Here's what we know about Ruth Bader Ginsburg's latest cancer alert



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Supreme Court Justice Ruth Bader Ginsburg arrives in the House before Barack Obama's first speech at a joint congressional session in 2005.

Scott J. Ferrell | CQ-Roll Call Group | Getty Images

The Supreme Court Judge, Ruth Bader Ginsburg, appeared in good health Monday during a public appearance at the University of Buffalo, three days after taking a three-week radiation treatment in New York to treat a tumor found on his pancreas.

"It was beyond my wildest imagination that I would someday become the 'notorious RBG'. I am now 86 years old and yet, people of all ages want to take their picture with me, "joked Ginsburg during a speech at the university. "Unbelievable."

The health of Liberal justice has become a public concern because of the partisan composition of the nine-member panel.

With the two choices of President Donald Trump on the siege, Judges Brett Kavanaugh and Neil Gorsuch, the court now has a trustworthy conservative majority, made up of five people nominated by Republicans.

In the coming years, the Supreme Court should weigh in on some of the country's most controversial issues, such as the power of big business, the Second Amendment, LGBT rights, and abortion. If Ginsburg withdraws while a Republican controls the presidency, the Conservatives will likely be able to exert more influence over the direction of the country for years to come.

Trump said Friday that he hoped Ginsburg would heal.

"I hope it will be fine," Trump told reporters ahead of the G-7 leaders conference in France. "She has gone through a lot, she is strong, very hard."

Here is what we know about Ginsburg Cancer.

What kind of cancer was it?

Probably pancreatic cancer, but not definitively. If it was pancreatic cancer, it is unclear what type.

In a statement, the Supreme Court said that Ginsburg had been treated for a "pancreatic tumor", although it did not specify the type of cells involved. A biopsy performed in July confirmed that the tumor was malignant and "localized", which meant that it had not spread to other parts of her body.

Ginsburg has already been treated for cancer of the colon and pancreas, as well as for cancerous tumors found in his lungs. Cancers of the colon and lung can metastasize to the pancreas, but they are rare.

The fact that the tumor is localized increases the risk of pancreatic cancer in Ginsburg, according to Raja Flores, a cancer surgeon and chair of the department of thoracic surgery at Mount Sinai Medical Center in New York.

Still, Flores said, "there are a lot of unknowns here."

How is it bad?

It depends on what type of cancer it is, what the Supreme Court does not reveal. (The Supreme Court has not responded to a request for additional information, including this one.)

There are two main types of pancreatic cancer: adenocarcinoma and neuroendocrine carcinoma. According to the Network of Action Against Pancreatic Cancer, about 90% of pancreatic cancers fall into the first category, where the survival rate is lower.

According to the American Cancer Society, the five – year survival rate of localized adenocarcinoma is about 34%. In comparison, the five-year survival rate of localized neuroendocrine carcinoma is about 94%.

There is reason to believe that Ginsburg is the least common form of cancer and the most likely to survive. Indeed, Ginsburg was treated for pancreatic cancer 10 years ago and is still alive. This suggests that Ginsburg had a neuroendocrine carcinoma and that he returned, said Mount Sinai's Flores.

"My feeling, because she's alive a decade later, leads me to think that it's more likely to be a neuroendocrine carcinoma," Flores said.

But another questioning point is the lack of a surgical procedure.

In December, surgeons removed two cancerous nodules from Ginsburg's left lung. In contrast, the recent treatment involved radiotherapy.

According to Joe Hines, director of the Agi Hirshberg Center for UCLA Pancreatic Diseases, radiation is more common in adenocarcinoma than in neuroendocrine carcinoma.

"I want to be very careful, it's impossible to say exactly," he said. But, for neuroendocrine carcinoma, "the treatment has generally been surgical".

The treatment received by Ginsburg is known as stereotactic ablative radiotherapy. The treatment is usually used for small tumors and is presented as an effective and practical procedure usually performed as an outpatient. Side effects of radiation include fatigue.

The December operation, Flores told CNBC at the time, would not have been carried out if doctors did not believe that it would be possible to cure Ginsburg of the disease.

"The difference is, at the time [after the December surgery]I had more information about the procedure, which was curative, "Flores said. Radiation can be curative, but it can also be palliative. "

In his statement, the Supreme Court stated that the tumor "was treated definitively and that there was no evidence of disease elsewhere in the body".

"No additional treatment is needed at the moment," he said.

And after?

The court said that because of the treatment inflicted by Ginsburg, she had canceled her annual trip to Santa Fe, where she usually goes in the summer to enjoy the local opera and arts scene. But, he noted, she also "kept an active schedule".

Flores said that, according to the Supreme Court's statement, he is not worried about Ginsburg's recovery in the near term, in the next three months or so.

"The question is more long-term – is it going to be because there are no more tumors in his body? Or his body has mutated, where there will be more and more tumors in his body? " he said. "I am cautiously optimistic."

Flores said that the human body is always creating new growth, but that the immune system is acting to control these growths. If the system that detects these growths is underperforming, problems could result.

He said the results of an analysis conducted in about six months would be "critical".

"You want to see if there are residual tumors," he said.

The Supreme Court is currently on summer vacation, but judges will meet again for their opening conference in October. They will start hearing the arguments on October 7th.

Ginsburg missed her first oral arguments in 25 years on the bench earlier this year as she was recovering from her cancer operation. She continued to participate in cases based on court filings and transcripts of oral arguments.

Flores said that in the absence of complications with his bile duct or radiation fatigue, he expects Ginsburg to be on the bench when the court is back.

"I'm waiting for her to be ready for work when the time comes," he said.

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