Justice Ruth Bader Ginsburg Undergoes Surgery For Lung Cancer

Dec 21, 2018
Originally published on December 21, 2018 10:07 pm

Updated at 10:28 p.m. ET

Justice Ruth Bader Ginsburg underwent surgery Friday for early stage lung cancer, a Supreme Court spokesperson tells NPR. Doctors at Memorial Sloan Kettering hospital in New York performed a lobectomy, removing one of the five lobes of the lung.

On Friday afternoon, shortly after her surgery, she cast a decisive vote, refusing to allow the Trump administration to implement its new rules prohibiting people from seeking asylum if they cross the border illegally. The 5-to-4 decision was a setback for the administration, preventing the president from carrying out the policy immediately.

By Friday night, Ginsburg was sitting up in a chair, and calling friends, who said she sounded strong, and pretty chipper.

Short of complications in recovery, doctors say prospects look good for a full recovery for Ginsburg, 85. She hopes to be back on the court for the start of the next argument session in early January.

The cancer was discovered after Ginsburg fell, fracturing several ribs in November. In taking CT scans of her ribs, doctors noticed an abnormality in one lobe of the lung. Subsequent biopsies and other initial tests revealed two non-small cell cancerous lesions, with no lymph node involvement detectable.

According to a press release from the Supreme Court:

"According to the thoracic surgeon Valerie Rusch, both nodules removed during surgery were found to be malignant on initial pathology evaluation. Post-surgery, there was no evidence of any remaining disease. Scans performed before surgery indicated no evidence of disease elsewhere in the body. Currently, no further treatment is planned. Justice Ginsburg is resting comfortably and is expected to remain in the hospital for a few days."

Dr. Douglas Mathisen, chairman of thoracic surgery at Massachusetts General Hospital, said that recovery from such an operation typically ranges from two to four days in the hospital, with the patient able to go home, do desk work and make calls within a week. That assumes that the operation goes smoothly and that there are no complications.

Mathisen said, "These days we are seeing more and more patients in their 70s and 80s make relatively quick recoveries, because we are detecting so many more lung cancers at early stages" when treatment is far more effective and successful.

Removal of a lobe is considered "the gold standard" in treatment, and while it means a loss of 15 to 20 percent of the lung, it "can recover," he said, with the other four lobes taking over some of the lost function.

Mathisen and other thoracic surgeons said Justice Ginsburg's prognosis ultimately will depend on the pathology findings, which will not be available until days after the surgery. If there is no lymph node involvement, surgeons contacted by NPR said the prognosis for being cancer-free at five years out is 80 percent.

Lymph node involvement would drop those odds down to 50 to 55 percent, Mathisen said. Dr. Cameron Wright, also a Massachusetts General thoracic surgeon and a Harvard Medical School professor of surgery, put the odds lower, at 40 percent, if there is lymph node involvement.

Rusch, who performed the surgery at Sloan Kettering, is a world-renowned lung surgeon. The American College of Surgeons this year selected her for its highest honor, the Distinguished Service Award. Rusch uses a robot and video cameras to perform operations.

This and other new methods of thoracic surgery are minimally invasive and use only small incisions. But serious complications from the surgery range from 5 to 10 percent, Wright said. And the mortality rate of the surgery is 1 in 100.

Third bout with cancer

This is Justice Ginsburg's third bout with cancer. In 1999, she was treated for colorectal cancer; in 2009, it was pancreatic cancer and, now, lung cancer. During her 25 years on the court, though, she has never missed a day of oral argument.

The next argument day is Jan. 7, and Mathisen said it is possible that she will be able to keep her record intact, but he warned that overdoing things can ultimately slow a patient down, meaning "one step forward and five steps back."

News of Ginsburg's latest bout with cancer is yet another blow to the Supreme Court's liberals, now outnumbered 5-4 on the nation's highest court.

Ginsburg has become something of a feminist cultural icon and defies the image of the angry feminist. She is both decorous and determined and makes it a point not to "waste energy" on emotional reactions.

She has become the leading liberal voice on the Supreme Court, and even if she recovers fully from this latest bout with cancer, she likely will be "playing hurt" for a while. That is something she has done for years, powering through even the death of her beloved husband of 56 years in 2010. But she is 85, and there is no way of sugarcoating that fact — even though her mind remains sharp as a tack.

Indeed, last week, even as she was secretly undergoing a series of tests and consulting an array of doctors, she made multiple public appearances and was interviewed in front of audiences three times, at one point reciting from memory the words of several arias from an opera about her famous friendship and legal dueling with the late conservative Justice Antonin Scalia.

