King urged transparency about the diagnosis, raising more questions

When Buckingham Palace announced on Monday that King Charles III had been diagnosed with cancer and would be suspending his public commitments to undergo treatment, it predictably set off a firestorm of questions.

What kind of cancer? How advanced? What form of treatment? How long would he be sidelined? And the essential, if often unspoken, question when a patient is faced with a potentially existential threat to health: would he survive?

Paradoxically, the palace has fueled this madness by revealing more about the king's medical condition than about Queen Elizabeth II or any other former British monarch. It said this was done at the insistence of Charles himself, who “wanted to share his diagnosis to avoid speculation and in the hope that it could increase public understanding for everyone around the world affected by cancer.”

However well-intentioned the king may have been, the palace's decision to make some facts public and not others – the medical equivalent of half-raising the curtain – raised many more questions than it answered.

Britain now finds itself in an anguished middle ground, aware that its 75-year-old king has a life-threatening illness but not quite sure what that means. Could he live for many more years with treatment, as cancer survivors his age often do? Or should the British gird themselves for the death of a new sovereign?

This search for signposts in a misty landscape was evident from Prime Minister Rishi Sunak's comments on Tuesday morning. Speaking to BBC Radio 5 Live, Mr Sunak said he was “shocked and saddened” when he heard the news about Charles. But then he added: “Luckily this was caught early.”

These words of encouragement made headlines in the British news media. But when reporters pressed the spokesman at 10 Downing Street on what Mr Sunak had based his assessment on, they were referred back to the palace's original statement, which praised the “quick intervention” of Charles' medical team.

That four-paragraph document was a tug-of-war between disclosure and omission. The king had 'a form of cancer', which was discovered after his treatment for a 'benign prostate enlargement'. But the statement did not say which species. Palace officials clarified to reporters that it was not prostate cancer, which would have been the most common form of cancer discovered during a prostate procedure.

Now that that was ruled out, cancer experts put forward other theories. “Lung and bladder cancer are also common in older men,” says Mieke Van Hemelrijck, professor of cancer epidemiology at King's College London.

Commenters with no medical experience threw out possibilities: “Lymphoma?” said a royal watcher on Sky News on Monday night. The anchor quickly noticed that this was speculation. On Tuesday, Sky interviewed Joan Bakewell, a 90-year-old journalist and member of the House of Lords who has survived cancer, about the need to come to terms with your mortality.

Buckingham Palace said it would not issue regular bulletins on the king's condition. Palace officials also asked journalists not to attempt to contact doctors or other professionals treating Charles.

On Tuesday, the British media contented themselves with images of Prince Harry arriving at his father's London residence, Clarence House, for a visit. Later, a smiling King and Queen Camilla were photographed in a limousine as they returned to their country retreat at Sandringham, where Charles was recovering from his prostate procedure until last weekend.

That the palace could expect the British tabloids to withdraw from investigating the king's health is a testament to the complicated nature of the relationship between the royal family and the press. While much about the royal family is considered fair game by tabloid editors – from their legal travails to their personal lives – there are some topics on which the news media are less likely to question the family's privacy.

That power dynamic became clear late last year when the Dutch edition of a new book about the royal family included the inflammatory claim that Charles and Catherine, Prince William's wife, had expressed concerns about the skin color of the unborn child of Prince Harry and his wife Meghan.

The author, Omid Scobie, insisted the passage had been included by mistake, and the Dutch publisher withdrew the book from stores – but not before Charles and Catherine's names were widely circulated on social media.

Yet no British news organization published the names until Piers Morgan, a leading broadcaster, reported them on his program. Some media critics expected the palace to take legal action against Mr. Morgan; In the end that didn't happen.

Despite all the limitations in the palace's communications, royal historians pointed out that it had still revealed far more about Charles than previous monarchs – or even than other current members of the royal family.

The king's grandfather, George VI, had surgery in 1951 for what doctors later concluded was lung cancer. The palace withheld most details, adding to the shock when the king died five months later.

Kensington Palace has said little about the abdominal surgery that recently led to Catherine spending almost two weeks in a London hospital. Buckingham Palace informed the public in advance that Charles would enter the same hospital, the London Clinic, to undergo treatment for an enlarged prostate.

Britain's National Health Service reported that its web page with advice on how to deal with an enlarged prostate attracted eleven times as many visitors the day after the announcement as on a normal day. How long patients in the busy NHS have to wait for a prostate procedure is another question.

The tension between the royal family's right to privacy and public interest in it reflects a broader debate in Britain about privacy, a debate that is more acute than that in the United States, especially on issues such as health.

The royal family also fulfills a more ceremonial role in British society than, for example, political leaders, who some argue should be entitled to a certain degree of privacy, although the king has a special role as head of state.

Yet the royal family is not the only British institution under scrutiny for its reluctance to provide medical information. In 2020, Boris Johnson, then Prime Minister, spent three days in the intensive care unit of a London hospital with severe Covid-19. Downing Street published daily updates saying he was in 'extremely good humour'.

Only after he was discharged did Mr Johnson himself acknowledge that the nurses had saved his life by giving him oxygen throughout the night. “It could have gone either way,” he said.