Venezuela's Chavez has shot at a cure-doctors

As Hugo Chavez heads to Cuba to have surgery on a second lesion in his pelvis, medical experts say the Venezuelan president still has a chance to be cured, but he may have to battle fatigue as he campaigns for re-election in October.   

After declaring himself cancer-free last October, Chavez now says he has a 2 centimeter (0.79 inch) lesion in the same pelvic area where doctors in Cuba removed a baseball-sized tumor during his original treatment last year.   

Doctors say the fact that Chavez' cancer has returned is worrisome, but the second surgery will give him one more chance at a cure.   

"If it is localized and they can get it out and they get good, clean surgical margins, there is a 20 to 25 percent chance that he could be cured," said Dr. Richard Schilsky, a specialist in gastrointestinal cancers at University of Chicago Medicine who is not treating Chavez.  

It is still not clear what kind of cancer the Venezuelan leader has, but comments made by Chavez and his handlers suggest he may have rectal or bladder cancer, or possibly soft tissue sarcoma. Schilsky said colon or rectal cancers sometimes come back in the pelvis or abdomen.   

"It's hard to know without knowing what the primary tumor was. Local occurrence of colon cancer is less common than rectal cancer," Schilsky said.   

Dr. Charles Fuchs, director of the gastrointestinal oncology program at the Dana-Farber Cancer Institute in Boston, said rectal cancer is more prone to local recurrence than colon cancer because the pelvis is such a crowded area that it is difficult for surgeons to get clean margins.   

"Nothing has been said as to the origin of the cancer. All we know is that this was a tumor in the pelvis. After that he had a number of cycles of chemotherapy, presumably around 6 cycles. We don't even know what drugs he was given in the way of chemotherapy," said Sunil Daryanani, an oncologist at the Hospital de Clnicas Caracas.   

He said because Chavez' tumor was diagnosed with an infection, the fact that he has had a local recurrence is not a surprise, but the time between treatment and progression of the cancer has been pretty short.       

"This could imply that the original chemotherapy wasn't effective enough, but this is just speculation," Daryanani said.   

"Once they've opened him up (on Monday/Tuesday), they'll have an idea if this is a localized occurrence or something more advanced," he said.   

With a local recurrence of cancer, doctors will likely remove the tumor and then use radiation to "sterilize" the area and potentially kill off any remaining local cells, said Dr. Michael Pishvaian, a gastrointestinal cancer specialist at Georgetown University's Lombardi Comprehensive Cancer Center.   

Radiation typically starts about a month after surgery and involves daily treatment, Monday-Friday, for five to six weeks.

The whole treatment process could last through mid-May.   

Reuters