Diary

Quick Thoughts About Ginsburg

US Supreme Court Justice Ruth Bader Ginsburg speaks after the screening of "RBG," the documentary about her, in Jerusalem, Thursday, July 5, 2018. Ginsburg says she hopes the traditional "bipartisan spirit" of congressional hearings for judges will once again prevail rather than recent votes that have divided along party lines. (AP Photo/Caron Creighton)

It is being reported that Ruth Bader Ginsburg is being treated for a recurrence of liver cancer.  This is incorrect, and the reporters who are saying that don’t understand how cancer works.  I’m not insulting them, cancer is an odd beast, and Ginsburg’s statement intentionally obfuscates the issue.

Statement from Justice Ruth Bader Ginsburg:

On May 19, I began a course of chemotherapy (gemcitabine) to treat a recurrence of cancer. A periodic scan in February followed by a biopsy revealed lesions on my liver. My recent hospitalizations to remove gall stones and treat an infection were unrelated to this recurrence.

Immunotherapy first essayed proved unsuccessful. The chemotherapy course, however, is yielding positive results. Satisfied that my treatment course is now clear, I am providing this information.

My most recent scan on July 7 indicated significant reduction of the liver lesions and no new disease. I am tolerating chemotherapy well and am encouraged by the success of my current treatment.  I will continue bi-weekly chemotherapy to keep my cancer at bay, and am able to maintain an active daily routine. Throughout, I have kept up with opinion writing and all other Court work.

I have often said I would remain a member of the Court as long as I can do the job full steam. I remain fully able to do that.

The bolding is mine.  The cancer has come back.  Separately she has lesions on her liver.  If liver lesions can be treated surgically they generally are, but often they cannot be removed with surgery.  This is not a liver cancer, it is cancer that has spread to the liver.  She had a similar statement about lesions in the lung – not lung cancer.  Ginsburg has had colon cancer and pancreatic cancer, and has had lesions in the lung and on her liver.  Between colon and pancreatic cancers it is pancreatic that will spread to both lung and liver.  The chemo in use is gemcitabine.

Gemcitabine:  Acording to the National Cancer Institute it is approved for use in treating four types of cancer: Breast, non-small-cell Lung, Ovarian, Pancreatic.  For patients with pancreatic cancer it is used alone in patients whose disease is locally advanced or metastatic and who have been treated with fluorouracil.

Immunotherapy is generally a “last effort” in cancer treatment.  That is, you get immunotherapy after everything else fails.  Justice Ginsburg probably has stage 4 pancreatic cancer, and it was diagnosed 6 months ago.  She has already received radiation therapy relatively recently and likely is not a candidate for additional radiation to the abdomen.    The cancer cannot be treated with immunotherapy.  That leaves chemotherapy, and gemcitabine is only used after fluorouracil has failed.

Notice that the treatment course is clear.  This does not specify that the doctors are attempting to cure the cancer.  In fact, in the release the goal is to “keep the cancer at bay.”  Sometimes the goal of therapy is either an extra couple months of life or to reduce symptoms.  In a “keep the cancer at bay” approach typically it is expected that the lesions will shrink then hold steady for a bit (for a few months total), then rapidly spread leading to a decline in health and death over the course of a couple of weeks.  My personal hope is that Justice Ginsburg comes to a saving knowledge of Christ before she shuffles off of this mortal coil.  Unlike many she has been given ample heads up.