Thursday 30 October 2014

Maurice Gueret: Minister faces up to challenge of cancer news

Michael Noonan acted decisively to quell any speculation on his health

Maurice Gueret

Published 15/06/2014 | 02:30

TREATMENT: Minister for Finance Michael Noonan after he spoke to the media about his surgery. Photo: Tom Burke
TREATMENT: Minister for Finance Michael Noonan after he spoke to the media about his surgery. Photo: Tom Burke

I have been musing on Ireland's unique place amongst the nations of Europe – our great little country that levies taxes like Sweden and delivers the public services of Albania in return.

Little did I know that the man who sets our tariffs, and whom we all hope will conduct a neat excision of tax rates next winter, would himself become the medical news story of the month.

In February last, the Finance Minister takes a shower and finds a lump in the vicinity of his right shoulder.

Michael Noonan is a one-time Minister for Health. Prominent on his CV may be poor handling of Hepatitis C legal cases in the mid-Nineties, but on the credit side he was the Health Minister who drove Ireland towards a long-awaited National Cancer Strategy. He knows you don't dilly-dally with lumps.

Noonan attends his doctor and gets an early appointment for a surgical biopsy which is sent along the line to a histopathologist for examination under a microscope. Sarcoma is diagnosed. We don't know of what type, grade, spread or severity. At the end of March, Noonan begins a five-week course of radiation treatment to shrink the lump at St Luke's in Dublin. Then on May 28, he is admitted to Cappagh National Orthopaedic Hospital in Finglas.

The choice of Cappagh is interesting. Unlike President Higgins who went private with his joint replacement to the Bons, Noonan had his surgery in a public institution, one of our old voluntary hospitals. Cappagh began in 1908 with open wards for TB care but in more recent decades, it has pioneered the speciality of orthopaedic surgery. It conducts non-emergency surgery on spines, limbs, sports injuries, joint replacements and tumours of the muscle, joints and bones. This hospital pioneered autologous blood transfusion in Ireland, where patients can donate their own blood prior to surgery, in case replacement is needed during an operation.

The minister had his surgery to remove the lump on the last Wednesday in May. He was discharged on the Saturday and back to work in two days. He didn't even need a weekly cert for Enda.

Now Noonan issued his brief statement to the media just three days after his discharge. Not, I suspect, because he wanted to, but because journalists got wind and were asking questions about his health. He judged that the wisest thing was to get the facts of his condition out before hot air turned the rumour mill. Our Finance Minister is to be admired for this approach. His predecessor, the late Brian Lenihan junior, found himself in the same predicament in Christmas 2009.

However, Mr Lenihan wasn't afforded the space to plan his announcement. Nor did he have as good news to impart as Mr Noonan.

Politicians, if allowed, can go to great lengths to disguise and conceal bouts of poor health. In 1893, US President Grover Cleveland booked a cruise holiday off Long Island. On board his pleasure craft, Cleveland secretly underwent major jaw and palate surgery for a cancerous ulcer in his mouth. The press were fobbed off with a story about two rotten teeth. The surgery was so extensive, the president had to be fitted with an uncomfortable rubber prosthesis to get him speaking properly again and looking presentable. Cleveland lived on until 1908 and it was not until a decade after his death that the real story came out.

In his statement, Noonan said he had a sarcoma, which is basically a tumour of the flesh, usually soft tissue below the skin though it can arise in bone. The fact that he felt a lump suggests a soft tissue

tumour of the muscle, fat or joint tissue and not a more serious and deeper lying sarcoma of the bone. Most common cancers are known as carcinomas because they originate in the surface or epithelial cells of organs. But sarcomas are different for they are malignant tumours that begin in the middle earth of body tissues, what we call mesenchymal cells.

Sarcomas in humans are not hugely common and certainly don't attract the attention that skin or breast or bowel or lung cancers get in the media. Veterinary practitioners would come across a lot more cases than GPs. Large breed dogs such as Saint Bernards, boxers and German shepherds are particularly susceptible to sarcomas.

Noonan's statement said that his medical team believe treatment had "gone very well" and that they are "upbeat about the prognosis". The tumour was extracted without damaging shoulder muscles and the minister also said "my risk of recurrence is low". Even at 71 years of age, soft tissue sarcomas of the shoulder girdle respond well to treatment and studies would suggest that less than a third of tumours recur and that 80 per cent of patients are still doing well 10 years later. Which is all good news for Michael Noonan. Good news for those who really don't want Joan Burton as Minister for Finance. And perhaps good news for hard-pressed taxpayers this autumn.

Get well, Michael. Soon.

Dr Maurice Gueret is editor of the Irish Medical Directory

Twitter @mauricegueret

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