The Case of Justice Ruth Bader Ginsburg vs Cancer

UPDATE 18th SEPTEMBER 2020

RIP Justice Ruth Bader Ginsburg

UPDATE 17 JULY 2020

Justice Ruth Bader Ginsburg said Friday that she had had a recurrence of cancer but had been undergoing chemotherapy that had shown “positive results”. Justice Ginsburg, who is 87, said she had begun a course of chemotherapy on May 19, after a periodic scan in February followed by a biopsy revealed lesions on her liver. She also stated that “Immunotherapy” first essayed proved unsuccessful, but the chemotherapy course is yielding positive results. She said a scan this month showed the liver lesions had been significantly reduced and that she is tolerating chemotherapy well. Justice Ginsburg did not say where the tumours in her liver are thought to have originated, but she did say her chemotherapy was called gemcitabine. That drug is generally used for pancreatic cancer.

UPDATE 7 MAY 2020

US Supreme Court Justice Ruth Bader Ginsburg has taken part in legal arguments from her hospital bed, just a day after she was admitted with a gallbladder condition. Ms Ginsburg was treated for an inflammatory condition of the gallbladder known as acute cholecystitis on Tuesday afternoon, Ms Arberg said in an earlier statement. Ms Ginsburg, 87, participated in two cases shortly after receiving non-surgical treatment for an infection. A court spokeswoman earlier said she was “resting comfortably” at Baltimore’s Johns Hopkins Hospital. Ms Ginsburg was discharged from hospital late on Wednesday. Ms Ginsburg was “doing well and glad to be home”, court spokeswoman Kathy Arberg said in a statement.

Original article continues:

The news that Justice Ruth Bader Ginsburg (RBG) has been treated for ‘Pancreatic Cancer’ has hit the headlines and effectively gone viral. She is not only famous for being a member of the US Supreme Court, but also because she has had many bouts with cancer. What has also gone viral, but only in the Neuroendocrine Cancer community, is a debate on whether RBG’s ‘pancreatic cancer’ is actually a Neuroendocrine Tumour, as it also did when it was announced she had Lung Cancer last year. It wouldn’t be the first time a famous person has been associated with the wrong cancer, think Steve Jobs and Aretha Franklin, curiously also pancreatic related.

One of the issues with celebrity cancers is that the detail of what we know is controlled by their spokesperson, the celebrity themselves and their doctors/hospitals. The media may speculate, and they may also print informed comment, but they still don’t have access to the celebrity’s medical records. So, we really need to believe what we read from their spokespersons.

Still, although there are lot of unknowns in this case, the fact that the tumour was localized makes it more likely that Ginsburg had pancreatic cancer, according to Raja Flores, a leading cancer surgeon and the chairman for the department of thoracic surgery at the Mount Sinai Medical Center in New York. Clearly NET patients in the know, will be comparing the longevity and survival issues to claim ownership of RGB (however crude that may appear) but it’s a myth to say that all pancreatic adenocarcinomas are lethal – sure the survival statistics are not good, but some survive, particularly if the cancer is caught early. Compare a 5-year survival rate of 9% in the worst case to a 34% survival in the case of localised tumours.

RBG’s History of Cancer

When you look at her history of cancer related illness, you can see she is one tough lady to have survived these ordeals. Let’s summarise the 87-year old’s cancer history here.

Colon Cancer: In September 1999, she was diagnosed with colon cancer. It was found incidentally when she had gone to the doctor for an abdominal infection. She underwent a sigmoid colectomy followed by “precautionary” chemotherapy and radiation treatments which began in October and finished in June 2000. According to Ginsburg, “Following the treatments, it is anticipated that I will require only routine examinations to assure my continuing good health.”

Pancreatic Cancer (1st time): During one of her routine examinations as a follow up to colon cancer in 2009, a CT scan found a single 1cm lesion in the centre of her pancreas. She underwent surgery to remove the body and tail of the pancreas along with her spleen.

Lung Cancer: On November 8, 2018, RBG (now 85) was hospitalised after a fall in her office left her with three broken ribs. She was discharged two days later and worked from home for a few days. A week after the fall, she attended a Medal of Freedom ceremony at the White House for her late friend and fellow Justice Antonin Scalia. She returned to the bench on November 26. The CT scan used to assess her rib breaks had found something suspicious in her lung. On December 21, two malignant lesions were removed by a lobectomy which took place at Memorial Sloan Kettering Cancer Center in New York City. Her surgeon, Dr. Valerie W. Rusch, reported that “there was no evidence of any remaining disease” and “scans performed before surgery indicated no evidence of disease elsewhere in the body. Currently, no further treatment is planned. Justice Ginsburg is resting comfortably and is expected to remain in the hospital for a few days.”

Pancreatic Cancer (2nd time): The Supreme Court announced on Friday 23rd August 2019 that JBG had been treated for pancreatic cancer. The full announcement is here:

“Justice Ruth Bader Ginsburg today completed a three-week course of stereotactic ablative radiation therapy at Memorial Sloan Kettering Cancer Center in New York City. The focused radiation treatment began on August 5 and was administered on an outpatient basis to treat a tumor on her pancreas. The abnormality was first detected after a routine blood test in early July, and a biopsy performed on July 31 at Sloan Kettering confirmed a localized malignant tumor. As part of her treatment, a bile duct stent was placed. The Justice tolerated treatment well. She cancelled her annual summer visit to Santa Fe but has otherwise maintained an active schedule. The tumour was treated definitively and there is no evidence of disease elsewhere in the body. Justice Ginsburg will continue to have periodic blood tests and scans. No further treatment is needed at this time.”.

Does RBG have Neuroendocrine Cancer?

If you read all of the above then the answer is no. However, the speculative and inquisitive nature of the average NET patient means at the very least, they will ponder the possibility. Let’s face it, the medical community and the media have form for disguising Neuroendocrine Cancer as a type of another anatomically related cancer. So I understand the suspicions within the community.

When you look at the connections to the above cancer diagnoses, you can see common locations for NETs, you can see common metastasis sites for NETs (e.g. lung is often a metastatic site for pancreatic primary tumours). Whether she has 3 primary cancers or two with metastases is also speculative, but this may be confirmed downstream. Another possibility of 2nd and 3rd primary cancer occurrence is the long-term effects of certain cancer treatments. This possibility was covered nicely by Medpage in this article back in January following the ‘Lung Cancer’ diagnosis. For interest, I attached a link to stereotactic ablative radiation therapy (SART), seems like cutting edge medical technology.

One thing is for sure, the latest announcement has resulted in some great awareness for ‘Pancreatic Cancer‘. However, one of the best reports I read is this one from CNN which seems to be more about Neuroendocrine Tumours than Pancreatic Cancer, albeit covered under the umbrella of the latter. One of the most informed comments came from Dr Mark Lewis who is an Oncologist, specialising in pancreatic disease. He’s also a pNET/MEN patient. His professional opinion based on therapy given, is that she has a pancreatic ductal adenocarcinoma (PDAC), i.e. not a Neuroendocrine Tumour.

Whatever Justice Ruth Bader Ginsburg has, I wish her a speedy recovery and best wishes for the future.

Does RBG have a NET? The jury is out on that one. Probably best not to speculate too much.

Thanks for reading

Ronny

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