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Supreme Court Justice Ginsburg Faces Tough Battle Against Pancreatic Cancer
Date:2/6/2009

Experts note high recurrence rate, even when malignancy is found early

FRIDAY, Feb. 6 (HealthDay News) -- U.S. Supreme Court Justice Ruth Bader Ginsburg will face tough challenges following her surgery on Thursday for early-stage pancreatic cancer, experts say.

At this point, it's not clear exactly what type of pancreatic cancer Ginsburg has, but the odds suggest pancreatic adenocarcinoma, which accounts for about 85 percent of all cases and is a far deadlier malignancy than neuroendocrine pancreatic cancer.

"The difference [in survival rates] is staggering," said Dr. Aaron Sasson, chief of gastrointestinal surgical oncology at the University of Nebraska Medical Center in Omaha. "The odds are that it's pancreatic adenocarcinoma, but there's a chance that it could be a neuroendocrine tumor."

A 2-centimeter neuroendocrine tumor, once removed surgically, could be considered cured, Sasson said. Ginsburg's tumor was reported to be 1 centimeter across.

Roughly 5 percent of people diagnosed with the more common form of pancreatic cancer will survive five years from diagnosis, according to the American Cancer Society.

Reports surfacing in the media, along with statements from the Supreme Court, suggest that the justice has an early-stage malignancy.

"She was able to have surgery, and only people who are early-stage cases are amenable to surgery, so that's probably true," said Dr. Allyson J. Ocean, an assistant professor of medicine at the Jay Monahan Center for Gastrointestinal Health at New York Presbyterian Hospital/Weill Cornell Medical Center in New York City.

Even after surgery in the more hopeful cases, however, the cancer has a high recurrence rate, and Ginsburg will likely undergo chemotherapy and radiation.

There again, though, the outlook is grim. "Pancreatic cancer usually responds poorly to our available therapies," Ocean said.

Ginsburg, 75, underwent surgery at Memorial Sloan-Kettering Cancer Center in New York City. Given the length of the hospital stay (seven to 10 days) and the location of the tumor, she probably underwent a distal pancreatectomy (removal of the end of the pancreas) and likely had her spleen removed as well, Sasson said.

The tumor was apparently found during routine testing that was part of an annual physical.

Ginsburg is a 10-year survivor of colon cancer. The cancers could be connected, but only in a minority of patients, Sasson said.

Ginsburg is not the first high-profile American to be stricken with pancreatic cancer in recent years.

Actor Patrick Swayze was diagnosed a year ago with pancreatic cancer. Meanwhile, speculation is rampant that Steve Jobs, CEO of Apple Inc., has had a recurrence of the less deadly form of the disease.

These high-profile cases don't indicate a rise in the incidence of the disease, which struck some 38,000 people in the United States in 2008, both Sasson and Ocean said.

The only known risk factors are smoking and a family history of the disease, Ocean said.

There are no specific screening protocols in place, which is why so many of these tumors are diagnosed so late.

"They're mostly diagnosed at a late stage because the symptoms don't happen until it's already late," Ocean said. "The symptoms can be very insidious, weight loss over time, vague abdominal pain."

Dr. Otis W. Brawley, chief medical officer of the American Cancer Society, said in a statement: "Justice Ginsburg's success in beating back a diagnosis of colon cancer nearly 10 years ago has inspired and given hope to many in the cancer fight. This new diagnosis is unfortunate, and we take hope in reports that this was apparently an early stage of disease, and wish her well, offer our support and prayers, and want to encourage her in what we know is going to be a challenging course of therapy."

More information

The American Cancer Society has more on pancreatic cancer.



SOURCES: Allyson J. Ocean, M.D., assistant professor, medicine, The Jay Monahan Center for Gastrointestinal Health, New York Presbyterian Hospital/Weill Cornell Medical Center, New York City; Aaron Sasson, M.D., associate professor, surgery, and chief, gastrointestinal surgical oncology, University of Nebraska Medical Center, Omaha; Feb. 5, 2009, statement, Otis W. Brawley, M.D., chief medical officer, American Cancer Society, Atlanta


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