Should Ginsburg's health falter further, President Trump could see a third opportunity to fill a seat on the Supreme Court.

After Justice Anthony Kennedy, a centrist conservative, announced his retirement earlier this year, Trump picked conservative Brett Kavanaugh to replace Kennedy. After two contentious sets of hearings, including one involving charges of sexual assault that Kavanaugh denied, he was confirmed on a close vote.

In early 2017, the GOP-controlled Senate changed the rules to allow a simple majority to confirm a Supreme Court justice, which paved the way for Trump's first pick to the court, conservative Neil Gorsuch.

A year prior, Senate Majority Leader Mitch McConnell took the unprecedented step of blocking President Barack Obama's nominee to the court, Merrick Garland, for nearly a year after conservative Scalia died in February 2016.

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AILSA CHANG, HOST:

Supreme Court Justice Ruth Bader Ginsburg had surgery today for early stage lung cancer. The odds for a full recovery from the disease at that stage have dramatically improved in recent years. That said, this is the 85-year-old liberal icon's third bout with cancer.

To talk more about Ginsburg's health, we're joined in the studio now by NPR legal affairs correspondent Nina Totenberg. Hey, Nina.

NINA TOTENBERG, BYLINE: Hi.

CHANG: So Ginsburg had surgery at Memorial Sloan Kettering Cancer Center in New York today. What details can you share about the procedure she had? How did it go?

TOTENBERG: Well, so far, so good is the report. The surgery was a lobectomy, the removal of one of the five lobes of the lung. It was performed this morning at Memorial Sloan Kettering, as you said. The justice had no symptoms prior to the discovery of the cancer. It was discovered incidentally last month when she fell and fractured several ribs. Subsequent scans followed by other tests and biopsies showed two suspicious lesions.

Both were confirmed today as malignant, according to Dr. Valerie Rusch, who performed the surgery. She said there was no evidence of any remaining disease. Also, scans performed before the surgery indicated no evidence of disease elsewhere in the body. Dr. Rusch said that currently there is - no further treatment is planned, meaning no chemotherapy or radiation is planned as of now.

CHANG: OK, so early stage cancer, and it sounds like it wasn't too severe.

TOTENBERG: Well, I've talked to a bunch of leading thoracic surgeons who say Ginsburg was incredibly lucky that this was discovered so early, when the odds of recovery are better, especially in light of new minimally invasive surgical methods that involve small incisions and not much pain compared to the old open way of doing these operations that involved just huge wounds.

CHANG: What are the prospects for recovery in her case or in cases like this?

TOTENBERG: Well, a lot depends on what the pathology report shows days from now. The existence of two lesions may make this a stage 2 instead of a stage 1 cancer. But Dr. Douglas Mathisen, who's chief of thoracic surgery at Massachusetts General Hospital, says if the pathology report shows no lymph node involvement...

DOUGLAS MATHISEN: Then you may have upwards of a 75 or 80 percent five-year survival with complete removal of the tumor.

TOTENBERG: If there is lymph node involvement within the lobe that's been removed, he said, the odds of survival at five years out drop down to about 50 percent.

CHANG: OK, so the court reconvenes to hear arguments January 7, which is just a little more than two weeks away. And during her 25 years on the court, Justice Ginsburg has never missed a day, not a single day of oral arguments, which is just incredible. But is she really going to be able to keep that track record going? I mean, doesn't she need to rest?

TOTENBERG: She might, but doctors say that if there are no serious complications, she'd likely be home in three or four days and able to make calls and do desk work. And barring complications, her main enemy in the short run will be fatigue. But doctors say if she doesn't overdo it, she should be in pretty good shape maybe to be there in time for the next argument calendar, maybe in four weeks.

CHANG: Of course the question on many people's minds whenever Ginsburg's health comes up - you know, she's 85. As we said, this is her third bout with cancer. Are liberals getting nervous about the possibility that President Trump could get a third pick for the Supreme Court?

TOTENBERG: You bet (laughter). Democrats, liberals - they're terrified that Trump will get a third bite at the Supreme Court apple. And just to underline the stakes, today the Supreme Court dealt a setback to the Trump administration in its attempt to implement a new rule that bars people who cross the border illegally from seeking asylum. The lower courts so far have prevented the policy from going into effect. The vote not to intervene at the Supreme Court level was 5 to 4 with Chief Justice Roberts joining the court's four liberals. Now, if Ginsburg were not on the court, the vote likely would have gone the other way.

CHANG: That's NPR's Nina Totenberg. Thanks so much, Nina.

TOTENBERG: Thank you. Transcript provided by NPR, Copyright NPR.