A Cancer Doctor Explains RBG’s Surgery

Photo: AFP/Getty Images

Earlier today it was reported that Supreme Court Justice Ruth Bader Ginsburg underwent surgery to remove cancerous nodules from her lungs, which were discovered following Ginsburg’s earlier hospitalization for broken ribs. To learn more about what a procedure like this one involves, the Cut spoke to Raja Flores, chair of thoracic surgery at Mount Sinai in New York.

Can you explain what the procedure Ruth Bader Ginsburg is reported to have undergone today entails?

Ginsburg had had surgery a while back, I think seven or eight years ago [it was in 2009], something called a whipple resection for pancreatic cancer. Now, they went in there after she had some broken ribs, and they got a scan, and saw these nodules in there. They just did a lobectomy to take them out, and found two different cancers there. So when you see two different cancers in the lung, the question is, did they come from someplace else? Is this spread from her pancreatic cancer into her lungs?

You have different cancers: cancers that are rabbits and cancers that are turtles. If this is a pancreatic cancer that spread to the lung, then it’s behaving like a turtle. Even though it’s metastatic, it’s not growing rapidly, it’s not overtaking an organ system. What she had done was a removal of that lower part of the lung to get those cancers out. The question is, is it related to the pancreatic cancer that she had before, or are these new primary lung cancers, and we’re going to need to wait to see what the final pathology shows. Either way, the fact that it’s out, and there’s no evidence of disease anywhere else, shows that she should be fine.

So even though she had this other surgery eight years ago, it’s possible there was still cancer, but it just spread without causing symptoms?

Exactly, because it’s behaving like a turtle. It’s moving very slowly, and it could have just stayed there for the next decade or so.

Do we know what causes certain cancers to move more quickly or slowly than others?

No. That’s the mystery of cancer.

What does the pathology entail, and how do doctors determine where the cancer originated?

So they look at the tissue under the microscope, and they look to see what kind of cells are there. If they see pancreas cells, then they know that the cancer came from the pancreas. If they only see lung cells, then they know that the cancer originated in the lung, and it’s a lung cancer.

Because reports say there’s no remaining signs of cancer, does it matter necessarily where it came from, as far as how she’ll be treated?

Not really. As long as it’s out, that’s the main thing.

What’s the typical recovery process for someone who’s had this procedure?

Usually you’re in the hospital for about four days. Given the fact that she’s over 80, though, I would be a little more conservative, and keep her in the hospital a few more days. But she’s in great shape. As soon as her chest tubes are out, and her pain is under control, she’ll be able to go home.