Dr. Ellen M. Willard, an oncologist at FirstHealth Moore Regional Hospital, says she was "saddened, but not surprised" that Elizabeth Edwards' cancer had returned.

"This is the way recurrent breast cancer behaves," said Willard, who is a cancer specialist with the FirstHealth Out-patient Cancer Center. She has treated thousands of patients with a variety of cancers.

The center, which recently unveiled its newly renovated building in February, serves about 100 patients per day. It allows patients to see their doctors and receive chemotherapy and other treatment in one location.

When asked about possible treatments for Edwards, Willard said she lacked enough information to advise a course of treatment.

"The wrong thing to do at this point is to start speculating," Willard said. "I am sure there are more staging studies that will be done to define the extent of the disease. Not all cancers grow and behave in the same way. Tumors don't carry signs that say, Treat Me With This Drug.'"

Some of the things Willard said would be important in advising a treatment plan are: previous type and size of the cancer, previous treatments, where the metastases or recurrent cancers are, and biological characteristics of the tumor.

Elizabeth Edwards, wife of Democratic presidential candidate John Edwards, was first diagnosed with invasive ductile breast cancer the day after the election in 2004. It is the most common type of breast cancer.

Last Thursday, the Edwardses announced Elizabeth's cancer had returned. The announcement came days after an X-ray revealed a fractured rib and a suspicious spot on another rib, later diagnosed as stage IV metastic breast cancer.

Metastases are malignant cancer cells from one part of the body that spread to another, often bones. According to the Web site, www.cancerindex.org, bone metastases are particularly common in people with breast, lung or prostate cancer.

Stage IV breast cancer is considered a systemic disease, meaning it is no longer contained in one area but is throughout the body. Surgery isn't usually considered effective because it will remove cancer cells only from one area, but the cancer is more likely located in other places.

Edwards' oncologist Dr. Lisa Carey has said her cancer is no longer curable and results of further tests will determine treatment.

During Thursday's press conference, the Edwardses also announced they would continue his campaign for the presidency.

Willard said it is likely that doctors will tailor a treatment plan to Elizabeth Edwards' lifestyle, allowing her the opportunity to maintain a busy schedule.

"We know that patients who don't actively engage in life don't do as well because they are not as physically fit," Willard said.

Willard said that with all the uncertainty surrounding Edwards' diagnosis, one thing is sure:

"Her treatment options are clearly better now than 10 years ago," Willard said. "There are a lot more treatment options. . . She could live for many years."

Tom Embrey can be reached at 693-2473 or by e-mail at tembrey@thepilot.com.