Recovery Is Excellent but Prognosis Depends on Pathology Report
President Reagan’s physicians said Saturday that his postoperative recovery from intestinal surgery is excellent, but his longer-term prognosis depends heavily on the outcome of the pathology report due Monday.
That report, based on an extensive microscopic examination of tissue, will indicate whether cancer was present in the two-inch polyp removed from the President’s colon Saturday during a 2-hour, 53-minute operation at Bethesda Naval Medical Center by a team of six doctors led by Capt. Dale Oller, chief of general surgery at the hospital.
The chances of cancer being present in the type and size of polyp removed from Reagan are more than 50%, said Dr. Steven Rosenberg, chief of surgery at the National Cancer Institute and a member of the operating team.
If cancer is found in the polyp, Rosenberg indicated, the key question will then be how deeply it invaded the polyp itself, and perhaps even the wall of the colon--where it could spread to other organs.
If the extent of the invasion of cancer cells is minimal, Rosenberg said the prognosis is “excellent.”
Could Have Migrated
However, a spread to distant organs could occur if the tumor had invaded blood vessels inside the wall of the colon. Under such circumstances, cancer cells could have been carried by the blood to other parts of the body.
Oller said “no sign of cancer whatsoever” was detected during the operation. He said that the liver, which is nearby, and lymph nodes “looked totally normal.”
An earlier report released by the White House said that computerized images, or CAT scans, taken on Friday in the area of the liver and other abdominal organs revealed no involvement with cancer cells.
The surgeons removed approximately one foot of colon on each side of the site of the polyp, or growth, which was located in the cecum--the part of the colon where it joins with the small intestine.
One reason for removing that much is that the colon and its blood supply are divided into segments and two feet is a convenient anatomical length at which to make a cut.
Rosenberg said it is possible that Reagan will develop recurrent polyps. Although he said there is a “high level of likelihood” that the surgery corrected any possibility of localized cancer, it is possible that cancer could develop at another site.
He said the polyp, known as a villous adenoma, may have been present for several years. At a news briefing, reporters raised the question whether the growth might have been detected 14 months ago when doctors removed a less hazardous “pseudo-polyp” from the President’s colon.
At that time doctors considered performing an extensive examination of the entire colon with an instrument called a colonoscope, but decided there was “no indication” it was necessary, said Dr. Edward Cattau, chief of gastroenterology at Bethesda.
Cattau said that American Cancer Society standards of care had been followed in making that decision.