Supreme Court Associate Justice Ruth Bader Ginsburg, who died Friday evening, had overcome four bouts with pancreatic, lung and colon cancer dating back two decades.
Ginsburg, 87, could not beat the most recent spread to her liver and died from complications of metastatic pancreatic cancer.
In January, she announced she was cancer-free, saying a periodic scan and biopsy revealed lesions on her liver but that chemotherapy treatment that began in May was “yielding positive results.” But by July, Ginsburg said she was battling cancer again and was undergoing chemotherapy after a lesion was found on her liver.
“It’s fairly uncommon to have so many cancers successfully treated and then to be able to live through them, certainly as long as she did – and to tolerate the treatment of these in her 80s, it’s a testament to her,” said Dr. Kiran Turaga, director of the Surgical Gastrointestinal Cancer Program at the University of Chicago Medicine.
Ginsburg had her first bout of cancer in 1999, when doctors discovered colon cancer at an early stage by accident due to an unrelated abdominal infection. A decade later, when Ginsburg was undergoing regular screenings, doctors discovered pancreatic cancer and removed parts of her pancreas, along with her spleen. In 2018, she had two cancerous growths removed from her lungs – again discovered by chance after she fell and broke several ribs. And last year, Ginsburg was treated for a malignant tumor on her pancreas.
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Ginsburg had yet to graduate high school when her mother, Celia Bader, died from cervical cancer. Years later, her husband, Martin Ginsburg, was diagnosed with testicular cancer and underwent two surgeries. He died in 2010 of complications from metastatic cancer. The two had been married 56 years.
“Like too many Americans, Justice Ginsburg had an extensive history with cancer having lost her mother and husband to the disease,” Gary M. Reedy, CEO of the American Cancer Society, said in a statement Friday. “Her personal health history and active survivorship made her an inspiration for many patients and survivors and helped inform her deep commitment to public health policy.”
Compared to colon cancer, pancreatic cancer is less common but more deadly. About 57,000 people will be diagnosed with pancreatic cancer this year, and about 47,000 people will die from it, according to the American Cancer Society. While pancreatic cancer accounts for about 3% of all cancers in the U.S., it accounts for about 7% of all cancer deaths.
“It has remained one of the most, if not the most difficult cancer for us to treat,” said Dr. Brian Wolpin, director of the Gastrointestinal Cancer Center and Hale Family Center for Pancreatic Cancer Research at Dana-Farber Cancer Institute. “It does tend to present late, and there are not many specific symptoms for pancreatic cancer. They tend to be things like abdominal discomfort or weight loss.”
The cancer also tends to be more aggressive, Wolpin said. It grows faster than other types of cancer and is less responsive to treatment. Less than 10% of patients survive five years or more after diagnosis, Wolpin said.
“She lived 10 years with this disease. She beat the odds, and it was a remarkable fight,” said Dr. Timothy Donahue, chief of surgical oncology at UCLA’s Jonsson Comprehensive Cancer Center. “But it’s not uncommon for this disease to have a long latency period and then come back are recur even more than 10 years later, so we continue to surveil these patients years after their diagnosis.”
Pancreatic cancer can be painful because the pancreas is located near many nerve endings, Donahue said. It often causes back pain, he said.
“Not only is it painful, it’s very difficult to live with because of the weight loss and the extremely poor energy levels,” Donahue said. “There’s something particular about this tumor that causes many issues for these patients – much more so than other comparable cancers.”
There are two compartments of the pancreas, and two larger categories of pancreatic cancer, Donahue said. Steve Jobs, for example, died from complications of a rare form of pancreatic cancer that is less aggressive.
There’s no colonoscopy or mammogram equivalent for pancreatic cancer, and it’s often discovered incidentally, experts say.
“We don’t have a good detection. You can have a tiny little cancer, and you can operate on it, but it still has a high risk of coming back,” said Dr. Mary Mulcahy, oncologist at Lurie Cancer Center at Northwestern Memorial Hospital.
But researchers are looking into how blood-based tests may be used to screen for pancreatic cancer.
“These are still reasonably early days. There’s no standard blood test that we use yet,” Wolpin said. “How we would then apply that in a large population would be hard to figure out.”
Others are investigating the role of a specific cancer-causing genetic mutation, known as KRAS, which is implicated in nearly all pancreatic cancer cases, according to Donahue. There’s a campaign underway to encourage all patients newly diagnosed with pancreatic cancer to get their genes sequenced so researchers can learn more about the genetics of the disease, Donahue said.
“Universal genetic testing is important not only because it might influence some of the treatments they receive for their own cancer, but also whether their immediate family members need to speak with a genetic counselor about receiving a genetic test themselves,” said Anirban Maitra, a pancreatic cancer researcher at MD Anderson Cancer Center.
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While pancreatic cancer typically effects people who are older, colon cancer is increasingly affecting young Americans. Deaths from colon and rectal cancers have been declining for several decades due to improved screening and treatment measures, but deaths among young people have been increasing slightly in recent years, according to researchers.
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But science is making huge strides. In the U.S., the five-year survival rate for all cancers combined has increased substantially since the early 1960s, from 39% to 70% among white people and from 27% to 64% among Black people, according to the American Cancer Society.
“Even today, people think cancer is a death diagnosis,” Turaga said. “But in the last three years, there are so many new years of treating cancers. We’re making so much progress.”
Contributing: Richard Wolf, Ken Alltucker, Kristine Phillips
