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

Key Points
  • Ruth Bader Ginsburg appeared healthy on Monday during a public appearance at the University at Buffalo, three days after completing a three-week course of radiation therapy in New York to treat a tumor found on her pancreas.
  • The justice's health has become a matter of public concern because of partisan make-up of the nine-member panel.
  • If Ginsburg retires while a Republican controls the presidency, conservatives are likely to be able to wield more influence over the direction of the country for years to come.
Supreme Court Justice Ruth Bader Ginsburg.
Scott J. Ferrell | CQ-Roll Call Group | Getty Images

Supreme Court Justice Ruth Bader Ginsburg appeared healthy on Monday during a public appearance at the University at Buffalo, three days after completing a three-week course of radiation therapy in New York to treat a tumor found on her pancreas.

"It was beyond my wildest imagination that I would one day become the 'notorious RBG.' I am now 86 years old, yet people of all ages want to take their picture with me," Ginsburg joked during an address at the university. "Amazing."

The liberal justice's health has become a matter of public concern because of partisan make-up of the nine-member panel.

With President Donald Trump's two picks on the bench, Justices Brett Kavanaugh and Neil Gorsuch, the court now has a reliable conservative majority including five Republican-appointees.

In the coming years, the Supreme Court is expected to weigh in on some of the nation's most divisive issues, such as the power of big business, the Second Amendment, LGBT rights and abortion. If Ginsburg retires while a Republican controls the presidency, conservatives are likely to be able to wield more influence over the direction of the country for years to come.

Trump said Friday that he hopes Ginsburg heals.

"I'm hoping she's going to be fine," Trump told reporters ahead of the G-7 conference of world leaders in France. "She's pulled through a lot. She's strong, very tough."

Here's what we know about Ginsburg's cancer.

What kind of cancer was it?

Likely pancreatic cancer, but not definitively. If it was pancreatic cancer, it is not clear which kind.

In a statement, the Supreme Court said Ginsburg was treated for a "tumor on her pancreas," though it did not specify which kind of cells were involved. A biopsy performed in July confirmed that the tumor was malignant and "localized," meaning it had not spread to other parts of her body.

Ginsburg has previously been treated for colon and pancreatic cancer, as well as for cancerous growths found on her lungs. Colon and lung cancers can metastasize to the pancreas, but it is rare.

The fact that the tumor was localized makes it more likely that Ginsburg had pancreatic cancer, according to Raja Flores, a leading cancer surgeon and the chairman for the department of thoracic surgery at the Mount Sinai Medical Center in New York.

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

How bad is it?

That depends on which kind of cancer it is, which the Supreme Court isn't disclosing. (The Supreme Court did not respond to a request for more details, including this one.)

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

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

There is reason to believe that Ginsburg has the less common, more survivable form of cancer. That is because Ginsburg was treated for pancreatic cancer 10 years ago, and is still alive. That makes it likely that Ginsburg had neuroendocrine carcinoma, and that it came back, Mount Sinai's Flores said.

"My sense, because she is alive a decade later, leads me to believe it was more likely a neuroendocrine carcinoma," Flores said.

But another question mark is the absence of a surgical procedure.

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

Radiation is more common for adenocarcinoma than for neuroendocrine carcinoma, according to Joe Hines, the director of UCLA's Agi Hirshberg Center for Pancreatic Disease.

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

The treatment Ginsburg received is known as stereotactive ablative radiation therapy. The treatment is generally used for small tumors and is advertised as an effective and convenient procedure typically done on an outpatient basis. Side effects of the radiation include tiredness.

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

"The difference is, back then [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 the statement, the Supreme Court said the tumor "was treated definitively and there is no evidence of disease elsewhere in the body."

"No further treatment is needed at this time," it said.

What's next?

The court said that because of Ginsburg's treatment, she cancelled her annual trip to Santa Fe, where she typically travels in the summer to appreciate the local opera and art scene. But, it noted, she has "otherwise maintained an active schedule."

Flores said that based on the Supreme Court's statement, he is not concerned about Ginsburg's recovery in the short term, over the next three-or-so months.

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

Flores said that the human body is always creating new growths, but the immune system acts in ways to keep those growths in check. If the system that detects those growths is under-performing, it could spell trouble.

He said the results of a scan in about six months will be "critical."

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

The Supreme Court is currently on its summer recess, but the justices will meet again for their opening conference in October. They will begin hearing oral arguments Oct. 7.

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

Flores said, absent complications with her bile duct or tiredness from the radiation, he expects Ginsburg to be on the bench when the court returns.

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

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Correction: A photo caption incorrectly said who was president in 2005.