For Cardinal Francis George, the five-year survival rate for bladder cancer is not an abstract number. Five years is the time he has left as the Roman Catholic archbishop of Chicago before he must offer to step down at age 75.
On Thursday the future of George’s ministry hung in the balance as doctors successfully removed his cancerous bladder but disclosed that the cancer also was found in one of his ureters, the tubes that connect the bladder to the kidneys.
It will take one week for pathology tests on the removed bladder and other organs to assess how much George’s cancer has spread–a crucial gauge of the threat posed by his disease.
In the meantime, George will begin a regimen of recovery tailored to his condition as a 69-year-old polio survivor and bolstered by prayers from Catholics and others for the beloved archbishop.
“This is an important medical moment for the cardinal and the church, but it is also an important moment of faith for us,” said Rev. John Canary, vicar general for the Archdiocese of Chicago. “I think the prayers really did make a difference.”
Though upbeat after the five-hour operation at Loyola University Medical Center in Maywood, George’s doctors expressed concern about his condition. Presurgical tests conducted in recent weeks found that in addition to the bladder cancer, George had a cancerous growth that was blocking his right ureter.
Had George’s ureter not been affected, experts said, his five-year survival odds would be high–85 percent of patients with his type of bladder cancer and no other complications survive at least that long. In general, patients with cancer in the ureter have a worse outlook.
The surgery came a day after the archbishop told the public of his diagnosis with bladder cancer. Doctors removed George’s bladder, prostate, lymph nodes and part of the right ureter.
“The cardinal did very, very well in surgery,” said Dr. Robert Flanigan, chairman of urology at Loyola, who performed the operation.
Normally with George’s type of bladder cancer, the first round of treatment would involve months of drug therapy, with surgery required only if the drugs are unsuccessful. But the finding of cancer in the ureter persuaded George and his doctors to proceed straight to removal of the bladder.
“We were very concerned that there may be more extensive disease that we just couldn’t appreciate,” Flanigan said. “There is a poorer prognosis associated overall with cancers of the ureter than with cancers of the bladder.”
The added risk from cancer in the ureter stems from several factors, experts said. The muscle that lines the ureter wall is thinner than the bladder lining, and a thinner wall can foster the spread of cancer cells, Flanigan said.
“Tumors, if they do escape into the … lining of the organ, don’t have a long distance before they’re able to escape outside the organ,” Flanigan said.
Another cause for concern is that the ureter cancer appeared to block the flow of urine into George’s bladder, said Dr. Gary Steinberg, director of urologic oncology at the University of Chicago Hospitals.
“When you see an obstruction like that, you worry that you have a deeply invasive tumor,” Steinberg said. “Many times, that tumor is invading into the muscle of the bladder, or the wall of the ureter, or even into the fat around the ureter.”
Also of concern is how long the cancer might have gone undetected. Dr. Myles Sheehan, the cardinal’s physician and also a priest, said a battery of tests in January, including urinalysis, might not have shown signs of an abnormality even if cancer was present. It was not until George saw blood in his urine and called Sheehan on the night of June 8 that cancer became a concern. On June 23, doctors examined the inside of his bladder and found “atypical cells suspicious for cancer.”
A biopsy confirmed cancer and a CAT scan showed the right ureter to be partially blocked near the bladder and swollen all the way up to the kidney as a result. A stent was placed inside the ureter until Thursday’s operation.
Before that surgery, the cardinal and other priests recited their daily prayers. Wearing a hospital gown instead of a collar, he carried no medals or rosaries into the operating room.
“This is a man who is being treated for cancer, and from the outside observer he would look like any other patient,” said Colleen Dolan, communications director for the archdiocese, who joined the priests in George’s hospital room for the morning ritual. “The trappings were gone, and there was just a person with great faith.”
Following the surgery, George was awake but unaware of what doctors had discovered or how they had diverted his urinary tract, Canary said. George is expected to stay in the hospital for a week, and Flanigan said the cardinal will not be able to eat for three to four days.Across Chicago, people prayed for his recovery. At Holy Name Cathedral, nearly 200 attended the 12:15 p.m. mass, where Rev. John Boivin prayed for the cardinal and Chicago’s first lady, Maggie Daley, who had a tumor removed from a breast Thursday morning.
“No matter what may unfold in our lives, we are not alone and our God is with us,” Boivin said.
After the mass, Tony Cascino, 57, an attorney, said Boivin had addressed his questions about why George, a man he called “a great leader and a great shepherd,” would get such a serious illness.
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“What counts is how you deal with it, and he’s dealing with it beautifully,” Cascino said. “He’s admitted he’s scared, but he has his faith. He puts faith in his doctors, and he puts faith in his faith.”
Later Thursday night, the faithful gathered with the church’s bishops in the cathedral to thank God for watching over their cardinal. An overnight vigil that included silent adoration of the Eucharist, the consecrated wafer that Catholics consider to be the body of Christ, was to last until Friday at dawn.
The community of concern for George extended beyond the Roman Catholic Church. A conclave of Chicago’s top religious leaders gathered Thursday morning to pray inside the chapel at the Stritch School of Medicine at Loyola.
Rev. Demetri Kantzavelos, chancellor of Chicago’s Greek Orthodox Metropolis, recalled St. Paul’s message in Corinthians: “When one member of our family suffers, we all suffer,” he said. “We’ve come to know each other as brothers and sisters.”
Rabbi Ira Youdovin, executive vice president of the Chicago Board of Rabbis, said he pondered the meaning of the service on his drive over to the hospital and realized he was here to “remind God what a wonderful person” George is.
But it was a 7-year-old girl who prayed among the dozen religious leaders who moved Rev. Paul Rutgers, a Presbyterian minister, the most. A former Loyola cancer patient, she herself had undergone “significant therapy” in recent weeks.
And since George had prayed for her, Rutgers said, she wanted to return the favor.
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