancer to have participated in major clinical trials.
Even the classic “staging” of tumors to predict cancer progression do not necessarily apply to this type of case because long-term survival rates have been so dismal.
The overall survival rate for pancreatic cancer is only 2 percent. Median survival in patients with pancreatic tumors who undergo Whipple resections-though they are usually in worse shape than Bernardin with more lymph node involvement-is between 16 and 30 months.
Yet Bernardin’s tumor was so small-only 2.1 centimeters (just under an inch) in diameter-and was caught so early, that his doctors give him one chance in four of surviving at least five years.
Other cancer experts agreed.
“Median survival for all patients is certainly less than one year,” says Dr. Al Benson, medical oncologist at Northwestern University Medical Center. “But those who can undergo surgery may go to one- and two-year survivals. Some continue to live five years after diagnosis.
“In some small studies, the survival rate has increased to 50 percent over 5 years-versus the 20 to 25 percent that is seen without using these additional, or adjuvant, agents after surgical resection of the tumor.”
In fact, Dr. Robert Levin, chief of surgical oncology at Mt. Sinai Medical Center, would give Bernardin those odds.
“I think Loyola is being conservative,” he said. “I’d give him 50 percent.”
The cardinal’s right kidney, which also was removed during surgery Monday, was first believed to be cancerous, but now has turned into something of a mystery. Pending more tests, pathologists declined to say that it actually was malignant, but reported that it was not related to the pancreas, “and very rare.”
“The lump removed from the kidney is a very unique tumorous mass,” said Dr. Robert Flanigan, chairman of the urology department at Loyola. “At this time, we don’t know if it’s malignant or benign. The cardinal probably had it for a long time. It was entirely contained and will not affect his prognosis.”
The cardinal’s friend and colleague, Rev. Raymond E. Goedert, auxiliary bishop of Chicago, said Wednesday that after Bernardin had heard the news he said: “Let’s get on with that walk I`m supposed to take.”
Whereupon Bernardin walked down the corridor two days after major surgery.
The cardinal has “placed his faith in God’s hands,” Goedert said. “I ask you to continue to pray for him.”
Shortly after the news of the malignancy was announced, about 100 parishioners, a normal turnout, sat scattered in the pews at Holy Name Cathedral for the day’s final 5:15 p.m. mass.
Michael Kane, 37, a maintenance worker at Holy Name, knelt in back of the church and, along with others, offered a special prayer for the cardinal.
Kane, who has been battling prostate cancer since October, has found special strength in Bernardin’s faith, he said.
“He said to me, `Mike, We’re all here for a reason, and when we die, we all go to a better place,’ ” Kane said, recalling a conversation he had with Bernardin. “And that is why I think he is not afraid to die.
“He is an example for people with cancer and people without cancer. He has a lot of faith and a lot of love in his heart.”
Rev. Thomas Paprocki, who said mass, updated worshipers on the cardinal’s condition. He told them the news was both good and bad.
More Top Picks Best Folding Phones
“We’re very sorry to hear that the tumor was malignant,” Paprocki said. “But we are happy to hear that with continued therapy, he will be able to return to his duties.”
Edward O’Hayer, 55, said that he traveled from the South Side on Wednesday to pray for the cardinal and heard en route that the tumor was malignant.
“We wanted to come and offer a little something extra,” O’Hayer said. “It’s good to pray anyway. Even if the news is bad, the prayer was not wasted.”
Agnes Clement, of Chicago, said she will continue to look to Bernardin for strength.
“He is a very holy man and he is suffering,” she said. “But he always tells people to put their trust in God, and that is what he does.”