The New York Times - December 19, 1986
Lawrence K. Altman

Medical experts say it may take several days to determine what, if any, physical and mental deficits the 73-year-old Mr. Casey will suffer on a long-term basis.

The lymphoma is presumed to be malignant. Final results of the tests will determine whether the lymphoma is cancerous and what type of lymphoma it is, according to a statement issued at Georgetown Hospital in Washington after Mr. Casey's five-hour operation.

This diagnosis is customarily based on studies that pathologists make by adding chemicals to the tissue and then looking at it through a microscope. The statement said that preliminary tests, presumably those done on a thin, frozen section of the tumor itself, indicated the lymphoma "appears treatable."

It is the general consensus of the medical profession that a lymphoma is malignant. Medical scientists, however, say that in some rare cases a lymphoma can prove to be benign.

Outlook on Treatment

If it is the type of cancerous lymphoma being seen with increasing frequency, it will be treated with radiation, sometimes in combination with drugs administered before radiation is begun.

The treatment usually results in a disappearance of the tumor for about a year. The patient often suffers a relapse, medical authorities say, although some patients escape without the condition's recurring.

Dr. Jerome B. Posner, a leading neurologist at Memorial Sloan-Kettering Cancer Cancer, said in an interview, "There is a good chance of remission. Some people may live many years without suffering a relapse."

However, Dr. Posner and several other experts said the information released by Georgetown Hospital did not permit them to determine the full extent of Mr. Casey's illness.

The prospects of radiation and possible chemotherapy make it unlikely that the C.I.A. Director will be able to work at full capacity for several weeks, if then.

The immediate problem is to determine whether Mr. Casey lost any ability to speak or think as a result of surgery. Generally, it takes several days to determine how well any patient, particularly one in his 70's who has undergone general anesthesia for brain surgery, responds. The lymphoma could have damaged Mr. Casey's intellectual capacities in the last few months, or even years, but it is also entirely possible that he could have escaped any intellectual impairment.

Patient's Ability to Function

The extent to which Mr. Casey will be able to function depends on several factors that were not detailed in the hospital statement. One is the precise anatomical location of the lymphoma. Another is what areas of the brain the surgeons had to cut to reach the tumor. It is possible that Mr. Casey will have some difficulty with his speech.

Also, the statement did not exclude the possibility that some lymphoma tissue was left in Mr. Casey's brain because it was inaccessible to the surgeons. Nor did it exclude the possibility that Mr. Casey has systemic lymphoma that affects other areas of his body. In about 10 percent of patients with systemic lymphoma, the cancer spreads from elsewhere in the body to the brain.

However, doctors not connected with the case said the type of lymphoma was probably what doctors call a primary tumor of the brain, meaning it started there. In most cases this does not spread elsewhere. Dr. Nicholas T. Zervas, chief of neurosurgery at the Massachusetts General Hospital in Boston, said that when the lymphoma "is first found in the brain it is usually confined."

Dr. William R. Shapiro, professor of neurology at Memorial Sloan-Kettering Cancer Center who is head of the National Brain Tumor Cooperative Group sponsored by the National Institutes of Health, said, "This is an unusual disease, but it is being seen more frequently." He said that though the usual treatment was radiation, some experts were beginning to administer chemotherapy in advance of radiation in experimental studies.

Puzzle About Diagnoses

Doctors do not know why they are diagnosing more primary lymphomas of the brain. One possibility is that as experts in cancer centers rely on specialized, three-dimensional CAT-scan X-rays, and other new diagnostic technology, they are recognizing the tumor more often.

Another possibility is that the increase is the result of a change in the unknown factor or factors that causes them.

Dr. Shapiro said that in the last five years he and his colleagues at Memorial Sloan-Kettering Cancer Center diagnosed about five primary lymphomas of the brain each year. Doctors there diagnose about 80 primary brain tumors of all types each year.

Medical scientists have noted that there is a higher incidence of lymphomas of the brain in young AIDS patients, but virtually none of the elderly people with primary lymphomas of the brain develop acquired immune deficiency syndrome. Dr. Posner, for example, said none of the elderly Sloan-Kettering patients had ever been found to have the syndrome or been infected with its virus.

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