Democratic presidential candidate John Edwards' wife Elizabeth Edwards has been diagnosed with a recurrent case of breast cancer. This time it is located in the right rib bone and hence classified as metastatic or stage IV cancer.
Mrs. Edwards, who battled breast cancer and underwent treatment, was cancer free for the last two years.
Mrs. Edwards said at a press conference in North Carolina that she had sought medical treatment for pain on her left side. While this turned out to be a cracked rib she suffered while moving furniture in her new house the same X-ray that revealed the break also showed a suspicious spot on the opposite side of her ribcage.
A bone study and other follow-up tests confirmed that there was cancer in a rib bone.
Yet experts say like all chronic diseases, the progression of late stage breast cancer too, can be managed.
Survival will hinge on many factors, including the number of areas affected by cancer and how big the tumors are, doctors say.
Treatment options for breast cancer that has spread to bone break down into two categories, according to Harold Burstein, medical oncologist at Dana-Farber Cancer Institute in Boston and an assistant professor of medicine at Harvard Medical School.
A group of drugs called bisphosphonates are used to strengthen and heal the bone. The drugs, Zometa and Aredia, are similar to drugs taken to combat osteoporosis but are more powerful and are given intravenously rather than orally.
"Doctors may also start specific treatment against the tumor," says Burstein.
This may include drugs that block estrogen, if the tumor is fueled by that hormone, or chemotherapy. Looking to the future, a monoclonal antibody called denosumab is currently in clinical trials for use against both bone metastasis and osteoporosis, say scientists.
While the treatments now available can only delay the progression of the cancer and alleviate symptoms, the tumor may become resistant to one treatment over time, forcing a switch to something else. But experts say this can extend the life of even a late-stage cancer patient for years.
"There is hope," Burstein says. "A recurrence of cancer does not mean there's no hope, and people can live a very productive, comfortable life."
Yet, how much Elizabeth Edwards can be expected to campaign while receiving treatment is the question hanging in the air.
Dr. Rache Simmons, breast surgeon at the New York-Presbyterian Weill-Cornell Medical Center's Breast Cancer Center suggests ,in general : "For patients who become metastatic, the prognosis depends on where it presents. Eventually, most likely, they will die from the breast cancer. So it's a matter of how long they live, and how good is their quality of life."