Dr. Zane Cohen updates the media on the condition of Toronto Mayor Rob Ford during a press conference at Mount Sinai Hospital on Sept 17 2014. Testing showed Ford has a malignant tumour and will begin chemotherapy shortly.Fred Lum/The Globe and Mail
As Mayor Rob Ford begins his chemotherapy treatment for pleomorphic liposarcoma, it's becoming clear that he faces an uphill challenge with a disease that is rare and aggressive and for which there is no breakthrough treatment on the horizon.
Because his type of cancer is so unusual and people with it respond differently to treatment, it's impossible to predict what his outcome will be. Doctors revealed this week Mr. Ford has a 12-centimetre-by-12-centimetre mass in his abdomen.
Mr. Ford could respond well to treatment and make a full recovery. Zane Cohen, a colorectal surgeon at Toronto's Mount Sinai Hospital where Mr. Ford is being treated, said he is "optimistic about this tumour." But the next few months will be critical in determining what path the disease will take.
Pleomorphic liposarcoma is a type of cancer that grows in the body's soft tissue, and it's the rarest of the four subtypes of liposarcoma. "Pleomorphic" refers to the fact the tumour is made up of many different types of cells. That can pose a challenge because chemotherapy drugs may not be able to target all of the various cell types in the tumour, said Mark Duncan, a surgical oncologist and vice-chair in the department of surgery at Johns Hopkins University in Baltimore who regularly treats liposarcomas.
Dr. Duncan added that surgery to remove the tumour is often the first-line treatment for patients with liposarcoma. The fact the doctors will start him on chemotherapy is likely because the cancer has already spread – there's a small tumour in his left buttock. Chemotherapy may shrink the tumours, but it can also target other cancer cells that may have spread through the body but are not yet detectable on scans.
Dr. Duncan said that when liposarcoma spreads to one location, it's likely that it will keep spreading to others, relatively quickly.
Once Mr. Ford finishes chemotherapy, doctors will re-image his body and determine the next steps. Surgery or radiation is a likely possibility, said Mary O'Connor, who specializes in the surgical treatment of bone and soft tissue sarcomas with the Mayo Clinic in Florida.
Chemotherapy on its own is likely not enough to get rid of the cancer, Dr. Duncan said. He added that, in general, sarcomas tend not to respond well to chemotherapy. Surgery to remove the mass could also involve removing some organs, such as a kidney, Dr. Duncan said. And the likelihood of recurrence is relatively high.