Ginsburg Undergoes Surgery For Cancer

By Carrie Johnson and Rob Stein
Washington Post Staff Writers
Friday, February 6, 2009

U.S. Supreme Court Justice Ruth Bader Ginsburg underwent surgery yesterday in New York for pancreatic cancer, one of the deadliest forms of the disease.

Ginsburg, who received a diagnosis of colon cancer nearly 10 years ago, had experienced no symptoms from the pancreatic cancer, which apparently was found at an early stage during a routine checkup last month, according to a statement issued by the court.

The 75-year-old justice will be hospitalized for a week to 10 days at the Memorial Sloan-Kettering Cancer Center, attending surgeon Murray F. Brennan told court officials.

Pancreatic cancer is diagnosed in more than 37,000 Americans each year and more than 34,000 die of the disease, according to the American Cancer Society. One of the reasons is that there is no easy way to spot the illness early and it usually does not cause symptoms until it has spread. The cancer is detected early in only about 7 percent of cases.

If pancreatic cancer is discovered at an early stage, treatment usually consists of surgery and chemotherapy, which can extend survival and relieve symptoms but "seldom produces a cure," according to the society. About 24 percent of patients survive one year after diagnosis and 5 percent survive years, the society said.

Ginsburg's outlook could be on the more optimistic end of the spectrum, because her tumor was relatively small and was found during a routine scan.

"She has a much better chance than most of the other typical patients to be cured of this," said Paul P. Lin, a pancreatic surgeon at George Washington University.

The fact that doctors decided to operate is a good sign, several experts said. For most patients with pancreatic cancer, the tumor is discovered too late to make surgery helpful.

"She's fairly lucky," said Sarah Thayer, a pancreatic surgeon at Massachusetts General Hospital in Boston. Thayer said the cancer shows up in 80 percent of patients "when it is no longer operable and there's no chance. She's luckier than lucky because it's a relatively small tumor."

But pancreatic tumors tend to have spread even when detected early, Lin and others said. Doctors will probably assess Ginsburg's course of treatment after examining tissue removed in the surgery, including lymph nodes, Lin said. It is often more difficult to remove a tumor from a pancreas than other areas because the organ is located behind the stomach and surrounds key arteries and veins.

The exact location of the tumor would have determined how extensive an operation was necessary, Thayer said. If the tumor was in the "head" of the pancreas, a much more complicated procedure known as the Whipple would have been needed. That procedure involves the removal of part of the small intestine, bile duct, gallbladder and perhaps part of the stomach, she said.

A Supreme Court spokeswoman said that a CT scan Ginsburg had at the National Institutes of Health in Bethesda in late January detected a small tumor, "approximately one centimeter across, in the center of the pancreas."

Ginsburg was appointed by President Bill Clinton and has served for 15 years. Legal scholars consider her a reliable liberal vote, though she has fostered warm relationships with her conservative colleagues. She sought to tamp down speculation last year that she would retire.

Disclosure of her illness comes only weeks into the Obama administration, which is still finding its legal footing. Attorney General Eric H. Holder Jr. has been serving in his post since Tuesday, and Elena Kagan, nominated as solicitor general, the administration's chief representative before the Supreme Court, is scheduled to appear before the Senate Judiciary Committee next week for a confirmation hearing.

Administration officials had been considering possible court appointees in the abstract, and that effort may accelerate depending on Ginsburg's prognosis.

In 1999, after her colon cancer was diagnosed, she underwent surgery, chemotherapy and radiation. She did not miss any court sessions, spokeswoman Kathy Arberg said.

The court is not scheduled to hold a private conference until Feb. 20 and will not hear cases again until Feb. 23, leaving open the possibility that Ginsburg could return to the bench by that time.

White House press secretary Robert Gibbs told reporters yesterday afternoon that President Obama "has not talked with the justice, but his thoughts and prayers are with her and her family right now."

Ginsburg, a former law professor and general counsel at the American Civil Liberties Union, has advanced women's rights throughout much of her career. After graduating from Columbia Law School, she could not secure a high-level legal post, and that propelled her work on sex discrimination cases.

With Justice Sandra Day O'Connor's departure in 2006, Ginsburg became the court's only woman.

Ginsburg's illness could provide Obama with an early and unexpected opportunity to put his stamp on the court. There are now four liberals, including Ginsburg, and four conservatives, with Justice Anthony M. Kennedy in the middle.

During his presidential campaign, Obama said that in making a selection for the high court, he would consider adherence to prior court decisions and the Constitution but also "the basis of one's deepest values, one's core concerns, one's broader perspectives on how the world works and the depth and breadth of one's empathy."

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