Ruth Bader Ginsburg's Long Experience With Cancer

A public record, in her own words

Unusually for a public figure, Justice Ruth Bader Ginsburg's cancer history was documented in official statements from the Supreme Court's public information office. There is no need to speculate here. The record speaks.

NPR reported that she had colon cancer in 1999 and pancreatic cancer ten years later.

In December 2018, the Court announced she had a pulmonary lobectomy, removal of part of a lung, at Memorial Sloan Kettering. Two nodules in the lower lobe of her left lung "were discovered incidentally" during tests for rib fractures from a fall. Both were malignant. The statement said scans before surgery showed no disease elsewhere, and no further treatment was planned.

In August 2019, the Court announced she had finished three weeks of stereotactic ablative radiation therapy for a tumor on her pancreas. It said the abnormality "was first detected after a routine blood test in early July," and a biopsy confirmed a localized malignant tumor. A bile duct stent was placed.

In July 2020, she issued her own statement. "On May 19, I began a course of chemotherapy (gemcitabine) to treat a recurrence of cancer," she wrote. "A periodic scan in February followed by a biopsy revealed lesions on my liver." She added that immunotherapy "first essayed proved unsuccessful," and reported that a July 7 scan showed significant reduction of the liver lesions.

She died on September 18, 2020, at 87. The Court said the cause was complications of metastatic pancreas cancer.

A second cancer is not the first one spreading

This distinction matters and is often muddled. A new cancer in a new organ is usually a separate disease with its own biology, stage, and treatment. Colon cancer in 1999 and pancreatic cancer in 2009 are two diagnoses, not one.

Metastasis is different. It means cells from an existing cancer traveled and grew elsewhere. Liver lesions arising after a pancreatic tumor are pancreatic cancer in the liver, and they are treated as pancreatic cancer.

Why this cancer is usually found late

The National Cancer Institute (NCI) is blunt about the reason. Pancreatic cancer typically presents late because there are no noticeable signs or symptoms in the early stages. The pancreas sits deep in the abdomen, behind the stomach, which makes it hard to image and hard to feel. Early symptoms also mimic ordinary complaints.

The result shows up in the data. SEER, NCI's cancer surveillance program, reports that only 15% of cases are found while still localized. Fully 51% are already distant at diagnosis.

Risk factors NCI lists include family history, cigarette smoking, obesity, chronic pancreatitis, and inherited changes in the BRCA1, BRCA2, PALB2, and ATM genes.

When it is caught early, it is often by accident

Both of the early findings in Justice Ginsburg's record came from tests done for another reason. The lung nodules were incidental, found while investigating broken ribs. The pancreatic tumor followed a routine blood test.

That is a real pattern, not a fluke. Small pancreatic tumors are frequently spotted on scans ordered for something else entirely.

Go the same day for these

Pancreatic cancer does eventually announce itself. NCI lists jaundice, light-colored stools, dark urine, upper or middle abdominal pain, unexplained weight loss, loss of appetite, and fatigue.

Seek care the same day for:

• Yellowing of the whites of the eyes or the skin
• Pale, clay-colored stools together with dark urine
• Itching all over the body along with any yellowing

Book an appointment within days for:

• Upper abdominal pain that bores through to the back, often worse lying flat and easier leaning forward
• Weight loss over weeks that you did not intend
• New diabetes diagnosed after age 50, especially alongside weight loss

Jaundice means bile is not draining. When a tumor blocks the bile duct, a stent can be placed to reopen it, as was done in Justice Ginsburg's case.

Can it be removed?

Everything in treatment turns on one question. NCI sorts tumors into four categories.

Resectable means no involvement of nearby major blood vessels. Borderline resectable means some vessel involvement, or a high chance the surgeon cannot get a clean margin. Locally advanced means vessel invasion that rules out surgery. Metastatic means it has reached distant organs.

The workup uses helical CT, MRI, and endoscopic ultrasonography. CA 19-9, a blood marker, is measured, but NCI cautions that it has low specificity and that a normal level does not rule out recurrence.

What treatment involves

The standard operation is the Whipple procedure, which removes the head of the pancreas along with part of the small intestine, the gallbladder, and the bile duct. NCI reports that complete resection can yield five-year survival of 18% to 24%.

Where you have it done matters. NCI reports operative mortality of 16% at low-volume centers against 4% at high-volume centers.

After surgery, chemotherapy follows. The PRODIGE-24 trial compared FOLFIRINOX, a four-drug regimen, against gemcitabine alone. Median overall survival was 53.5 months versus 35.5 months, with five-year survival of 43.2% versus 31.4%. The tradeoff was severe: grade 3 or 4 side effects hit 75.9% of the FOLFIRINOX group.

For tumors that cannot be removed, focused radiation is an option. Stereotactic body radiotherapy delivers 33 to 40 Gy in five sessions. That is the same family of technique described in the Court's 2019 statement.

The numbers, stated plainly

SEER puts five-year relative survival for pancreatic cancer at 13.7% overall, counting people diagnosed between 2016 and 2022. By stage it runs 43.6% for localized disease, 17.0% for regional disease, and 3.4% for distant disease. For 2026 the American Cancer Society projects about 67,530 new cases and 52,740 deaths, most often diagnosed between ages 65 and 74.

These are hard numbers, and they are group averages built from people diagnosed years ago. They describe a population. They do not forecast one person, and they do not account for treatments approved since.

Sources

• https://www.cancer.gov/types/pancreatic/hp/pancreatic-treatment-pdq
• https://seer.cancer.gov/statfacts/html/pancreas.html
• https://www.supremecourt.gov/publicinfo/press/pressreleases/pr_12-21-18
• https://www.supremecourt.gov/publicinfo/press/pressreleases/pr_08-23-19
• https://www.supremecourt.gov/publicinfo/press/pressreleases/pr_07-17-20
• https://www.supremecourt.gov/publicinfo/press/pressreleases/pr_09-18-20
• https://www.npr.org/2020/09/18/100306972/justice-ruth-bader-ginsburg-champion-of-gender-equality-dies-at-87