Author and provocateur Christopher Hitchens, 61, announced this week he would cut short a book tour for his new memoir, "Hitch-22," because he will undergo chemotherapy for esophageal cancer, a serious diagnosis that rarely has a happy ending.
The disease kills 14,530 Americans a year and one type -– squamous cell carcinoma -– is associated with smoking and drinking, habits Hitchens extolled as virtues in essays and features for Vanity Fair magazine.
"It tends to be an aggressive cancer," said Dr. Richard Battafarano, chief of thoracic surgery at the University of Maryland. "By the time a person knows he has esophageal cancer, it's already moved to stage 3 or 4. By the time people go to the doctor because their voice has changed or their swallowing has changed, the tumor has advanced."
Speculation has already begun on what role Hitchens' self-proclaimed hedonistic lifestyle played in his diagnosis.
"The fact that people are also calling it throat cancer tells me it's high up behind the voice box," said Battafarano. "We know he had a prolific consumption of alcohol and cigarettes and he had quit smoking, but it might be a little late."
The British-American author's statement on his publisher's website had little detail.
"I have been advised by my physician that I must undergo a course of chemotherapy on my esophagus," he wrote. "This advice seems persuasive to me. I regret having had to cancel so many engagements at such short notice."
If the cancer is localized and has not yet spread, Hitchens would likely not get chemotherapy alone, according to Battafarano. At the same time, he may have refused surgery, which can damage the nerves around the voice box.
"He could have told the surgeon, No way I am risking my voice box,'" Battafarano said. "It's hard to guess. If it's outside of the esophagus and he's getting chemotherapy because [the cancer] has metastasized, that's not good. It they are using a strategy that starts with chemotherapy and moves into radiation next, it could be localized."
"[Hitchens] is being very private, as he should be," said Battafarano. "We could be wildly wrong or right on."
As the author of more than dozen books and magazine features, many of them about his personal proclivities, Hitchens often celebrated his love of Johnny Walker Black.
"What the soothing people at Alcoholics Anonymous don't or won't understand is that suicide or self-destruction would probably have come much earlier to some people if they could not have had a drink," he wrote in a 2003 essay on booze, "Living Proof."
Hitchens gave up tobacco in 2008, but had been seen sneaking a puff or two, according to the Washington Post. His wife Carol Blue said it was "fear" and a desire to "live to see his political enemies defeated."
Another drinker and chain smoker, Humphrey Bogart, died of esophageal cancer at age 57 reportedly uttering the famous last words "I never should have switched from scotch to martinis."
Other celebrities who died of the disease included Texas Governor Ann Richards and actor Ron Silver.