Hogan's cancer is advanced, but there's 'reason to be optimistic'

70 percent of those with non-Hodgkin lymphoma live 5 years.

Gov. Larry Hogan announced Monday that he has non-Hodgkin's lymphoma, a cancer of the lymphatic system, and that it is advanced. But cancer doctors say that doesn't mean it's incurable.

Hogan, 59, said his cancer was diagnosed in a late stage after he felt a lump in his neck while shaving, a typical scenario for those with the disease. After testing, 20 to 30 more masses were discovered in his neck, chest, abdomen, groin area and near his spinal column.

But advances in chemotherapy drugs in the past decade or so have produced better survival rates, and Hogan "has every reason to be optimistic," said Dr. Kevin J. Cullen, a professor of oncology at the University of Maryland School of Medicine.

About 70 percent of those diagnosed with this kind of cancer survive five years or more, said Cullen, who is also director of the University of Maryland's Marlene and Stewart Greenebaum Cancer Center, where Hogan went for testing.

Cullen has not treated Hogan, whose staff said he has settled on a treatment team from Johns Hopkins Hospital and Anne Arundel Medical Center, which is affiliated with the Hopkins medical system, for his treatment.

Hogan said during a news conference that he would have 18 weeks of treatment, with chemotherapy once every three weeks.

Doctors have told Hogan he has B-cell lymphoma, which is the most common type, and it is Stage 3 or Stage 4, which would mean that it has spread to other parts of his body.

In this case, that means it likely spread to Hogan's bone marrow, Cullen said. Hogan said he had a bone marrow biopsy via a 12-inch needle on Monday. For that, he said, he was on some pain medication.

But unlike other metastatic, or spreading, cancers, including breast and lung cancer, non-Hodgkin's lymphoma is still curable at later stages, Cullen said.

Hogan, who delivered the news with a mix of humor and emotion, said he expected a tough time.

"Over the coming months I will be receiving multiple, very aggressive chemotherapy treatments," Hogan said. "The fact is that I am just like the more than 75,000 people diagnosed with lymphoma every single year who fight it, beat it and continue doing their jobs at the same time."

Non-Hodgkin's lymphoma is the seventh most common type of cancer. It makes up about 4 percent of new cancer cases and 3 percent of cancer deaths, with about 20,000 deaths expected this year, according to the National Cancer Institute.

It's the disease that Paul Allen, the billionaire investor best known as the co-founder of Microsoft Corp., was diagnosed with in 2009. Arlen Specter, the former U.S. senator from Pennsylvania, died of complications from the disease in 2012, though he'd had a long history of cancer.

It's unclear what might have put Hogan at risk for the disease, such as exposure to radiation or industrial chemicals. Family history is not considered a risk factor.

"I'm sure stress and work exacerbates the problem, but it didn't cause the situation," Hogan said. "This is something that doesn't seem to have been around for along time. It just hit me in a short period of time."

Non-Hodgkin's lymphoma occurs when a mutation causes immune system cells to grow unchecked, collecting in tumors in the lymph nodes. That can suppress the lymph nodes' ability to identify and fight other pathogens, and, in rare cases where treatment doesn't work, tumors can press on other organs and cause them to fail, said Dr. Jason Westin, an assistant professor in the department of lymphoma and myeloma at the University of Texas MD Anderson Cancer Center in Houston.

The lymph nodes are the hubs of the lymphatic system, which works in tandem with the circulatory system to filter viruses and bacteria from the bloodstream and dispatch white blood cells to attack such pathogens.

Because of this relation to the circulatory system, lymphoma can spread easily around the body.

For treatment, a drug known as Rituximab is often used to spur the immune system into fighting the cancer, introducing antibodies that attack a protein on the outside of cancer cells. The drug has been around for about 15 years and has been proved effective, Westin said.

Many patients handle treatment of non-Hodgkin's lymphoma well. The chemotherapy can lead to fatigue, as well as hair loss and nausea, but many patients aren't excessively limited in their normal daily activities, said Beatrice Abetti, director of the Leukemia and Lymphoma Society's information resource center.

"For the most part, people don't complain that the treatment is awful or really unbearable," Abetti said.

Hogan, who described himself as a "workaholic," said he planned to continue as much of his work schedule as he could, with Lt. Gov. Boyd Rutherford filling in when needed.

In fact, Monday's news conference came hours after the painful bone marrow procedure. He said jokingly that his doctor thought holding the news conference the same day was a bad idea.

"We go seven days a week, 12 hours a day, 15 hours a day," he said. "I think even if I were to work half time, it would be twice as much as any other governor's worked."

Other doctors also said a good outcome was possible.

"Even more advanced-stage lymphomas are treatable and hopefully even curable," said Dr. Robert Brookland, a American Cancer Society board member and chief of radiation oncology at Greater Baltimore Medical Center. "He and everyone should remain hopeful and optimistic for him, despite the fact that it sounds scary. It's hopefully very treatable, and he may do very well."


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