Understanding Ruth Bader Ginsburg's cancer operation

Posted at 6:06 PM, Dec 21, 2018
and last updated 2018-12-21 18:08:57-05

The Supreme Court announced Friday that Justice Ruth Bader Ginsburg had two cancerous nodules removed from her left lung's lower lobe in an operation known as a lobectomy.

The nodules were discovered while Ginsburg, 85, was being evaluated and treated for a rib fracture due to a fall last month.

What is a lobectomy?

A lobectomy refers to the removal of a single lobe in the lung. The left lung has two lobes, whereas the right lung has three.

Dr. Robert Miller, a professor of medicine at Vanderbilt University Medical Center who was not involved in Ginsburg's care, said a patient whose lungs are otherwise healthy "can recover from [a lobectomy] and not really notice significant impairment."

Ginsburg's lobectomy was performed by Dr. Valerie Rusch, a thoracic surgeon at Memorial Sloan Kettering Cancer Center in New York City.

According to her bio , Rusch "was among the first women in the country to be board certified in this specialty."

Memorial Sloan Kettering says on its website that the procedure is "the most common operation performed for non-small cell lung cancer and is the best treatment for an isolated lung cancer in an otherwise healthy patient."

The medical center deferred all questions to the Supreme Court.

How did it get there?

Miller said doctors would want to know, "Did it start in the lung, or did it come from somewhere else?"

For Ginsburg, there is no evidence of any remaining disease, nor is there evidence of disease elsewhere in the body, according to a court representative.

But there's always the chance that scans can miss something, Miller said. Additional tests may be performed to identify the source and type of cancer.

Ginsburg has a history of cancers, having undergone surgery for colorectal cancer in 1999. Ten years later, she was treated for early-stage pancreatic cancer.

Finding more than one nodule in a patient's lung, however, does not necessarily mean it's spreading. Among nonsmokers, for example, nodules that begin in the lung tend to form individually and typically involve different, less aggressive forms of cancer, experts say.

How serious could it be?

With cancer that originates in the lung, outcomes are often poor because it's usually found late -- after it's started spreading -- and not incidentally due to other medical tests.

"Early-stage lung cancers are usually not found," said Dr. Stephen Liu, associate professor of medicine at Georgetown University's Lombardi Comprehensive Cancer Center.

"It's usually stage 4 when detected," added Liu, who was not part of Ginsburg's care team.

If the justice hadn't fractured her ribs, Liu said, it's possible that doctors wouldn't have found the nodules and that they might have gotten larger. It is unclear from the court's statement how long the nodules were there or how quickly they had grown.

A patient's prognosis could be influenced by the size of the nodules found and whether cancer was found in any nearby lymph nodes, experts say. Doctors typically describe a nodule as less than 3 centimeters in diameter.

Doctors usually go into a lobectomy expecting to take out all the cancer, Miller said. Many patients have a good chance of being cured through lobectomy alone.

"Currently, no further treatment is planned," the court said.

But even for patients with more aggressive types of lung cancer, smokers included, treatments still offer patients substantial time when there's no evidence of disease elsewhere in the body, according to Dr. Joseph Shrager, professor and chief of the division of thoracic surgery at the Stanford University School of Medicine.

"Almost no one dies these days within two years for localized lung cancer," said Shrager, who was not involved in Ginsburg's care.

What's the recovery like?

Experts say that recovery after a lobectomy can last several days or more. Less invasive types of surgery -- including robotic and video-assisted surgeries -- may mean quicker recovery times, Shrager said.

The court did not detail how Ginsburg's doctors conducted the lobectomy.

Recovery from a lobectomy may also depend on any other health issues a patient might have, according to Miller.

"Justice Ginsburg is resting comfortably and is expected to remain in the hospital for a few days," the court's statement says.

Ginsburg has said that she'll continue to serve on the Supreme Court as long as she's able to do the job.

"I said I will do this job as long as I can do it full steam," Ginsburg said Sunday during an interview after a New York City screening of "On the Basis of Sex," a feature film about her years as a young lawyer.

Liu said there's always a risk of recurrence, so Ginsburg will probably be observed. But she's been in good hands, he added.

"Her surgeon is one of the best in the country."